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Chang Woo Kim 1 Article
Effect of chemotherapy and radiotherapy on cognitive impairment in colorectal cancer: evidence from Korean National Health Insurance Database Cohort
Kwanghyun Kim, Chang Woo Kim, Aesun Shin, Hyunseok Kang, Sun Jae Jung
Epidemiol Health. 2021;43:e2021093.   Published online November 2, 2021
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AbstractAbstract AbstractSummary PDFSupplementary Material
We investigated the risk of chemotherapy-related and radiotherapy-related cognitive impairment in colorectal cancer patients.
Medical use data of colorectal cancer patients were obtained from the Korean National Health Insurance Database from 2004 to 2018. We randomly selected 40% of all colorectal cancer patients (n=148,848). Cognitive impairment was defined as having 1 or more International Classification of Diseases, 10th revision diagnostic codes for dementia or mild cognitive impairment. Patients aged 18 years or younger, patients diagnosed with cognitive impairment before colorectal cancer diagnosis (n=8,225), and patients who did not receive primary resection (n=45,320) were excluded. The effects of individual chemotherapy regimens on cognitive impairment were estimated. We additionally estimated the effect of radiotherapy in rectal cancer patients. Time-dependent competing risk Cox regression was conducted to estimate the overall and age-specific hazard ratios (HR) separately for colon and rectal cancer. Landmark analyses with different lag times were conducted as sensitivity analyses.
Chemotherapy did not increase the risk of cognitive impairment in colorectal cancer patients (colon cancer: HR, 0.92; 95% confidence interval [CI], 0.83 to 1.03; rectal cancer: HR, 0.88; 95% CI, 0.75 to 1.04), while radiotherapy was negatively associated with cognitive impairment in rectal cancer patients (HR, 0.01; 95% CI, 0.84 to 0.99). Varying directions of the associations between regimens and cognitive impairment were detected. The adverse effect of certain chemotherapy regimens on cognition was more prominent in older adults.
Chemotherapy and radiotherapy did not increase the risk of cognitive impairment. Older patients with low cognitive reserve could be affected by the adverse cognitive effects of chemotherapy.
Korean summary
- 대장암 환자를 대상으로 한 항암화학요법 및 방사선요법은 인지기능저하의 위험을 높이지 않았다 - 일부 항암화학요법의 경우 고령의 대장암 환자에서 인지기능저하의 위험을 증가시킬 수 있다
Key Message
Results from nationwide cohort of Korea showed that chemotherapy and radiotherapy did not increase the risk of cognitive impairment in colorectal cancer patients.


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