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. Sabatino
  • Trevor D. Thompson
  • Xiao-Cheng Wu
  • Steven T. Fleming
  • Gretchen G. Kimmick
  • Amy Trentham-Dietz
  • Rosemary Cress
  • Roger T. Anderson
Epidemiology

DOI: 10.1007/s10549-014-2998-3

Cite this article as:
Sabatino, S.A., Thompson, T.D., Wu, XC. et al. Breast Cancer Res Treat (2014) 146: 199. doi:10.1007/s10549-014-2998-3

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 cancerDiabetesCancer treatmentSurgeryRadiationChemotherapyHormonal therapy

Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Susan A. Sabatino
    • 1
  • Trevor D. Thompson
    • 1
  • Xiao-Cheng Wu
    • 2
  • Steven T. Fleming
    • 3
  • Gretchen G. Kimmick
    • 4
  • Amy Trentham-Dietz
    • 5
  • Rosemary Cress
    • 6
    • 7
  • Roger T. Anderson
    • 8
  1. 1.Division of Cancer Prevention and ControlCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Epidemiology Program, School of Public HealthLSU Health Sciences CenterNew OrleansUSA
  3. 3.Department of EpidemiologyUniversity of Kentucky College of Public HealthLexingtonUSA
  4. 4.Internal Medicine, Medical Oncology, Multidisciplinary Breast ProgramDuke University Medical CenterDurhamUSA
  5. 5.Department of Population Health Sciences and Paul P. Carbone Comprehensive Cancer CenterUniversity of WisconsinMadisonUSA
  6. 6.Public Health InstituteCancer Registry of Greater CaliforniaSacramentoUSA
  7. 7.Department of Public Health SciencesUC Davis School of MedicineDavisUSA
  8. 8.Pennsylvania State College of MedicineHersheyUSA