The Impact of Diabetes Mellitus on the Second Primary Malignancies in Colorectal Cancer Patients

IntroductionAll colorectal cancer (CRC) survivors have an increased risk of developing second primary malignancies (SPMs). The association between diabetes mellitus (DM) and the risk of cancer is well known. However, the role of DM and its therapy in the development of SPMs in CRC patients is not well described.MethodsIn this single-institutional retrospective analysis we identified 1,174 colorectal carcinoma patients, median follow-up 10.1 years, (median age 63 years, 724 men). All patients over 18 years with histologically confirmed CRC who were admitted in the period 1.1. 2003- 31.12.2013 and followed-up till 31.12. 2018 at the Masaryk Memorial Cancer Institute (MMCI) were screened for eligibility. The exclusion criteria were CRC diagnosed at autopsy, lost to follow-up and high risk of development of SPMs due to hereditary cancer syndrome. Tumours are considered multiple primary malignancies if arising in different sites and/or are of a different histology or morphology group. Comparisons of the basic characteristics between the patients with SPM and the patients without SPM were performed as well as comparison of the occurrence of SPMs by the site of diagnosis between the DM and non-DM cohorts and survival analyses.ResultsA SPM was diagnosed in 234 (20%) patients, DM in 183 (15%) patients. DM was diagnosed in 22.6% of those with SPM vs. in 13.8% of those without SPM (p=0.001). The most common types of SPMs in DM patients were other CRC, kidney, lung, bladder and nonmelanoma skin cancer, but only carcinoma of the liver and bile duct tracts was significantly more common than in the group without DM. Although breast cancer was the second most common in the group with DM, its incidence was lower than in the group without DM, as well as prostate cancer. A significantly higher incidence of SPMs was found in older CRC patients (≥ 65 years) and in those with lower stage colon cancer and DM. No significant difference in DM treatment between those with and without a SPM was observed including analysis of type of insulin.ConclusionCRC patients with diabetes mellitus, especially those with older age, and early stages of colon cancer, should be screened for second primary malignancies more often than the standard population. Patients without DM have longer survival. According to the occurrence of the most common second malignancies, a clinical examination, blood count, and ultrasound of the abdomen is appropriate, together with standard breast and colorectal cancer screening, and lung cancer screening under certain conditions, and should be recommended in CRC survivors especially in patients with intercurrent DM, however the necessary frequency of screening remains unclear.

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Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region

Journal of Diabetes Research ◽

10.1155/2019/6036359 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Joanna Wojtasik-Bakalarz ◽

Zoltan Ruzsa ◽

Tomasz Rakowski ◽

Andreas Nyerges ◽

Krzysztof Bartuś ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Of Death ◽

Significant Difference ◽

Long Term Follow Up ◽

Artery Disease ◽

The Impact

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n=45 vs. non-CAD group: n=41) and DM (DM group: n=50 vs. non-DM group: n=36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

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Adjuvant chemotherapy with uracil-tegafur (UFT) for stage III colorectal cancer: Final results of randomized trials by the National Surgical Adjuvant Study of Colorectal Cancer (NSAS-CC)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4049 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4049-4049 ◽

Cited By ~ 2

Author(s):

T. Hamaguchi ◽

K. Shirao ◽

Y. Moriya ◽

S. Yoshida ◽

S. Kodaira ◽

...

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Hazard Ratio ◽

Stage Iii ◽

Control Group ◽

Significant Difference ◽

Resected Stage

4049 Background: In the latter 1990s, no consensus was reached as to whether adjuvant chemotherapy was standard treatment for completely resected stage III colorectal cancer in Japan. At that time, we started two randomized controlled trials to clarify the role of adjuvant chemotherapy of stage III colon and rectal cancer in the same time. Methods: Patients with completely resected stage III cancer of the colon or rectum (PS, 0 to 2; age, 20 to 75 years; no other adjuvant therapy) were eligible for these trials. Patients were registered within 6 weeks after surgery and were randomly assigned to receive surgery alone (control group) or surgery followed by treatment with UFT (400 mg/m2/day), given for 5 consecutive days per week for 1 year (UFT group). The target number of patients was 500 for colon cancer and 400 for rectal cancer (hazard ratio = 0.67, one-sided a= 0.05, β= 0.2). The primary endpoint was relapse-free survival (RFS), and the secondary end point was overall survival (OS). Results: Between October 1996 and April 2001, a total of 334 patients with colon cancer and 276 with rectal cancer were enrolled. Four ineligible patients were excluded; data from the remaining 332 patients with colon cancer and 274 with rectal cancer were analyzed. The patients’ characteristics were similar in the groups. Analysis of the results of follow-up until March 2006, at least 5 years after surgery in all patients (median follow-up period, 6.2 years), showed no significant difference in RFS or OS in colon cancer. In rectal cancer, however, RFS and OS were significantly better in the UFT group than in the control group. The only grade 4 toxicity was diarrhea, occurring in 1 patient with colon cancer and 1 patient with rectal cancer. Conclusions: Postoperative adjuvant chemotherapy with UFT is well tolerated and improved RFS and OS in patients with stage III rectal cancer. In colon cancer, the expected benefits were not obtained (hazard ratio = 0.67). [Table: see text] No significant financial relationships to disclose.

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Increasing uptake of colon cancer screening in a medically underserved population with the addition of blood-based testing

10.21203/rs.3.rs-75393/v1 ◽

2020 ◽

Author(s):

Stephanie Ioannou ◽

Kyle Sutherland ◽

Daniel A. Sussman ◽

Amar R. Deshpande

Keyword(s):

Colon Cancer ◽

Cancer Screening ◽

Underserved Populations ◽

Colon Cancer Screening ◽

Medically Underserved ◽

Screening Methods ◽

Medically Underserved Populations ◽

Medically Underserved Population ◽

The Impact

Abstract Adherence to colorectal cancer screening is suboptimal, particularly in medically underserved populations. We report here on our assessment of the impact of offering a blood-based screening test on screening rates in a health fair setting. Patients attending student-run health fairs who met colon cancer screening guideline eligibility criteria received a recommendation to attend that screening station. Patients were offered recommended accepted screening methods, and if they declined they were offered blood-based testing. Screening rates, test outcomes, and the rate of follow up completion of colonoscopy were measured and compared with historic screening outcomes. Of 1401 screening eligible patients, 640 (45.7%) attended the colon cancer screening station, of whom 460 were eligible for assessment. Amongst these, none selected colonoscopy, 30 (6.5%) selected FIT, and 430 (93.5%) selected blood-based testing. Only 2 patients returned the FIT. For the blood test, 88 were positive, and 20 of these received a follow up colonoscopy. Based on this assessment, blood-based testing is an effective method to increase screening rates in medically underserved populations, though efforts to further improve access to follow up colonoscopy are necessary.

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How to choose your surgeon for colorectal cancer: The influence of fellowship training on outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18603 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18603-e18603

Author(s):

Christopher Thomas Aquina ◽

Adan Z. Becerra ◽

Aslam Ejaz ◽

John R.T. Monson ◽

Fergal J. Fleming

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

High Volume ◽

Fellowship Training ◽

Postoperative Outcomes ◽

Cancer Resection ◽

Colorectal Cancer Resection ◽

Significant Difference ◽

The Impact

e18603 Background: Rectal cancer has a well-established volume-outcome relationship. However, the impact of fellowship training on outcomes following colorectal cancer resection is unknown. Methods: Patients who underwent stage I-III colorectal adenocarcinoma resection (2004-2014) were identified in the New York State Cancer Registry and Statewide Planning & Research Cooperative System. Hierarchical analyses assessed the association between surgeon American Board of Colorectal Surgery (ABCRS) certification and postoperative outcomes and survival. Derived from volume tertiles, surgeons who performed ≥15 annual colon cancer resections or ≥10 annual rectal cancer resections were characterized as high-volume colon (HVCSs) or rectal (HVRSs) surgeons, respectively. Results: 47,491 colorectal cancer resections (right colon = 23,824, 50.2%; left colon = 18,154, 38.2%; rectal cancer = 5,513, 11.6%) met inclusion criteria. ABCRS-certified HVCSs (N = 92) comprised only 5.5% of the surgeon cohort but performed 20.6% of the colon cancer resections. Similarly, ABCRS-certified HVRSs (N = 31) comprised only 3.8% of the surgeon cohort but performed 16.5% of the rectal cancer resections. Despite no significant difference in complications, ABCRS-certified HVCS/HVRSs overall had better postoperative outcomes and were associated with improved survival following colorectal cancer resection. Conclusions: These results suggest that for the best outcomes and long-term survival following colon and rectal cancer resection, referral to high-volume, ABCRS-certified surgeons may be the best choice.[Table: see text]

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Mucinous colorectal cancer: Disease characteristics, treatment outcomes and the impact of metastasectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.3586 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 3586-3586

Author(s):

Darren Cowzer ◽

Emily Harrold ◽

Jane Sze Yin Sui ◽

Mairi Lucas ◽

Helen M Fenlon ◽

...

Keyword(s):

Colorectal Cancer ◽

De Novo ◽

Medical Oncology ◽

Disease Free Survival ◽

Stage Ii ◽

Stage Iii ◽

Metastatic Setting ◽

Significant Difference ◽

The Impact

3586 Background: Mucinous colorectal cancer (CRC) differs from adenocarcinoma with regard to clinical and histological features and is reported to have inferior outcomes when compared to non-mucinous CRC. This study aims to evaluate the clinical features and outcomes of patients with mucinous CRC at our institution. Methods: Medical records of patients with CRC that were referred to medical oncology between September 1999 and September 2018 were retrospectively reviewed. Mucinous histology was defined as those containing > 50% mucin identified on histology specimens. Statistical analysis was performed using Prism V9.0. Results: We identified 1,115 patients with CRC that were referred to medical oncology during this period. The tumours of 81 (7.3%) patients were classified as mucinous. Median age was 65 (28-94 years) and 45 (55.5%) were male. Forty-one patients (51%) had right sided tumours, 27 (33%) had left sided tumours and 13 (16%) had rectal tumours. Twenty-three (28.4%) had de novo metastatic disease. Eleven of 24 patients (46%) with stage II disease relapsed and 18 of 33 (55%) of those with stage III disease relapsed. Radiological surveillance identified 20/29 (69%) of relapsed disease, 5 (17%) were symptomatic and 4 (14%) had a rise in CEA. Median follow up for patients with stage II disease was 53 months and 3 year and 5-year disease free survival (DFS) was equal in both groups at 60.9%. For stage III disease 3- and 5-year DFS was 58.1% and 48.4% respectively with a median follow up of 43 months. In the metastatic setting, we observed no significant difference in overall survival (OS) between left and right sided tumours ( p = 0.550). Median OS for pts with stage IV mucinous CRC who received any treatment was 25 months. Metastasectomy was performed in 25/52 (48%) patients and was associated with a significant improvement in OS, 23 vs 51 months ( p < 0.005, HR 0.4). Conclusions: Mucinous CRC has been associated with inferior responses to treatment and worse overall outcomes compared to non-mucinous histologies. Survival in advanced-stage disease in our cohort is higher than what has been reported in the literature. With an effective multi-disciplinary approach and the increasing use of metastasectomy as a treatment option, survival in the advanced disease setting may be comparable to non-mucinous CRC.

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Meaningful reporting in primary care: An evaluation of the screening activity report.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.173 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 173-173

Author(s):

Nicki Cunningham ◽

Christine Stogios ◽

Shama Umar ◽

Dafna Carr ◽

Jason Garay ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Clinical Guidelines ◽

Participation Rates ◽

Screening Participation ◽

The Impact ◽

Screening Activity ◽

Activity Report

173 Background: Cancer Care Ontario (CCO) developed the ColonCancerCheck Screening Activity Report (CCC SAR) as a supplementary tool for primary care physicians (PCPs) who are part of a patient enrolment model in Ontario, Canada to support them in increasing their colorectal cancer screening rates and appropriate follow-ups. The report provides PCPs with a summary of their eligible patients’ colorectal cancer screening-related history and was designed with the intent of supporting both population health management and opportunistic screening. Delivered through an online platform, the SAR offers PCPs access to data to facilitate quality cancer screening practices aligned with CCO’s evidence-based clinical guidelines. Methods: The report leverages provincial datasets to summarize screening activities on a per-patient level and actionable follow-up recommendations based on CCO’s clinical guidelines. To evaluate the impact of the reports on colorectal screening participation rates, a Generalized Estimating Equation model was used. Results: Results on the report’s impact on colorectal cancer screening participation rates from the first release (February 2013) are promising. By identifying for PCPs which patients are overdue for screening, the SAR demonstrated a modest and statistically significant 6% increased likelihood of patients being screened using a Fecal Occult Blood Test (FOBT) if their PCP was registered to access the online report, compared to patients of unregistered PCPs. The impact to screening increased to 25% when comparing registered PCPs who logged in and viewed their SAR to registered PCPs who did not login; however, this analysis is at a greater risk of a volunteer bias. Such PCPs may be more likely to screen their patients independent of viewing their SAR. Conclusions: By equipping PCPs with patient-level data grounded in CCO’s evidence-based clinical guidelines, the SAR is innovative in its potential to increase screening rates and the appropriate follow-up of abnormal results. The successful launch of two online CCC SARs, sharing meaningful colorectal cancer screening data to frontline providers, has driven the report’s expansion to include breast and cervical cancer screening data in spring of 2014.

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Evaluation of the introduction of a standardised protocol for the staging and follow-up of colorectal cancer on resection rates for liver metastases

Annals of The Royal College of Surgeons of England ◽

10.1308/003588410x12628812458419 ◽

2010 ◽

Vol 92 (3) ◽

pp. 225-230 ◽

Cited By ~ 7

Author(s):

J Tiernan ◽

CD Briggs ◽

GRB Irving ◽

MT Swinscoe ◽

M Peterson ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Liver Metastases ◽

Disease Free Survival ◽

District Hospitals ◽

Significant Difference ◽

Specialist Centre ◽

The Uk ◽

The Impact

INTRODUCTION In 2004, an audit in our unit demonstrated wide variation in liver resection rates for colorectal cancer (CRC) metastases within the cancer network. Subsequently, a network-wide CT-based follow-up and referral policy was introduced for all patients. A second audit was performed to assess the impact of the guidelines on liver resection rates. SUBJECTS AND METHODS Analysis of prospective liver resection database between 1997 and 2004 and after the introduction of standardised guidelines between January 2005 and April 2008. RESULTS A total of 362 patients underwent liver resection for CRC metastases between 1997 and 2008, 237 prior to the introduction of the referral guidelines and 125 after. Liver resection rates according to referring hospital varied from 0.92 to 2.32 per 100,000 population before guidelines were introduced. After 2005, resection rates from the four district hospitals standardised (1.68–1.84 per 100,000 population), but the central unit rate (Sheffield) remained significantly higher (2.67 per 100,000 population). No significant difference in 1-year disease-free survival between patients from Sheffield and the outlying hospitals was found (P = 0.553). CONCLUSIONS Introduction of a referral protocol standardised resection rates from the four district hospitals, but these remain lower compared to the specialist centre. The wide-spread adoption of a policy to discuss all patients with liver metastases at an advanced disease multidisciplinary team meeting, in the presence of hepatobiliary specialists, may further increase resection rates across the UK.

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Internet Interest in Colon Cancer following Chadwick Boseman’s Death (Preprint)

10.2196/preprints.27052 ◽

2021 ◽

Author(s):

Hiten Naik ◽

Maximilian Desmond Dimitri Johnson ◽

Michael Roger Johnson

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Cancer Screening ◽

The United States ◽

Colon Cancer Screening ◽

Black American ◽

Online Activity ◽

The Public ◽

Search Terms ◽

The Impact

BACKGROUND Compared to White Americans, Black Americans have greater incidence and mortality rates from colon cancer, but lower up-to-date screening rates. Chadwick Boseman was a prominent Black American actor who died of colon cancer on August 28, 2020. As announcements of celebrity diagnoses often result in an increased awareness of particular conditions, Boseman’s death may have resulted in greater online interest in colon cancer. OBJECTIVE The objective of this study was to quantify the impact Chadwick Boseman’s death on online search interest in colon cancer, and thereby identify an opportunity for healthcare providers to educate the public and advocate for higher risk groups. METHODS We used Google Trends (GT) and Wikipedia pageview analysis to assess the change in online activity related to colon cancer in the United States from two years prior to Chadwick’s death to three months following the announcement of his death. We used two of GT search topics (“colorectal cancer” and “colon cancer screening”) and fifteen search terms related to colon cancer screening, symptoms, diagnosis and risk factors. We forecasted what RSVs and number of pageviews would be expected if his death had not occurred, and compared this to what was observed. The forecasts were generated with 95% bootstrapped confidence intervals (CIs) using the ARIMA algorithm in R software. RESULTS GT’s observed RSVs for the topics “colorectal cancer” and “colon cancer screening” increased by as much as 598% and 707%, respectively, and were on average 121% (95% CI, 72%-193%) and 256% (95% CI, 35%-814%) greater than expected during the first three months following Boseman’s death. Ten out of fifteen search terms had mean observed RSVs significantly higher than expected within the first and second month following Boseman’s death. Three of the fifteen search terms (“colon cancer signs”, “colon cancer survival” and “colon cancer symptoms”) remained significantly greater than expected within the third month following August 28, 2020. Daily Wikipedia pageview volume during the two months following Boseman’s death was on average 1,979% (95% CI, 1,375%-2,894%) greater than expected. Altogether, it is estimated that this represented 547,354 (95% CI, 497,708-585,167) excess Wikipedia pageviews beyond what would be expected if Boseman’s death had not occurred. CONCLUSIONS There has been a significant increase in online activity related to colon cancer following Chadwick Boseman’s death. This reflects a heightened public awareness that can be leveraged to further educate the public, including the high-risk Black American subgroup. The magnitude and duration of increased Google searches and Wikipedia pageviews following Boseman’s death is unprecedented in the literature and future research will reveal if this translates to improved screening and detection rates for colon cancer.

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Second primary malignancies in colorectal cancer patients

Scientific Reports ◽

10.1038/s41598-021-82248-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jana Halamkova ◽

Tomas Kazda ◽

Lucie Pehalova ◽

Roman Gonec ◽

Sarka Kozakova ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Median Time ◽

Cancer Diagnosis ◽

Second Primary ◽

Early Stage Disease ◽

Primary Tumors ◽

Second Primary Malignancies ◽

Colorectal Cancer Patients

AbstractThe prevalence of second primary malignancies (SPMs) in the western world is continually increasing with the risk of a new primary cancer in patients with previously diagnosed carcinoma at about 20%. The aim of this retrospective analysis is to identify SPMs in colorectal cancer patients in a single-institution cohort, describe the most frequent SPMs in colorectal cancer patients, and discover the time period to occurrence of second primary tumors. We identified 1174 patients diagnosed with colorectal cancer in the period 2003–2013, with follow-up till 31.12.2018, and median follow-up of 10.1 years, (median age 63 years, 724 men). A second primary neoplasm was diagnosed in 234 patients (19.9%). Older age patients, those with early-stage disease and those with no relapse have a higher risk of secondary cancer development. The median time from cancer diagnosis to development of CRC was 8.9 years for breast cancer and 3.4 years for prostate cancer. For the most common cancer diagnosis after primary CRC, the median time to development was 0–5.2 years, depending on the type of malignancy. Patients with a diagnosis of breast, prostate, or kidney cancer, or melanoma should be regularly screened for CRC. CRC patients should also be screened for additional CRC as well as cancers of the breast, prostate, kidney, and bladder. The screening of cancer patients for the most frequent malignancies along with systematic patient education in this field should be the standard of surveillance for colorectal cancer patients.

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Increasing uptake of colon cancer screening in a medically underserved population with the addition of blood-based testing

BMC Cancer ◽

10.1186/s12885-021-08678-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stephanie Ioannou ◽

Kyle Sutherland ◽

Daniel A. Sussman ◽

Amar R. Deshpande

Keyword(s):

Colorectal Cancer ◽

United States ◽

Colon Cancer ◽

Cancer Screening ◽

Underserved Populations ◽

The United States ◽

Colon Cancer Screening ◽

Medically Underserved ◽

Medically Underserved Populations

Abstract Background Adherence to colorectal cancer screening in the United States is suboptimal, particularly in medically underserved populations due to significant barriers to care. Unique accessible, low-cost, and non-invasive screening tests for this population could greatly benefit current rates. In this article, we assess patient preference and the impact of offering a blood-based test on screening rates in a cost-free health fair setting from April 2017 to April 2019. Methods Participants who met colorectal cancer screening eligibility criteria set forth by the United States Preventive Services Task Force were recommended to attend the colon cancer screening station. Those participants who elected to attend were offered various, accepted screening methods, and if they declined, were offered alternative blood-based testing. Screening rates, test outcomes, and the rate of follow up completion of colonoscopy were measured and compared with historic screening outcomes. Results Of 1401 participants who were recommended to attend, 640 (45.7%) participants were evaluated at the colon cancer screening station, of whom 460 were eligible for testing. Amongst these, none selected colonoscopy, 30 (6.5%) selected fecal immunochemical testing, and 430 (93.5%) selected blood-based testing. Only 2 participants returned the fecal immunochemical tests. In the blood test cohort, 88 were positive and 20 received a follow up colonoscopy. Conclusions Based on this assessment, blood-based testing is an effective method to increase screening rates in medically underserved populations, though efforts to further improve access to follow up colonoscopy are necessary.

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