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Abnormal bowel movement frequency increases the risk of rectal cancer: evidence from cohort studies with one million people.

ABSTRACT: Previous studies from case-control studies failed to draw reliable conclusions regarding the relationship between bowel movement frequency and the risk of colorectal cancer. To further examine this relationship, we collect the data from cohort studies that make a more accurate estimation. Several online data were searched from inception to February 29, 2020. Ten cohort studies involving 1,038,598 individuals were included in our study. The pooled results indicated that a bowel movement of less than once per day was not associated with the risk of colorectal cancer (relative risk (RR)= 1.00, 95% confidence interval (CI): 0.87-1.16, P = 0.950) compared with that of once per day. Compared with a bowel movement frequency of once per day, a bowel movement of more than once per day was also not related to elevated risk of colorectal cancer (RR = 1.04, 95% CI: 0.91-1.19, P = 0.570). The subgroup analyses indicated a low or high bowel movement frequency did not increase the risk of colon cancer (RR = 0.91, 95% CI: 0.80-1.03, P = 0.130). However, an increased frequency of bowel movements increased the risk of rectal cancer (RR = 1.34, 95% CI: 1.19-1.52, P < 0.001). The sensitivity analysis still supports the results. No significant publication bias existed. The data from cohort indicated that less bowel movement frequency was not associated with the risk of colorectal cancer. The frequency of bowel movement affects the risk of rectal cancer.

SUBMITTER: Shen L

PROVIDER: S-EPMC7160378 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Abnormal bowel movement frequency increases the risk of rectal cancer: evidence from cohort studies with one million people.

Shen Lin L Li Chao C Li Na N Shen Liangfang L Li Zhanzhan Z

Bioscience reports 20200401 4

Previous studies from case-control studies failed to draw reliable conclusions regarding the relationship between bowel movement frequency and the risk of colorectal cancer. To further examine this relationship, we collect the data from cohort studies that make a more accurate estimation. Several online data were searched from inception to February 29, 2020. Ten cohort studies involving 1,038,598 individuals were included in our study. The pooled results indicated that a bowel movement of less t ...[more]

PMID: 32232384

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Project description:BackgroundTelotristat ethyl is approved to treat carcinoid syndrome diarrhea in combination with somatostatin analogs. In TELESTAR and TELECAST phase III studies, patients with carcinoid syndrome received telotristat ethyl 250 or 500 mg 3 times per day (tid) or placebo tid in addition to somatostatin analogs. The aim of this prespecified analysis was to examine the time to reductions in bowel movements (BMs) in the TELESTAR and TELECAST studies using survival analysis methods.MethodsFirst occurrence of sustained response was defined as the time to the first day of 2 consecutive weeks with a mean BM frequency improvement of ≥ 30% from baseline during the 12-week double-blind treatment periods. Time to first ≥ 30% worsening in BM frequency was also measured. Treatments were compared with the log-rank test; Cox regression models provided point and confidence interval estimates of the hazard ratios for each trial.ResultsIn TELESTAR and TELECAST, majority of patients (69%) on telotristat ethyl experienced a sustained ≥ 30% improvement in BM frequency. The median time to sustained reduction of at least 30% in BM frequency was significantly faster (fewer days to onset) for telotristat ethyl compared with placebo in both TELESTAR (250 mg, HR = 2.3 [95% CI, 1.3-4.1, P = 0.004]; 500 mg, HR = 2.2 [95% CI, 1.2-3.9, P = 0.009]) and TELECAST (250 mg, HR = 3.9 [95% CI, 1.6-11.1, P = 0.003]; 500 mg, HR = 4.2 [95% CI, 1.7-11.7, P = 0.002]). In TELECAST, 42% of patients on placebo experienced sustained worsening in BM frequency compared with 20% on telotristat ethyl; no significant difference was observed in TELESTAR.ConclusionThe time of onset of sustained BM frequency improvement mean and range are important when considering use of telotristat ethyl in patients with carcinoid syndrome diarrhea. Telotristat ethyl may also reduce sustained worsening in BM frequency.Trial registrationClinicalTrials.gov Identifiers: NCT01677910, NCT02063659.

Project description:BACKGROUND:Carcinoid syndrome is associated with a reduced quality of life that can be attributed to symptoms such as diarrhea and fatigue as well as social and financial issues. This study was conducted to psychometrically assess meaningful change in bowel movement frequency among carcinoid syndrome patients using data from the TELESTAR clinical study. METHODS:An anchor-based approach for deriving meaningful change thresholds consisted of mapping change from baseline bowel movement frequency to other patient-reported assessments of change. These included the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire - Core Questionnaire (QLQ-C30) Diarrhea Symptom responders, the EORTC Gastrointestinal NET questionnaire (GI.NET21) GI Symptom responders, and reported adequate relief at Week 12 (? 10-point score decrease from Day 1 to Week 12). Parameters included within-group mean change from baseline to Week 12, t-tests of the change (Wilcoxon rank sum for adequate relief), and effect size. RESULTS:There were 135 carcinoid syndrome patients with a mean baseline frequency of 5.7 bowel movements a day. A distribution-based method yielded meaningful change estimates of 0.62 bowel movements a day for overall frequency and 0.83 bowel movements a day at Week 12. Anchor-based analysis indicated a large effect size among patients who reported adequate relief at Week 12 (-?1.58; n?=?18; P?=?0.014), the QLQ-C30 Diarrhea domain responders (-?1.24; n?=?40; P?<?0.001), and the GI.NET21 GI Symptoms Domain responders (-?1.49; n?=?25; P?=?0.005). Exit interview data for meaningful change yielded effect size estimates of -?1.57 for overall change during the Double-blind Treatment Period and?-?1.97 for change between Baseline and Week 12. CONCLUSIONS:Meaningful change derivation is critical to interpret patient outcomes for evaluating treatment efficacy. In this study, carcinoid syndrome patients experienced clinically meaningful reductions in bowel movement frequency of ?30% over 12?weeks with telotristat ethyl treatment. TRIAL REGISTRATION:NCT01677910 .

Dataset Information

Abnormal bowel movement frequency increases the risk of rectal cancer: evidence from cohort studies with one million people.

Publications

Abnormal bowel movement frequency increases the risk of rectal cancer: evidence from cohort studies with one million people.

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