Date of Award

January 2016

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Deborah D. Proctor

Abstract

Inflammatory Bowel Diseases (IBD), specifically Crohn’s disease and ulcerative colitis, have been associated with numerous intestinal and extra- intestinal malignancies. Recent studies have suggested use of immunomodulator therapies has increased risks of malignancies, including melanoma, non-epithelial skin cancers, cervical cancer, and bladder and urinary tract cancers. The question regarding how biologic agents, which became a mainstay therapy of IBD in the early 2000s, have influenced malignancy risk among patients with IBD has yet to be definitely answered.

The aims of this study were to characterize prevalence of comorbid malignancies among hospitalized patients with IBD and how it has changed over the past decade, to develop a sense of the chronology by which malignancies present in IBD patients relative to the general population, and to identify malignancies that are less well defined in the context of IBD. The overall hypothesis of this work is that the prevalence of co- diagnosed malignancies among hospitalized patients with IBD has changed significantly over the study period.

This is a cross-sectional analysis characterizing the comorbid malignancies of hospitalized patients, with and without IBD, across the United States at two time points, spanning nearly a decade. Using the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) database years 2002 and 2003, and 2010 and 2011, the absolute and percent prevalence of malignancies were calculated for patients with and without IBD, stratified by age. A prevalence rate ratio was calculated to assess rate of change of prevalence in patients with IBD relative to patients without IBD.

There was no difference in prevalence of colon cancer among IBD patients in 2010-2011 compared to 2002-2003, across all age groups. Both anorectal and colon cancer rates were increased among patients with IBD compared to those without. There was an increase in the co-diagnosis of Non-Hodgkin lymphoma and IBD in the 58-67 year old age group in 2010-2011 compared to 2002-2003. Cervical cancer prevalence was increased among 38-47 year old women with IBD, and non-epithelial skin cancers were increased among older IBD patients. There were no statistical differences in rates of Hodgkin lymphoma, leukemia, melanoma, pancreatic and bladder cancers between patients with or without IBD.

Substantial changes in the prevalence of several types of cancers among hospitalized patients with IBD have occurred in the study time period. There continues to be an increased risk of colon, anal, and rectal cancers. The prevalence of bladder cancer, pancreatic cancer, melanoma, Hodgkin lymphoma, and leukemias among hospitalized patients with IBD has not significantly increased among IBD patients in the study period. Thyroid cancers, non-epithelial skin cancers, non-Hodgkin lymphoma, and cervical cancer rates were increased among IBD patients relative to the general population. Further investigation into these associations is warranted.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 08/24/2018.

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