cardiovascular-agents and Colorectal-Neoplasms

Most chemotherapy regimens in colorectal cancer treatment are 5-fluorouracil (5-FU)/leucovorin or capecitabine-based. Cardiotoxicity is a less common but potentially lethal complication of 5-FU or capecitabine treatment, and some physicians might be unfamiliar with treatment alternatives. Rechallenging should be avoided because it carries a high risk of recurrence of the cardiac symptoms and prophylactic treatment is not always protective. Possible alternative treatment options to be considered are to replace the oral capecitabine or intravenous 5-FU by a 5-FU bolus regimen, by uracil-tegafur or tegafur/gimeracil/oteracil, both oral fluoropyrimidines combining a 5-FU prodrug with a dihydropyrimidine dehydrogenase (DPD) inhibitor, or by raltitrexed, a thymidilate synthase inhibitor whose metabolism is independent of DPD. Patients with advanced colorectal cancer and fluoropyrimidine-induced cardiotoxicity can be treated with other non-fluoropyrimidine related chemotherapy, either as a single agent, combined, or in combination with biological agents. In this report we discuss the different alternative treatment options.

Topics: Animals; Antimetabolites, Antineoplastic; Capecitabine; Cardiovascular Agents; Colorectal Neoplasms; Deoxycytidine; Fluorouracil; Heart Diseases; Humans

The aim of this study was to evaluate the influence of an approaching cancer death on end-of-life aspirin use, a frequently prescribed medication for cardiovascular disease prevention.. This study was conducted using linked cancer registry and prescribing data. Breast (n=1151) and colorectal (n=1859) cancer decedents were matched to cancer survivors and the probability of either initiating aspirin, or continuing established aspirin use, was estimated in consecutive periods over the 5 years approaching a cancer-specific death (decedents) or matched index date (survivors).. Using the linked data sets, we identified patients who died of their cancer (decedents) between 1 January 2001 and 31 December 2009. In the 5 years prior to death, we compared (1) the probability of initiating aspirin use for the first time, and (2) the probability of continuing aspirin use. In comparison to matched cancer survivors, an approaching cancer death was not associated with a reduction in aspirin initiation by breast or colorectal cancer decedents. However, the probability of continuing established aspirin use declined considerably in the 24 months approaching death and at the time of a death was significantly lower for breast (risk difference (RD) -0.26, 95% CI -0.33 to -0.20) and colorectal (RD -0.38, 95% CI -0.46 to -0.30) cancer decedents versus matched survivors.. A significant proportion of patients discontinue their aspirin in the time approaching a breast or colorectal cancer-specific death. The safety and benefits of this are unclear and empirical data are needed to guide decisions about aspirin use in the end of life.

Topics: Aged; Aged, 80 and over; Aspirin; Breast Neoplasms; Cancer Survivors; Cardiovascular Agents; Cardiovascular Diseases; Colorectal Neoplasms; Female; Humans; Male; Prospective Studies; Terminal Care

To study health-related differences between hormone replacement therapy (HRT) users and nonusers among colorectal cases and women without diagnosed cancer.. Data from the Saskatchewan Health population-based databases were used to ascertain the use of HRT, oral contraceptives (OCs), cardiovascular system (CVS) drugs, central nervous system (CNS) drugs, prescribed NSAIDs and vitamins among 3338 women diagnosed with colorectal cancer and 13025 women without diagnosed cancer. Physician visits and sigmoidoscopy procedures were also determined.. Among women without diagnosed cancer, HRT was associated with CVS drugs (OR = 1.23, 95%CI: 1.10-1.37), CNS drugs (OR = 1.96, 95% CI: 1.72-2.23), other hormones (OR = 1.12, 95% CI: 1.01-1.24), prescribed vitamins (OR = 1.37, 95% CI: 1.22-1.55), NSAIDs (OR = 1.41, 95% CI: 1.18-1.68), having had a sigmoidoscopy 3-5 years prior to index dates (OR = 1.33, 95% CI: 1.12-1.59) and 15 or more visits to physicians during the 5th year prior to assigned index date (OR = 2.0, 95% CI: 1.77-2.35). Similar results were observed among women diagnosed with colorectal cancer, but HRT use was not associated with having had a sigmoidoscopy.. Health-related characteristics of HRT users and nonusers are identified and described. Some of these factors may contribute to selection bias in studies examining the health benefits of HRT.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Agents; Central Nervous System Agents; Colorectal Neoplasms; Estrogen Replacement Therapy; Female; Health Behavior; Humans; Middle Aged; Office Visits; Practice Patterns, Physicians'; Saskatchewan; Sigmoidoscopy; Vitamins