Cancer Causes & Control

, Volume 29, Issue 11, pp 1093–1103 | Cite as

Risk of colon cancer recurrence in relation to diabetes

  • Jessica ChubakEmail author
  • Onchee Yu
  • Rebecca A. Ziebell
  • Erin J. Aiello Bowles
  • Andrew T. Sterrett
  • Monica M. Fujii
  • Jennifer M. Boggs
  • Andrea N. Burnett-Hartman
  • Denise M. Boudreau
  • Lu Chen
  • James S. Floyd
  • Debra P. Ritzwoller
  • Rebecca A. Hubbard
Original paper



To describe the association between diabetes and colon cancer recurrence.


We conducted a cohort study at two integrated health care delivery systems in the United States. Using tumor registry data, we identified patients aged ≥ 18 years when diagnosed with stage I–IIIA adenocarcinomas of the colon during 1995–2014. Pre-existing diabetes was ascertained via diagnosis codes. Medical records were reviewed for eligibility and to abstract recurrence and covariate information. Recurrence was ascertained beginning 90 days after the end of colon cancer treatment (i.e., cohort entry). Recurrence of any cancer or a new primary cancer at any site was a secondary outcome. We used multivariable Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for the associations between diabetes at cohort entry and study outcomes.


Among the 1,923 eligible patients, 393 (16.7%) had diabetes at cohort entry. Diabetes was not associated with recurrence (HR 0.87; 95% CI 0.56–1.33) or with any subsequent cancer (HR 1.09; 95% CI 0.85–1.40). When the definition of recurrence included second primary colorectal cancer, risk was non-significantly higher in patients with diabetes than without diabetes.


The risk of colon cancer recurrence appears to be similar in patients with and without diabetes at diagnosis.


Future studies should evaluate the association between diabetes and colorectal cancer outcomes, especially second primary colon cancers, in larger populations.


Colon cancer Recurrence Diabetes Survivorship 



We would like to thank Dr. Elizabeth Trice Loggers for assistance with designing the medical record abstraction instrument and providing clinical input, and Lee Barr, Kate Burniece, and Angela Plata for reviewing medical records. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers R01CA172073 (Chubak) and R50CA211115 (Bowles). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The collection of cancer incidence data used in this study was supported by the Cancer Surveillance System of the Fred Hutchinson Cancer Research Center, which is funded by Contract No. N01-CN-67009 and N01-PC-35142 from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute with additional support from the Fred Hutchinson Cancer Research Center and the State of Washington. Funders did not participate in the design, data collection, manuscript drafting, or decision to submit the manuscript for publication.


Monica Fujii reports receiving funding from a research contracts awarded to Kaiser Permanente Washington Health Research Institute from Allergan, BioDelivery Sciences, Collegium, Daiichi Sankyo, Depomed, Egalet, Endo, Janssen, Mallinckrodt, Pernix, Pfizer, Purdue, and West-Ward. Denise Boudreau reports receiving funding from research contracts awarded to Kaiser Permanente Washington Health Research Institute from Allergan, BioDelivery Sciences, Collegium, Daiichi Sankyo, Depomed, Egalet, Endo, Janssen, Mallinckrodt, Pernix, Pfizer, Purdue, and West-Ward. Onchee Yu reports receiving funding from a research grant awarded to the Kaiser Permanente Washington Health Research Institute from Bayer.

Compliance with ethical standards

Informed consent

For this type of study, formal consent is not required.

Research involving animals

This article does not contain any studies with animals performed by any of the authors.

Supplementary material

10552_2018_1083_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 KB)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Jessica Chubak
    • 1
    • 2
    Email author return OK on get
  • Onchee Yu
    • 1
  • Rebecca A. Ziebell
    • 1
  • Erin J. Aiello Bowles
    • 1
  • Andrew T. Sterrett
    • 3
  • Monica M. Fujii
    • 1
  • Jennifer M. Boggs
    • 3
  • Andrea N. Burnett-Hartman
    • 3
  • Denise M. Boudreau
    • 1
    • 2
    • 4
  • Lu Chen
    • 1
  • James S. Floyd
    • 2
    • 5
  • Debra P. Ritzwoller
    • 3
  • Rebecca A. Hubbard
    • 6
  1. 1.Kaiser Permanente Washington Health Research InstituteSeattleUSA
  2. 2.Department of Epidemiology, School of Public HealthUniversity of WashingtonSeattleUSA
  3. 3.Kaiser Permanente Colorado Institute for Health ResearchDenverUSA
  4. 4.School of PharmacyUniversity of WashingtonSeattleUSA
  5. 5.Department of Medicine, School of MedicineUniversity of WashingtonSeattleUSA
  6. 6.Department of Biostatistics, Epidemiology, and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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