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Epidemiol Health > Volume 43; 2021 > Article
Epidemiology and Health 2021;43: e2021093-0.
DOI: https://doi.org/10.4178/epih.e2021093    Published online Nov 2, 2021.
Effect of chemotherapy and radiotherapy on cognitive impairment in colorectal cancer: evidence from Korean National Health Insurance Database Cohort
Kwanghyun Kim1,2  , Chang Woo Kim3  , Aesun Shin4  , Hyunseok Kang5  , Sun Jae Jung1,2 
1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Public Health, Yonsei University, Seoul, Korea
3Department of Surgery, Ajou University School of Medicine, Suwon, Korea
4Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
5Department of Medicine, University of California, San Francisco, CA, USA
Correspondence  Sun Jae Jung ,Email: sunjaejung@yuhs.ac
Received: Aug 17, 2021  Accepted after revision: Nov 2, 2021
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.
Keywords: Chemotherapy, Radiotherapy, Cognitive impairment, Colorectal neoplasms


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