Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jul 20;16(14):2597.
doi: 10.3390/cancers16142597.

Chemotoxicity and Associated Risk Factors in Colorectal Cancer: A Systematic Review and Meta-Analysis

Claire J Han  1   2 , Xia Ning  3 , Christin E Burd  4 , Daniel J Spakowicz  5 , Fode Tounkara  6 , Matthew F Kalady  7 , Anne M Noonan  8 , Susan McCabe  1 , Diane Von Ah  1   2
Affiliations
Review

Chemotoxicity and Associated Risk Factors in Colorectal Cancer: A Systematic Review and Meta-Analysis

Claire J Han et al. Cancers (Basel). .

Abstract

Background: Colorectal cancer (CRC) patients experience multiple types of chemotoxicity affecting treatment compliance, survival, and quality of life (QOL). Prior research shows clinician-reported chemotoxicity (i.e., grading scales or diagnostic codes) predicts rehospitalization and cancer survival. However, a comprehensive synthesis of clinician-reported chemotoxicity is still lacking.

Objectives: We conducted a systematic review and meta-analysis to determine chemotoxicity's prevalence and risk factors in CRC.

Methods: A systematic search from 2009 to 2024 yielded 30 studies for review, with 25 included in the meta-analysis.

Results: Pooled prevalences of overall, non-hematological, and hematological moderate-to-severe toxicities were 45.7%, 39.2%, and 25.3%, respectively. The most common clinician-reported chemotoxicities were gastrointestinal (GI) toxicity (22.9%) and neuropathy or neutropenia (17.9%). Significant risk factors at baseline were malnutritional status, frailty, impaired immune or hepato-renal functions, short telomere lengths, low gut lactobacillus levels, age, female sex, aggressive chemotherapy, and low QOL. Age was associated with neutropenia (β: -1.44) and GI toxicity (β:1.85) (p-values < 0.01). Older adults (>65 y.o.) had higher prevalences of overall (OR: 1.14) and GI (OR: 1.65) toxicities, but a lower prevalence of neutropenia (OR: 0.65) than younger adults (p-values < 0.05).

Conclusions: Our findings highlight the importance of closely monitoring and managing chemotoxicity in CRC patients receiving chemotherapy.

Keywords: chemotoxicity; colorectal cancer; prevalence; review; risk factors.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The PRISMA 2020 flow diagram.
Figure 2
Figure 2
Funnel plot of publication bias (based on the 17 articles reporting prevalences of overall moderate-to-severe chemotoxicity data).
Figure 3
Figure 3
Forest plots for pooled prevalences of moderate-to-severe chemotoxicity (overall, non-hematological, and hematological toxicities) [7,30,31,32,33,34,35,39,40,41,43,44,45,46,47,48,49,50,52,53,54,55,56,58].
Figure 4
Figure 4
Forest plots for pooled prevalences of mild chemotoxicity (overall, non-hematological, and hematological toxicities) [7,31,32,49,50,52,54].
See this image and copyright information in PMC

References

    1. Arnold M., Abnet C.C., Neale R.E., Vignat J., Giovannucci E.L., McGlynn K.A., Bray F. Global Burden of 5 Major Types of Gastrointestinal Cancer. Gastroenterology. 2020;159:335–349. doi: 10.1053/j.gastro.2020.02.068. - DOI - PMC - PubMed
    1. Siegel R.L., Miller K.D., Wagle N.S., Jemal A. Cancer statistics, 2023. CA Cancer J. Clin. 2023;73:17–48. doi: 10.3322/caac.21763. - DOI - PubMed
    1. Wong M.C., Huang J., Lok V., Wang J., Fung F., Ding H., Zheng Z.-J. Differences in incidence and mortality trends of colorectal cancer worldwide based on sex, age, and anatomic location. Clin. Gastroenterol. Hepatol. 2021;19:955–966.e961. doi: 10.1016/j.cgh.2020.02.026. - DOI - PubMed
    1. Biller L.H., Schrag D. Diagnosis and treatment of metastatic colorectal cancer: A review. JAMA. 2021;325:669–685. doi: 10.1001/jama.2021.0106. - DOI - PubMed
    1. Chan G.H.J., Chee C.E. Making sense of adjuvant chemotherapy in colorectal cancer. J. Gastrointest. Oncol. 2019;10:1183–1192. doi: 10.21037/jgo.2019.06.03. - DOI - PMC - PubMed

LinkOut - more resources