Endometrial Cancer Treatment Linked to Long-Term Bowel Dysfunction in Older Women

Older Women who are endometrial cancer survivors can experience long-term gastrointestinal problems due to their cancer treatment, according to a recent study published in the journal Gynecologic Oncology.¹

Researchers from the center of gastrointestinal biology and disease at the University of North Carolina at Chapel Hill conducted the study. They said that following treatment for endometrial cancer, older survivors experience long-term gastrointestinal diagnoses that need to be managed.

Endometrial cancer ranks fourth in cancer prevalence among US women, and second among women who have survived the disease.¹ First-line treatment is hysterectomy, with or without removing the fallopian tubes and ovaries, together with chemotherapy and/or radiation, depending on the stage of cancer and other factors.

“These therapies, while prolonging survival from the original cancer diagnosis, may also contribute to acute and/or long-term symptoms and other adverse physical effects, with implications for quality of life and future medical care needs among endometrial cancer survivors,” the authors wrote.

Researchers performed a comprehensive analysis from SEER-Medicaid data of 44,386 women ≥66 years of age with an endometrial cancer diagnosis and matched them with 221,219 women who never had a cancer diagnosis between 2004-2017. The authors identified the index date as the date of cancer diagnosis and used ICD-9 and -10 codes from Medicare claims to identify gastrointestinal issues, such as abdominal pain, irritable bowel syndrome (IBS), fecal incontinence, constipation, bowel obstruction, ileus, colonic stricture, radiation enteritis or proctitis, and vascular insufficiency of the bowel. Researchers used multivariate Cox proportional hazards regression models to estimate hazard ratios for gastrointestinal incident issues.

The authors reported that women treated for endometrial cancer faced a much higher risk of gastrointestinal issues after the index date of diagnosis. “For all gastrointestinal outcomes that we examined, the cumulative incidence among women with endometrial cancer exceeded the incidence among the comparison group,” the authors said.

The treated group’s symptoms included abdominal pain (HR = 2.94; 95% CI: 2.89–2.99), constipation (HR = 2.27; 95% CI: 2.22–2.32), and fecal incontinence (HR = 1.96; 95% CI: 1.83–2.10). The risk of bowel obstruction (HR =5.72; 95% CI: 5.47–5.98) and ileus (HR = 7.22; 95% CI: 6.89–7.57) in women treated for endometrial cancer were also elevated. Researchers said the treatment group had a 34% chance of abdominal pain within 1 year. In 5 years, that rose to 57% and in 10 years, it was 67%. The associations stayed consistent even when sensitivity analyses were restricted to 1+ and 5+ years following the index date.

As the cancer patients aged, the risk of being diagnosed with fecal incontinence and constipation steadily rose. In addition, researchers found racial disparities. Black, Asian, and other women of color were less likely to have documented cases of IBS or fecal incontinence compared to White women. The risk for constipation and abdominal pain was slightly higher in Black and Hispanic women.

Women who had a hysterectomy without chemotherapy and/or radiation had less chance of gastrointestinal issues than women who had those treatments. “Those treated with hysterectomy, radiation, and chemotherapy, and chemotherapy and/or radiation (without hysterectomy) had an increased risk of fecal incontinence, abdominal pain, and constipation, but not IBS,” the authors wrote.

They added that abdominal pain and fecal incontinence risks were slightly higher for patients treated with radiation and hysterectomy. They also noted that women who had a hysterectomy with chemotherapy had a slightly higher risk of constipation compared with women who had a hysterectomy only.

Study limitations included only gastrointestinal issues that had been diagnosed by a provider and may underestimate the true gastrointestinal issue burden in endometrial cancer survivors.

Higher risks of long-term bowel dysfunction in older female endometrial cancer survivors show the need for comprehensive monitoring and care following cancer treatment.

“Surveillance for and management of these conditions may be a critical part of survivorship care, especially for those with more comorbidities, those with higher stage or grade cancer, and those treated with chemotherapy and/or radiation,” the authors said. Further research is needed to improve the understanding of gastrointestinal illness burden after the treatment of endometrial cancer.

Reference

1. Anderson C, Peery AF, Bae-Jump VL, et al. Gastrointestinal outcomes among older women with endometrial cancer. Gynecol Oncol. 2023;175:114-120. doi:10.1016/j.ygyno.2023.06.009