Beyond Weight Loss: Rethinking GLP-1 Receptor Agonists in Colorectal Cancer Care

Introduction

For years, we've thought about GLP-1 receptor agonists like semaglutide (Wegovy for obesity, Ozempic for diabetes) as metabolic drugs. Period. But this just-published study analyzing over 6,800 patients with primary colon cancer shows something unexpected: GLP-1 RA users had a five-year mortality rate of 15.5% compared to 37.1% for non-users. That's a more than 60% relative reduction in mortality (OR approximately 0.38) after adjusting for confounders.

What caught my attention as both a pharmacist and healthcare operator isn't just the magnitude of that difference. It's that this isn't about cancer prevention. It's about improved outcomes in people who already have diagnosed colorectal cancer. That fundamentally changes how we should think about these medications and what it means for how we structure care.

What the Study Actually Shows (and Doesn't)

The researchers looked at 6,871 patients with primary colon cancer from the University of California Health Data Warehouse. Five-year mortality for GLP-1 RA users came in at 15.5% versus 37.1% for non-users, with an adjusted odds ratio of roughly 0.38 (95% CI: 0.21-0.64). The effect was most pronounced in patients with BMI over 35 (basically Class II and III obesity).

Now, before anyone gets too excited: this is observational data, not a randomized controlled trial. The authors are careful to note they can't establish causation. There could be residual confounding. Maybe GLP-1 RA users are just healthier overall, getting better supportive care, or more engaged with their treatment. The study also has heterogeneity in cancer staging and treatment regimens, and GLP-1 usage might correlate with other lifestyle factors that independently affect outcomes.

The mechanistic explanation is speculative at this point: weight loss, improved insulin sensitivity, reduced systemic inflammation, possibly some direct anti-tumor effects. We simply don't know yet. But the signal is strong enough that it warrants serious attention.

What This Means for Pharmacy Practice and Healthcare Strategy

From where I sit (filling prescriptions, managing pharmacy operations, thinking about patient outcomes), several things jump out.

First, there's a positioning opportunity in oncology support. If GLP-1 RAs show this kind of survival association in colon cancer, specialty pharmacies working alongside oncology practices should think about these drugs as part of an integrated cancer care continuum. That means building real programs around medication adherence, metabolic monitoring, weight management support, and cross-functional care coordination. Not just dispensing and hoping for the best.

Second, formulary and benefit design conversations are about to shift. Right now, GLP-1 RAs sit squarely in the metabolic disease bucket. But if this data holds up and expands, we're looking at potential repositioning as metabolic-plus-oncology adjunct therapy. That means early conversations with payers, oncology networks, and benefit design committees about coverage rationale and outcomes tracking. The discussions around off-label use and reimbursement are coming whether we're ready or not.

Third, patient selection and outcomes tracking become critical. The BMI over 35 subgroup showed the most pronounced benefit. That raises an operational question: should we proactively identify colon cancer patients with high BMI for GLP-1 RA discussions, working closely with oncology and endocrine teams? And more importantly, are we tracking real-world outcomes in ways that let us build value-based care cases? Because if we're not measuring it, we can't prove it works in our specific patient population.

Fourth, this requires genuine clinical collaboration. To make any of this work operationally, pharmacy services need tight integration with oncology teams, metabolic specialists, and nutrition services. The economics and value proposition revolve around coordinated care (monitoring efficacy through weight, BMI, insulin, glucose, and inflammation markers while ensuring adherence). We should be building protocols and clinical pathways that reflect this expanded role, not waiting for someone else to figure it out.

Fifth, we have to manage risk and messaging carefully. These findings don't prove causation. Over-promising that GLP-1 RAs "treat" colon cancer would be both misleading and potentially dangerous. The message needs to be nuanced: emerging evidence suggests potential benefit, especially in high-BMI patients, and we're working to support comprehensive care within appropriate clinical frameworks. We also need to stay alert to safety signals. Earlier studies have flagged potential concerns with kidney and thyroid cancers in some populations using GLP-1 RAs.

Operational Next Steps

At Nimbus, here's what I'm thinking about implementing:

Conduct a rapid audit of our current GLP-1 RA user base among any colon cancer patients or obese patients in oncology-adjacent populations. Track BMI, adherence patterns, and outcomes where we have data.

Build a cross-functional working group specifically around GLP-1 use in oncology and metabolic syndrome. Get pharmacy operations, oncology nursing, endocrine specialists, and dietitians in the same room working on protocols together.

Establish an outcomes monitoring dashboard tracking key metrics: percentage of colon cancer patients with BMI over 35 on GLP-1 RAs, adherence rates, weight and BMI changes over time, and where possible, follow-up data on metastasis, recurrence, and overall survival.

Develop payer-facing materials that summarize these findings and their implications for value-based care. The cost-of-care reduction via improved survival is a compelling story, and we should position ourselves as partners in oncology-metabolic crossover care.

Educate the pharmacy team through targeted in-services on GLP-1 RAs (mechanism of action, metabolic effects, inflammation reduction, possible tumor microenvironment influences), and this emerging colorectal cancer survival data. They need to be able to counsel effectively and with appropriate nuance.

The Bigger Picture

This study might mark an inflection point. GLP-1 RAs could increasingly be repositioned beyond obesity and diabetes drugs to become adjunct therapies in high-risk metabolic comorbidity populations, including oncology. For us, this signals an opportunity to move past basic dispensing and deeper into therapeutic outcomes management. The ROI on adherence programs, outcomes tracking, and patient engagement becomes much sharper when survival benefits are potentially on the table.

Payers are increasingly rewarding interventions that address multiple comorbidities simultaneously. The obese colon cancer patient lives at the intersection of oncology and metabolic disease. A pharmacy program that can demonstrate measurable impact across both domains has real strategic advantage.

Important Caveats

The observational nature of this data demands caution. Clinical trials will be needed to confirm causality. Until then, our messaging has to stay balanced and evidence-appropriate.

Off-label usage creates reimbursement uncertainty. If GLP-1 RAs start being used for colon cancer survival support outside approved indications, documentation and collaboration with oncology teams become absolutely vital.

There are equity dimensions here too. If high-BMI patients benefit most, we need robust access programs and adherence support for underserved populations, not just those with premium coverage.

And we have to keep monitoring safety signals. While these survival trends look promising, previous meta-analyses have flagged potential increased risks of kidney and thyroid cancers with GLP-1 use in certain populations.

Conclusion

The Cuomo study adds compelling evidence to what's becoming a broader narrative: GLP-1 receptor agonists may have clinical utility far beyond glucose control and weight management. They may improve survival in colorectal cancer, particularly among patients with obesity.

For pharmacy leaders and healthcare operators, the implication is straightforward: we need to engage with this shift now, not wait for perfect data. Update clinical pathways. Build alignment with oncology and metabolic care teams. Monitor outcomes systematically. Start payer conversations. Educate teams properly.

The hardest part wasn't the code. It was understanding pharmacy well enough to know what to build. This is one of those moments where domain expertise matters more than anything else. The survival data are significant. Our response should be equally proactive, turning emerging evidence into structured care delivery that actually improves outcomes.

That's the difference between being a medication dispenser and being a healthcare partner. And it's exactly where pharmacy needs to be heading.

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