Diabetes alone should not be a reason for withholding adjuvant chemotherapy for stage III colon cancer
Journal: Journal of Comorbidity (Vol.1, No. 1)Publication Date: 2011-12-27
Authors : Maren A. van Waalwijk; Saskia A.M. van de Schans; Harm R. Haak; Martine Extermann; Wouter M.W. Dercksen; Maryska L.G. Janssen-Heijnen;
Page : 19-27
Keywords : colon cancer; comorbidity; diabetes mellitus; population-based; survival; treatment;
Abstract
Background: With increasing prevalence of diabetes mellitus and colon cancer, the number of patients suffering from both diseases is growing, and physicians are being faced with complicated treatment decisions. Objective: To investigate the association between diabetes and treatment/course of stage III colon cancer and the association between colon cancer and course of diabetes. Materials and Methods: Additional information was collected from the medical records of all patients with both stage III colon cancer and diabetes (n=201) and a random sample of stage III colon cancer patients without diabetes (n=206) in the area of the population-based Eindhoven Cancer Registry (1998?2007). Results: Colon cancer patients without diabetes were more likely to receive adjuvant chemotherapy compared with diabetic colon cancer patients (OR 1.8; 95% CI 1.2?2.7). After adjustment for age, this difference was borderline significant (OR 1.6; 95% CI 1.0?2.6). Diabetic patients did not have: significantly more side-effects from surgery or adjuvant chemotherapy; more recurrence from colon cancer; significantly shorter time interval until recurrence; or a poorer disease-free survival or overall survival. Age and withholding of adjuvant chemotherapy were most predictive of all-cause mortality. After colon cancer diagnosis, the dose of antiglycaemic medications was increased in 22% of diabetic patients, resulting in significantly lower glycaemic indexes than before colon cancer diagnosis. Conclusions: Since diabetic patients did not have more side-effects of adjuvant chemotherapy, and adjuvant chemotherapy had a positive effect on survival for both patients with and without diabetes, diabetes alone should not be a reason for withholding adjuvant chemotherapy.
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