The influence of diabetes severity on receipt of guideline-concordant treatment for breast cancer
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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.
KeywordsBreast cancer Diabetes Cancer treatment Surgery Radiation Chemotherapy Hormonal therapy
The data used for this publication were collected by the Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries (NPCR) Patterns of Care Study for Breast and Prostate Cancers (POCBP), which was funded by CDC through cooperative agreements with the participating state cancer registries. Dr. Sabatino and Mr. Thompson are employees of the Centers for Disease Control and Prevention. This manuscript is written on behalf of the POCBP Group. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Conflict of interest
Dr. Trentham-Dietz reported receiving funding from the Centers for Disease Control and Prevention. Dr. Anderson reported serving in a consultant/advisory role for Bayer and Abbott. Dr. Kimmick reported receiving remuneration from Genomic Health, Astra Zeneca, Pfizer and Novartis, serving in a consultant/advisory role for Genomic Health, Astra Zeneca, Pfizer and Novartis, and receiving funding from Astra Zeneca, Roche, Wyeth, Bristol-Meyers-Squibb, GlaxoSmithKline, and Bionovo. Dr. Sabatino reported stock ownership in Pfizer and a healthcare index fund. The remaining coauthors declared no conflict of interest.
- 1.US Cancer Statistics Working Group (2013) United States Cancer Statistics: 1999–2010 incidence and mortality web-based report. Department of Health and Human Services Centers for Disease Control and Prevention and National Cancer Institute, Atlanta, GA, USAGoogle Scholar
- 7.Sellers TA, Jensen LE, Vierkant RA, Fredericksen ZS, Brandt KR, Giuliano AR, Pankratz VS, Cerhan JR, Vachon CM (2007) Association of diabetes with mammographic breast density and breast cancer in the Minnesota breast cancer family study. Cancer Causes Control 18(5):505–515. doi: 10.1007/s10552-007-0128-9 PubMedCrossRefGoogle Scholar
- 11.Louwman WJ, Janssen-Heijnen ML, Houterman S, Voogd AC, van der Sangen MJ, Nieuwenhuijzen GA, Coebergh JW (2005) Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer 41(5):779–785. doi: 10.1016/j.ejca.2004.12.025 PubMedCrossRefGoogle Scholar
- 15.Barone BB, Yeh HC, Snyder CF, Peairs KS, Stein KB, Derr RL, Wolff AC, Brancati FL (2008) Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA 300(23):2754–2764. doi: 10.1001/jama.2008.824 PubMedCentralPubMedCrossRefGoogle Scholar
- 18.Hebert-Croteau N, Brisson J, Latreille J, Rivard M, Abdelaziz N, Martin G (2004) Compliance with consensus recommendations for systemic therapy is associated with improved survival of women with node-negative breast cancer. J Clin Oncol 22(18):3685–3693. doi: 10.1200/jco.2004.07.018 PubMedCrossRefGoogle Scholar
- 19.Wu XC, Lund MJ, Kimmick GG, Richardson LC, Sabatino SA, Chen VW, Fleming ST, Morris CR, Huang B, Trentham-Dietz A, Lipscomb J (2012) Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol 30(2):142–150PubMedCrossRefGoogle Scholar
- 22.van de Poll-Franse LV, Houterman S, Janssen-Heijnen ML, Dercksen MW, Coebergh JW, Haak HR (2007) Less aggressive treatment and worse overall survival in cancer patients with diabetes: a large population based analysis. Int J Cancer 120(9):1986–1992. doi: 10.1002/ijc.22532 PubMedCrossRefGoogle Scholar
- 23.Zhou J, Enewold L, Zahm SH, Jatoi I, Shriver C, Anderson WF, Jeffery DD, Andaya A, Potter JF, McGlynn KA, Zhu K (2013) Breast conserving surgery versus mastectomy: the influence of comorbidities on choice of surgical operation in the Department of Defense Health Care System. Am J Surg 206(3):393–399. doi: 10.1016/j.amjsurg.2013.01.034 PubMedCrossRefGoogle Scholar
- 24.Field TS, Bosco JL, Prout MN, Gold HT, Cutrona S, Pawloski PA, Ulcickas Yood M, Quinn VP, Thwin SS, Silliman RA (2011) Age, comorbidity, and breast cancer severity: impact on receipt of definitive local therapy and rate of recurrence among older women with early stage breast cancer. J Am Coll Surg 213(6):757–765. doi: 10.1016/j.jamcollsurg.2011.09.010 PubMedCentralPubMedCrossRefGoogle Scholar
- 25.Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group (2000) Lancet 355 (9217):1757–1770Google Scholar
- 27.Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y, Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2006) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106. doi: 10.1016/s0140-6736(05)67887-7 Google Scholar
- 31.Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group (1998). Lancet 352 (9132):930–942Google Scholar
- 35.van de Water W, Bastiaannet E, Dekkers OM, de Craen AJ, Westendorp RG, Voogd AC, van de Velde CJ, Liefers GJ (2012) Adherence to treatment guidelines and survival in patients with early stage breast cancer by age at diagnosis. Br J Surg 99(6):813–820. doi: 10.1002/bjs.8743 PubMedCrossRefGoogle Scholar
- 40.Crivellari D, Bonetti M, Castiglione-Gertsch M, Gelber RD, Rudenstam CM, Thurlimann B, Price KN, Coates AS, Hurny C, Bernhard J, Lindtner J, Collins J, Senn HJ, Cavalli F, Forbes J, Gudgeon A, Simoncini E, Cortes-Funes H, Veronesi A, Fey M, Goldhirsch A (2000) Burdens and benefits of adjuvant cyclophosphamide, methotrexate, and fluorouracil and tamoxifen for elderly patients with breast cancer: the International Breast Cancer Study Group Trial VII. J Clin Oncol 18(7):1412–1422PubMedGoogle Scholar