Risk of Malignancy in a Nationwide Cohort of Elderly Inflammatory Bowel Disease Patients

Abstract

BackgroundManagement of elderly inflammatory bowel disease (IBD) patients (≥ 65 years of age) is complicated due to many factors, including a higher risk of cancer, which may impact therapeutic decisions.ObjectiveThe aim of this study was to determine the risk of cancer among elderly IBD patients compared with younger IBD patients. Additionally, the absolute risk of malignancy and factors contributing to it were evaluated, and therapeutic patterns among the elderly were assessed.MethodsThis retrospective cohort study extracted data from the Truven Health Analytics MarketScan® database. Among adult IBD patients who were free of cancer before starting on corticosteroids, immunomodulators, or biologics, a Cox model for time to cancer was fitted that adjusted for several covariates, including time-dependent treatment. Baseline results were evaluated by age group, as were the incidence of cancer and the distribution of cancer subtypes.ResultsThe elderly IBD cohort (n = 8788) had a higher prevalence of cancer and several other ailments before starting treatment, relative to the younger IBD cohort aged 18–64 years (n = 54,971). During follow-up, the elderly IBD cohort experienced a higher incidence of malignancy, confirmed by a hazard ratio (HR) of 3.04 (95% confidence interval [CI] 2.71–3.41) from the Cox model fit. The risk of cancer was also significantly associated with male sex (HR 0.82 female), duration of disease (HR 1.08), several comorbidities and corticosteroid use (HR 1.35), but not with the use of immunomodulators or biologics. Non-Hodgkin’s lymphoma, urinary tract malignancy, and prostate, lung, and female breast cancers were observed more commonly in this elderly IBD cohort when compared with the same age group in the Surveillance, Epidemiology, and End Results (SEER) database.ConclusionsThe elderly with IBD have a higher risk of malignancy when compared with younger IBD patients and the general age-matched population, with certain cancers being more common among these patients.

Systematic review with meta‐analysis: biologics and risk of infection or cancer in elderly patients with inflammatory bowel disease

“…In total, 15 studies (13 full‐text articles and two abstracts) met the eligibility criteria and reported the occurrence of infections or malignancies in IBD patients ≥60 years old. Nine were cohort studies, five were case‐control studies and one was the post hoc analysis of a randomised controlled trial (RCT) . All studies reported at least one relevant outcome for IBD patients, and two of them also reported data regarding CD and UC patients, separately.…”

“…Seven studies scored six stars or higher and were rated as of high quality (Table S2). Two studies published as conference abstracts, were not assessed, as a critical appraisal of such publications is limited.…”

Efficacy and safety of granulocyte adsorption apheresis in elderly patients with ulcerative colitis

“…According to the European Crohn's and Colitis Organization (ECCO) guideline, the risk of new‐onset cancer or recurrence (regardless of the use or non‐use of immunosuppressive therapy) is twofold higher in IBD patients with a history of cancer than in IBD patients without such a history . Aging is a risk factor for many cancers, and the risk of malignancy is reported to be higher in elderly UC patients than in young UC patients . Accordingly, it is expected that the number of elderly UC patients with cancer will continue to increase in the future, which means that the relationship between cancer and treatment for UC should be taken into consideration …”

“…Whether or not tacrolimus (TAC) is carcinogenic remains unclear, but it has been pointed out that its carcinogenicity may depend on the dose of TAC and the duration of treatment after organ transplantation . There is also concern that long‐term systemic administration of PSL may be associated with cancer …”

“…12 There is also concern that long-term systemic administration of PSL may be associated with cancer. 12,14,19 In addition, if a UC patient is undergoing therapy for concomitant cancer, the use of biological agents, AZA, or TAC to treat UC should probably be avoided. The recommended first-line treatment for IBD during the initial 2-year period after the completion of anticancer therapy includes 5-ASA, local steroid therapy, nutritional therapy, antibiotics, and surgery.…”