Purpose

To describe long-term prescribed drug use after rectal cancer treatment.

Methods

We identified 12,871 rectal cancer patients without distant metastasis between 2005 and 2016 and 64,341 matched population comparators using CRCBaSe (a Swedish nationwide register linkage of colorectal cancer patients). Mean defined daily doses (DDDs) of drug dispensing during relapse-free follow-up were calculated by Anatomical Therapeutic Chemical drug categories. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) from negative binomial regression were used to compare drug dispensing between patients and comparators.

Results

The overall pattern of drug dispensing was similar among cancer survivors and comparators, although patients had higher mean DDDs of drugs regulating the digestive system. Excess dispensing of drugs for constipation (IRR, 3.35; 95% CI, 3.12–3.61), diarrhea (IRR, 6.43; 95% CI, 5.72–7.22), functional gastrointestinal disorders (IRR, 3.78; 95% CI, 3.15–4.54), and vitamin and mineral supplements (IRR, 1.37; 95% CI, 1.24–1.50) was observed up to 10 years after surgery. Treatment with Hartmann’s procedure was associated with higher dispensing rates of digestive drugs compared to surgery with anterior resection and abdominoperineal resection but the association was attributed to higher use of diabetic drugs. Additionally, excess digestive drug dispensing was associated with more advanced cancer stage but not with (chemo)radiotherapy treatment.

Conclusions

Excess drug use after rectal cancer is primarily driven by bowel-regulating drugs and is not modified by surgical or oncological treatment.

Implications for Cancer Survivors

The excess use of bowel-regulating drugs after rectal cancer indicated long-standing postsurgical gastrointestinal morbidity and need of prophylaxis. Reassuringly, no excess use of other drug classes was noted long term.

中文翻译：

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瑞典 I-III 期直肠癌患者长期使用处方药物，重点是手术和肿瘤治疗后的肠道调节药物

目的

描述直肠癌治疗后长期处方药物的使用。

方法

我们使用 CRCBaSe（瑞典全国结直肠癌患者登记链接）确定了 2005 年至 2016 年间 12,871 名无远处转移的直肠癌患者和 64,341 名匹配的人群比较者。无复发随访期间药物配药的平均每日剂量 (DDD) 根据解剖治疗化学药物类别计算。使用负二项回归的发生率比 (IRR) 和 95% 置信区间 (CI) 来比较患者和对照者之间的药物配药情况。

结果

尽管患者调节消化系统的药物的平均 DDD 较高，但癌症幸存者和对照者的总体配药模式相似。过量配药治疗便秘（IRR，3.35；95% CI，3.12–3.61）、腹泻（IRR，6.43；95% CI，5.72–7.22）、功能性胃肠道疾病（IRR，3.78；95% CI，3.15–4.54） ）以及维生素和矿物质补充剂（IRR，1.37；95% CI，1.24-1.50）的观察持续至术后 10 年。与前切除术和腹会阴切除术相比，哈特曼手术治疗与较高的消化药物配药率相关，但这种相关性归因于糖尿病药物的使用较多。此外，过量的消化药物配药与更晚期的癌症阶段相关，但与（化学）放射治疗无关。

结论

直肠癌后的过量药物使用主要是由肠道调节药物驱动的，并且不能通过手术或肿瘤治疗来改变。

对癌症幸存者的影响

直肠癌术后过度使用肠道调节药物表明术后胃肠道发病率长期存在，需要预防。令人欣慰的是，长期来看没有发现其他药物类别的过度使用。