Gynecol Oncol. 2023 Aug;175:114-120. doi: 10.1016/j.ygyno.2023.06.009. Epub 2023 Jun 22.

Chelsea Anderson ¹, Anne F Peery ², Victoria L Bae-Jump ³, Wendy R Brewster ³, Jennifer L Lund ⁴, Andrew F Olshan ⁴, Hazel B Nichols ⁴

Author information

¹Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA. Electronic address: Chelsea_Anderson@med.unc.edu.

²Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA.

³Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.

⁴Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.

Abstract

Objective: Treatment for endometrial cancer may contribute to bowel dysfunction and other gastrointestinal outcomes. We investigated the risk of several gastrointestinal diagnoses among older women with endometrial cancer and matched women without a history of cancer.

Methods: Women aged 66 years and older diagnosed with endometrial cancer during 2004-2017 (N = 44,386) and matched women without a known cancer history (N = 221,219) were identified in the SEER-Medicare linked data. An index date was defined as the endometrial cancer diagnosis date in that matched set. ICD-9 and -10 diagnosis codes were used to define gastrointestinal outcomes, including constipation, abdominal pain, IBS, fecal incontinence, bowel obstruction, ileus, radiation enteritis or proctitis, colonic stricture, and vascular insufficiency of the bowel in the Medicare claims. Hazard ratios (HRs) for incident gastrointestinal diagnoses were estimated using multivariable Cox proportional hazards regression models.

Results: Compared to women without cancer, women with endometrial cancer had an increased risk of gastrointestinal symptoms after the index date, including constipation (HR = 2.27; 95% CI: 2.22-2.32), abdominal pain (HR = 2.94; 95% CI: 2.89-2.99), and fecal incontinence (HR = 1.96; 95% CI: 1.83-2.10). The risk of other gastrointestinal diagnoses was also higher among women with endometrial cancer (e.g., bowel obstruction: HR = 5.72; 95% CI: 5.47-5.98; ileus: HR = 7.22; 95% CI: 6.89-7.57). These associations were also apparent in sensitivity analyses limited to 1+ and 5+ years after the index date.

Conclusions: Older women with endometrial cancer experience an excess risk of gastrointestinal diagnoses that may persist long after cancer diagnosis. Surveillance for these conditions may be a critical part of survivorship care.