BACKGROUND: Women with breast cancer have worse health outcomes with co-occurring type 2 diabetes, possibly due to suboptimal breast cancer treatment. METHODS: We created a cohort of women ages 66 to 85 y with stage I to III breast cancer from 1993 to 2012 from an integrated health care delivery system (n=1612) and fee-for-service Medicare beneficiaries (n=98,915), linked to Surveillance, Epidemiology, and End Results (SEER) data (total n=100,527). We evaluated associations between type 2 diabetes and other factors with undergoing guideline-concordant cancer treatment. We estimated χ tests for univariate analysis and relative risks (RRs) using multivariable log-binomial models for outcomes of (1) overall guideline-concordant treatment, (2) definitive surgical therapy (mastectomy or lumpectomy with radiation), (3) chemotherapy if indicated, and (4) endocrine therapy. RESULTS: Our cohort included 60% of subjects with stage 1 tumors, one quarter below 70 years old, 23% had diabetes, 35% underwent overall guideline-concordant treatment, 24% chemotherapy, and 83% endocrine therapy. Women with diabetes were less likely to undergo overall guideline-concordant treatment (RR: 0.96; 95% confidence interval: 0.94-0.98), and only slightly less likely to undergo guideline-concordant definitive surgical therapy (RR: 0.99; 95% confidence interval: 0.99-1.00). No differences were found for chemotherapy or endocrine therapy. Other factors significantly associated with a lower risk of guideline-concordant care were cancer stages II to III (vs. I; RR=0.47-0.69, P<0.0001), older age (vs. 66 to 69 y; RR=0.56-0.90, P<0.0001), higher comorbidity burden, and Medicaid dual-eligibility. CONCLUSIONS: Diabetes was associated with lower adherence to overall guideline-concordant breast cancer treatment. However, higher stage, older age, higher comorbidity burden, and Medicaid insurance were more strongly associated with lower use of guideline-concordant treatment. Given the heavy burden of breast cancer and diabetes, long-term outcomes analysis should consider guideline-concordant treatment. IMPACT: Other factors besides diabetes are more strongly associated with guideline-concordant breast cancer treatment.
BACKGROUND: Women with breast cancer have worse health outcomes with co-occurring type 2 diabetes, possibly due to suboptimal breast cancer treatment. METHODS: We created a cohort of women ages 66 to 85 y with stage I to III breast cancer from 1993 to 2012 from an integrated health care delivery system (n=1612) and fee-for-service Medicare beneficiaries (n=98,915), linked to Surveillance, Epidemiology, and End Results (SEER) data (total n=100,527). We evaluated associations between type 2 diabetes and other factors with undergoing guideline-concordant cancer treatment. We estimated χ tests for univariate analysis and relative risks (RRs) using multivariable log-binomial models for outcomes of (1) overall guideline-concordant treatment, (2) definitive surgical therapy (mastectomy or lumpectomy with radiation), (3) chemotherapy if indicated, and (4) endocrine therapy. RESULTS: Our cohort included 60% of subjects with stage 1 tumors, one quarter below 70 years old, 23% had diabetes, 35% underwent overall guideline-concordant treatment, 24% chemotherapy, and 83% endocrine therapy. Women with diabetes were less likely to undergo overall guideline-concordant treatment (RR: 0.96; 95% confidence interval: 0.94-0.98), and only slightly less likely to undergo guideline-concordant definitive surgical therapy (RR: 0.99; 95% confidence interval: 0.99-1.00). No differences were found for chemotherapy or endocrine therapy. Other factors significantly associated with a lower risk of guideline-concordant care were cancer stages II to III (vs. I; RR=0.47-0.69, P<0.0001), older age (vs. 66 to 69 y; RR=0.56-0.90, P<0.0001), higher comorbidity burden, and Medicaid dual-eligibility. CONCLUSIONS: Diabetes was associated with lower adherence to overall guideline-concordant breast cancer treatment. However, higher stage, older age, higher comorbidity burden, and Medicaid insurance were more strongly associated with lower use of guideline-concordant treatment. Given the heavy burden of breast cancer and diabetes, long-term outcomes analysis should consider guideline-concordant treatment. IMPACT: Other factors besides diabetes are more strongly associated with guideline-concordant breast cancer treatment.
Authors: Robert W Carlson; Susan J Moench; M Elizabeth H Hammond; Edith A Perez; Harold J Burstein; D Craig Allred; Charles L Vogel; Lori J Goldstein; George Somlo; William J Gradishar; Clifford A Hudis; Mohammad Jahanzeb; Azadeh Stark; Antonio C Wolff; Michael F Press; Eric P Winer; Soonmyung Paik; Britt-Marie Ljung Journal: J Natl Compr Canc Netw Date: 2006-07 Impact factor: 11.908
Authors: Iliana C Lega; Peter C Austin; Hadas D Fischer; Kinwah Fung; Monika K Krzyzanowska; Eitan Amir; Lorraine L Lipscombe Journal: Diabetes Care Date: 2018-01-19 Impact factor: 19.112
Authors: Steven M Willi; Adele Kennedy; Penny Wallace; Elizabeth Ganaway; Nikki L Rogers; W Timothy Garvey Journal: Diabetes Date: 2002-10 Impact factor: 9.461
Authors: Susan A Sabatino; Trevor D Thompson; Xiao-Cheng Wu; Steven T Fleming; Gretchen G Kimmick; Amy Trentham-Dietz; Rosemary Cress; Roger T Anderson Journal: Breast Cancer Res Treat Date: 2014-06-05 Impact factor: 4.872
Authors: David J A Jenkins; Cyril W C Kendall; Livia S A Augustin; Silvia Franceschi; Maryam Hamidi; Augustine Marchie; Alexandra L Jenkins; Mette Axelsen Journal: Am J Clin Nutr Date: 2002-07 Impact factor: 7.045
Authors: Ian R Lanza; Daniel K Short; Kevin R Short; Sreekumar Raghavakaimal; Rita Basu; Michael J Joyner; Joseph P McConnell; K Sreekumaran Nair Journal: Diabetes Date: 2008-08-20 Impact factor: 9.461