Risk of dementia in colorectal cancer patients receiving chemotherapy: A nationwide cohort study

Ru-Huang Chiu; Shiang-Ru Lu; Fu-Wen Liang; Chien-Liang Lin; Chung-Han Ho; Pei-Chi Hsiao

doi:10.1016/j.canep.2021.102083

Risk of dementia in colorectal cancer patients receiving chemotherapy: A nationwide cohort study

Cancer Epidemiol. 2022 Feb:76:102083. doi: 10.1016/j.canep.2021.102083. Epub 2021 Dec 15.

Authors

Ru-Huang Chiu¹, Shiang-Ru Lu², Fu-Wen Liang³, Chien-Liang Lin⁴, Chung-Han Ho⁵, Pei-Chi Hsiao⁶

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan. No.901, Zhonghua Rd. Yongkang Dist., Tainan 71004, Taiwan. Electronic address: ruhuang39@gmail.com.
² Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung 80756, Taiwan. Electronic address: srlu@kmu.edu.tw.
³ Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, No.100, Shih-Chuan 1st Rd, Sanmin Dist., Kaohsiung 80708, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung 80756 Taiwan. Electronic address: fwliang@kmu.edu.tw.
⁴ Division of Hematology and Oncology Division, Chi-Mei medical center, Liouying campus, Tainan, Taiwan., No.201, Taikang, Liuying Dist., Tainan 73657, Taiwan. Electronic address: kevin640209@yahoo.com.tw.
⁵ Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan, No.901, Zhonghua Rd. Yongkang Dist., Tainan 71004, Taiwan; Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, No. 111, Section 3, Xing-Long Road, Taipei 11696, Taiwan. Electronic address: ho.c.hank@gmail.com.
⁶ Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan. No.901, Zhonghua Rd. Yongkang Dist., Tainan 71004, Taiwan. Electronic address: peichi1227@gmail.com.

PMID: 34920341
DOI: 10.1016/j.canep.2021.102083

Abstract

Background: Studies have reported conflicting evidence regarding whether chemotherapy leads to dementia. This study aimed to determine whether chemotherapy increases dementia risk in Taiwanese patients with colorectal cancer (CRC).

Methods: Data from the Taiwan Cancer Registry and National Health Insurance Research Database were used. Patients newly diagnosed as having CRC between 2007 and 2015 without prior history of dementia or neurodegenerative disorders were identified. Based on whether they underwent chemotherapy, patients were divided into chemotherapy and non-chemotherapy groups. Those who later developed dementia were identified using validated diagnostic codes. The Fine and Gray subdistribution hazard model for all-cause dementia with competing risk of death was applied for all patients or each stratified group.

Results: A total of 76,130 patients with CRC were included, with 45,872 (60.25%) in the chemotherapy group and 30,258 (39.75%) in the non-chemotherapy group. A higher incidence of dementia was observed in the non-chemotherapy group compared with the chemotherapy group (3.75% vs. 2.40%, p < 0.0001), but the risk of dementia did not differ between the groups (adjusted subdistribution hazard ratio [HR^SD] = 0.97, 95% confidence interval [CI]: 0.88-1.06, p = 0.492). In the stratified analysis, chemotherapy was a risk factor for dementia in patients aged > 80 years (adjusted HR^SD = 1.20, 95% CI: 1.03-1.40, p = 0.0190), whereas gender, clinical cancer stage, comorbidities, surgery, and radiation therapy had no impact on the risk of dementia.

Conclusion: Chemotherapy increased the risk of dementia in elderly patients with CRC, highlighting the necessity to monitor their cognitive function after chemotherapy.

Keywords: Chemotherapy; Colorectal cancer; Dementia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cohort Studies
Colorectal Neoplasms* / drug therapy
Colorectal Neoplasms* / epidemiology
Dementia* / epidemiology
Humans
Incidence
Proportional Hazards Models