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Chemotherapy, radiotherapy use rises among patients with diabetes, colorectal cancer
The use of chemotherapy and radiotherapy among patients with diabetes and colorectal cancer has increased in recent years, though it remains less common than among nondiabetic patients, according to recent results.
Researchers evaluated 17,170 cases of primary colorectal cancer that occurred throughout southeastern Netherlands between 1995 and 2010, collected from the Eindhoven Cancer Registry. The cohort contained 11,893 patients with colon cancer and 5,277 with rectal cancer, including 1,711 colon cancer patients and 609 in the rectal cancer group who also had diabetes at diagnosis.
Diabetes prevalence increased significantly from 1995 to 2010 (9% vs. 17%; P<.0001). Regardless of cancer type, patients with diabetes were significantly older, more likely to have two or more comorbidities than patients without diabetes and more prone to comorbidities (cardiovascular and cerebrovascular disease and hypertension). Investigators said proximal tumors were more common among colon cancer patients with diabetes (P<.0001 for all comparisons).
Among patients with stage III colon cancer, chemotherapy administration increased from 17% between 1995 and 1998 to 50% between 2007 and 2010 among diabetic patients and from 38% to 63% among nondiabetic patients for the same time points (P<.0001). Multivariate analysis adjusting for age, sex, comorbidities and year of diagnosis, however, indicated patients with diabetes were significantly less likely to undergo adjuvant chemotherapy (OR=0.7; 95% CI, 0.5-0.9). Regardless of diabetes status, chemotherapy use increased significantly while resection decreased among patients with metastatic colon cancer.
Among those with T3 or T4 rectal tumors, no significant association was observed between chemoradiation use and diabetes status (OR=0.8; 95% CI, 0.6-1.1 for diabetes patients vs. nondiabetes patients). Investigators said radiotherapy use increased with time, and that from 2007-2010 a similar number of patients with and without diabetes with stage II or III rectal cancer underwent radiotherapy (81% with diabetes vs. 87% without diabetes).
“Although this study showed that the proportion of patients with colorectal cancer with diabetes receiving radiotherapy and chemotherapy increased, patients with diabetes still received chemotherapy less often than those without,” the researchers wrote. “In future studies, we will investigate the influence of more aggressive treatment on outcomes in patients with colorectal cancer with diabetes.”