Endocrine and Metabolic Diseases Among Colorectal Cancer Survivors in a Population-Based Cohort

Makenzie L. Hawkins; Brenna E. Blackburn; Kerry Rowe; John Snyder; Vikrant G. Deshmukh; Michael Newman; Alison Fraser; Ken Smith; Kimberly Herget; Patricia A. Ganz; N. Jewel Samadder; Mia Hashibe


J Natl Cancer Inst. 2020;112(1):78-86. 

In This Article

Abstract and Introduction


Background: There are an estimated 1.4 million colorectal cancer (CRC) survivors in the United States. Research on endocrine and metabolic diseases over the long term in CRC survivors is limited. Obesity is a risk factor for CRC; thus it is of interest to investigate diseases that may share this risk factor, such as diabetes, for long-term health outcomes among CRC survivors.

Methods: A total of 7114 CRC patients were identified from the Utah Population Database and matched to a general population cohort of 25 979 individuals on birth year, sex, and birth state. Disease diagnoses (assessed over three time periods of 1–5 years, 5–10 years, and >10 years) were identified using electronic medical records and statewide ambulatory and inpatient discharge data. Cox proportional hazard models were used to estimate the risk of endocrine and metabolic disease.

Results: Across all three time periods, risks for endocrine and metabolic diseases were statistically significantly greater for CRC survivors compared with the general population cohort. At 1–5 years postdiagnosis, CRC survivors' risk for diabetes mellitus with complications was statistically significantly elevated (hazard ratio [HR] = 1.36, 99% confidence interval [CI] = 1.09 to 1.70). CRC survivors also experienced a 40% increased risk of obesity at 1–5 years postcancer diagnosis (HR= 1.40, 99% CI= 1.66 to 2.18) and a 50% increased risk at 5–10 years postdiagnosis (HR = 1.50, 99% CI= 1.16 to 1.95).

Conclusions: Endocrine and metabolic diseases were statistically significantly higher in CRC survivors throughout the follow-up periods of 1–5 years, 5–10 years, and more than 10 years postdiagnosis. As the number of CRC survivors increases, understanding the long-term trajectory is critical for improved survivorship care.


Colorectal cancer (CRC) is the third-most common cancer among men and women in the United States.[1] There are an estimated 1.4 million CRC survivors and 140 000 new CRC diagnoses each year.[2] For individuals with CRC, the 5-year and 10-year relative survival rates are 65% and 58%, respectively, and those diagnosed with localized disease have a 90% 5-year relative survival rate.[3] As the number of CRC survivors increases and survival rates improve, understanding the long-term health trajectory is critical for improved survivorship care.

CRC survivors experience a high prevalence of comorbid conditions.[4,5] The prevalence of obesity has continued to rise both in male and female adult cancer survivors, with an especially higher obesity burden in CRC survivors.[6] Many of these comorbid conditions, including obesity and diabetes, are not only a risk factor for the incidence of CRC but have also been associated with poor outcomes after a cancer diagnosis.[7–12] The presence of these conditions affects cancer-related health outcomes as well as noncancer-related outcomes. For instance, diabetes has been shown to greatly increase the risk for recurrence and mortality in CRC survivors;[13–15] it is also a statistically significant predictor of other conditions such as cardiovascular disease and stroke.[16]

CRC survivors have been shown to have poorer health and poorer quality of life compared with healthy individuals.[17,18] Some of the common diseases in CRC survivors, often resulting from cancer treatment and therapy, include gastrointestinal issues, anxiety, depression, neuropathy, chronic pain, and bladder issues.[19–22] These conditions can be experienced more than 10 years following CRC diagnosis and treatment.[20] Because previous research has mostly focused on quality of life measures or comorbidities at diagnosis, there is limited research evaluating the incidence and development of these conditions after the diagnosis of cancer. However, a recent population-based study from Ontario, Canada, reported that CRC patients had a statistically significantly increased risk of developing diabetes after a CRC diagnosis compared with those without cancer.[23] This study is one of the first to address endocrine and metabolic disease risks in CRC survivors. Our study builds on this previous research by evaluating additional endocrine and metabolic disease as well as the type of diabetes.

The aim of our study was to evaluate the incidence of endocrine and metabolic diseases and disorders in CRC survivors compared with a general population cohort over three time periods of 1–5 years, 5–10 years, and more than 10 years postdiagnosis. Our results were further stratified by age and sex.