Epidemiology

Breast Cancer Research and Treatment

, Volume 146, Issue 1, pp 199-209

The influence of diabetes severity on receipt of guideline-concordant treatment for breast cancer

  • Susan A. SabatinoAffiliated withDivision of Cancer Prevention and Control, Centers for Disease Control and Prevention Email author 
  • , Trevor D. ThompsonAffiliated withDivision of Cancer Prevention and Control, Centers for Disease Control and Prevention
  • , Xiao-Cheng WuAffiliated withEpidemiology Program, School of Public Health, LSU Health Sciences Center
  • , Steven T. FlemingAffiliated withDepartment of Epidemiology, University of Kentucky College of Public Health
  • , Gretchen G. KimmickAffiliated withInternal Medicine, Medical Oncology, Multidisciplinary Breast Program, Duke University Medical Center
  • , Amy Trentham-DietzAffiliated withDepartment of Population Health Sciences and Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin
  • , Rosemary CressAffiliated withPublic Health Institute, Cancer Registry of Greater CaliforniaDepartment of Public Health Sciences, UC Davis School of Medicine
  • , Roger T. AndersonAffiliated withPennsylvania State College of Medicine

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Abstract

Diabetes severity may influence breast cancer treatment choices. We examined whether receipt of guideline-concordant breast cancer treatment varied with diabetes severity. Cancer registry data from seven states regarding 6,912 stage I–III breast cancers were supplemented by medical record abstraction and physician verification. We used logistic regression models to examine associations of diabetes severity with guideline-concordant locoregional treatment, adjuvant chemotherapy, and hormonal therapy adjusted for sociodemographics, comorbidity, and tumor characteristics. We defined guideline concordance using National Comprehensive Cancer Network guidelines, and diabetes and comorbidities using the Adult Comorbidity Evaluation-27 index. After adjustment, there was significant interaction of diabetes severity with age for locoregional treatment (p = 0.001), with many diabetic women under age 70 less frequently receiving guideline-concordant treatment than non-diabetic women. Among similarly aged women, guideline concordance was lower for women with mild diabetes in their late fifties through mid-sixties, and with moderate/severe diabetes in their late forties to early sixties. Among women in their mid-seventies to early eighties, moderate/severe diabetes was associated with increased guideline concordance. For adjuvant chemotherapy, moderate/severe diabetes was less frequently associated with guideline concordance than no diabetes [OR 0.58 (95 % CI 0.36–0.94)]. Diabetes was not associated with guideline-concordant hormonal treatment (p = 0.929). Some diabetic women were less likely to receive guideline-concordant treatment for stage I–III breast cancer than non-diabetic women. Diabetes severity was associated with lower guideline concordance for locoregional treatment among middle-aged women, and lower guideline concordance for adjuvant chemotherapy. Differences were not explained by comorbidity and may contribute to potentially worse breast cancer outcomes.

Keywords

Breast cancer Diabetes Cancer treatment Surgery Radiation Chemotherapy Hormonal therapy