Judy K Qiang1, Rinku Sutradhar2,3, Vasily Giannakeas3,4, Dominika Bhatia2, Simron Singh3, Lorraine L Lipscombe5,6,7,8. 1. Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Toronto, ON, Canada. 2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 3. ICES, Toronto, ON, Canada. 4. Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Room 6424, Toronto, ON, M5S 1B2, Canada. 5. Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Toronto, ON, Canada. Lorraine.Lipscombe@wchospital.ca. 6. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Lorraine.Lipscombe@wchospital.ca. 7. ICES, Toronto, ON, Canada. Lorraine.Lipscombe@wchospital.ca. 8. Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Room 6424, Toronto, ON, M5S 1B2, Canada. Lorraine.Lipscombe@wchospital.ca.
Abstract
AIMS/HYPOTHESIS: Diabetes is associated with an increased incidence of colorectal cancer (CRC). There exists conflicting evidence regarding the impact of diabetes on CRC-specific mortality (herein also referred to as cancer-specific mortality). The objectives of this study were to determine whether diabetes is associated with a more advanced CRC stage at diagnosis and with higher all-cause and cancer-specific mortality. METHODS: This retrospective cohort study used linked, population-based health databases from Ontario, Canada. Among individuals diagnosed with CRC from 2007 to 2015, we compared the likelihood of presenting with later- (III or IV) vs early- (I or II) stage CRC between patients with and without diabetes adjusting for relevant covariates. We then determined the association between diabetes and all-cause and CRC-specific mortality, after adjusting for CRC stage at diagnosis and other covariates. RESULTS: Of the 44,178 individuals with CRC, 11,822 (26.7%) had diabetes. After adjustment for CRC screening and other covariates, individuals with diabetes were not more likely to present with later-stage CRC (adjusted OR 0.97, 95% CI 0.93, 1.01). Over a median follow-up of 2.63 (interquartile range [IQR] 0.97-5.10) years, diabetes was associated with higher all-cause mortality (adjusted HR 1.08, 95% CI 1.04, 1.12) but similar cancer-specific survival (adjusted HR 1.0, 95% CI 0.95, 1.06). CONCLUSIONS/ INTERPRETATION: Individuals with diabetes who develop CRC are not more likely to present with a later stage of CRC and have similar cancer-specific mortality compared with those without diabetes. Diabetes was associated with higher all-cause mortality in CRC patients, indicating that greater attention to non-cancer care is needed for CRC survivors with diabetes.
AIMS/HYPOTHESIS: Diabetes is associated with an increased incidence of colorectal cancer (CRC). There exists conflicting evidence regarding the impact of diabetes on CRC-specific mortality (herein also referred to as cancer-specific mortality). The objectives of this study were to determine whether diabetes is associated with a more advanced CRC stage at diagnosis and with higher all-cause and cancer-specific mortality. METHODS: This retrospective cohort study used linked, population-based health databases from Ontario, Canada. Among individuals diagnosed with CRC from 2007 to 2015, we compared the likelihood of presenting with later- (III or IV) vs early- (I or II) stage CRC between patients with and without diabetes adjusting for relevant covariates. We then determined the association between diabetes and all-cause and CRC-specific mortality, after adjusting for CRC stage at diagnosis and other covariates. RESULTS: Of the 44,178 individuals with CRC, 11,822 (26.7%) had diabetes. After adjustment for CRC screening and other covariates, individuals with diabetes were not more likely to present with later-stage CRC (adjusted OR 0.97, 95% CI 0.93, 1.01). Over a median follow-up of 2.63 (interquartile range [IQR] 0.97-5.10) years, diabetes was associated with higher all-cause mortality (adjusted HR 1.08, 95% CI 1.04, 1.12) but similar cancer-specific survival (adjusted HR 1.0, 95% CI 0.95, 1.06). CONCLUSIONS/ INTERPRETATION: Individuals with diabetes who develop CRC are not more likely to present with a later stage of CRC and have similar cancer-specific mortality compared with those without diabetes. Diabetes was associated with higher all-cause mortality in CRCpatients, indicating that greater attention to non-cancer care is needed for CRC survivors with diabetes.
Entities:
Keywords:
Colorectal cancer mortality; Colorectal cancer stage; Diabetes mellitus
Authors: Iliana C Lega; Andrew S Wilton; Peter C Austin; Hadas D Fischer; Jeffrey A Johnson; Lorraine L Lipscombe Journal: Cancer Date: 2016-07-11 Impact factor: 6.860
Authors: Laura Fazio; Michelle Cotterchio; Michael Manno; John McLaughlin; Steven Gallinger Journal: Am J Gastroenterol Date: 2005-11 Impact factor: 10.864
Authors: Paul J H L Peeters; Marloes T Bazelier; Hubert G M Leufkens; Frank de Vries; Marie L De Bruin Journal: Diabetes Care Date: 2014-12-31 Impact factor: 19.112
Authors: Jessica K Paulus; Christina D Williams; Furha I Cossor; Michael J Kelley; Robert E Martell Journal: Cancer Epidemiol Biomarkers Prev Date: 2016-08-05 Impact factor: 4.254
Authors: Kelly B Stein; Claire F Snyder; Bethany B Barone; Hsin-Chieh Yeh; Kimberly S Peairs; Rachel L Derr; Antonio C Wolff; Frederick L Brancati Journal: Dig Dis Sci Date: 2010-07 Impact factor: 3.199
Authors: Erin Worndl; Kinwah Fung; Hadas D Fischer; Peter C Austin; Monika K Krzyzanowska; Lorraine L Lipscombe Journal: JNCI Cancer Spectr Date: 2018-05-11
Authors: Inna Y Gong; Matthew C Cheung; Stephanie Read; Yingbo Na; Iliana C Lega; Lorraine L Lipscombe Journal: Diabetologia Date: 2021-01-06 Impact factor: 10.122