April 4, 2023
Does cancer treatment increase risk of IBD relapse?
IBD patients with cancer have understandable concerns about the impact of their diagnosis and its treatment on the course of IBD. Unfortunately, these data suggest that relapse of IBD and gastrointestinal intolerance of cancer treatment are common.
Grimsdottir S, Attauabi M, Dahl EK, et al. Systematic review with meta-analysis: The impact of cancer treatments on the disease activity of inflammatory bowel diseases. J Crohns Colitis. Epub ahead of print Jan 22 2023; https://academic.oup.com/ecco-jcc
This systematic review and meta-analysis included 33 studies in IBD patients with cancer, documenting their IBD activity during the first year after completing cancer treatment. Most of the publications were retrospective cohort studies and they included 606 patients with ulcerative colitis, 552 with Crohn’s disease and 26 with indeterminate colitis. Eighty-five percent of patients had inactive IBD at the time of cancer treatment.
The results showed that 30% of patients experienced a relapse of IBD within the year after cancer treatment (95% Confidence Interval [CI]: 24–38%; p<0.01). In a subgroup analysis according to cancer treatment type, the highest risk of IBD relapse accompanied chemotherapy (48%; 95% CI: 3–97%), followed by immune checkpoint inhibitor treatment (33%; 95% CI: 25–42%) and radiation therapy (20%; 95% CI: 9–38%). There were insufficient studies to perform a meta-analysis of the effects of hormone therapy on IBD disease behavior, but the two publications that were included on this treatment type found that hormone therapy alone or in combination with chemotherapy was associated with a higher risk of IBD relapse than chemotherapy alone.
Relapses of IBD prompted systemic corticosteroids or biologic therapies in 25% and 10% of patients, respectively. Additionally, 14% of patients discontinued cancer treatment because of the gastrointestinal effects of treatment.
Patients with IBD were over three times more likely to experience treatment-related gastrointestinal adverse effects than a control group of patients without IBD (Risk Ratio: 3.62; 95% CI: 2.57–5.09; p<0.01). Cancer treatment did not increase the risk of IBD-related surgical interventions and the presence of IBD did not affect overall survival.
Study Design: Systematic review and meta-analysis
Allocation: Not applicable
Level of Evidence: 2a