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Treatment and outcomes in diabetic breast cancer patients

Breast Cancer Research and Treatment volume 143, pages 551–570 (2014)Cite this article

Abstract

Effective breast cancer management is more complex with diabetes present and may contribute to poor outcomes. Therefore, we conducted two simultaneous systematic reviews to address the association of diabetes with (1) treatment patterns in breast cancer patients and (2) breast cancer recurrence rates or breast cancer-specific and all-cause mortality. We searched major databases for English language peer-reviewed studies through November 2013, which addressed either of the above research questions, following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. Analyses compared treatment patterns or health outcomes for breast cancer subjects with and without diabetes. We used STROBE quality criteria and conducted a random-effects meta-analysis of all-cause mortality. The review yielded 11 publications for question 1 and 26 for question 2, with nine overlapping. Treatment studies showed chemotherapy was less likely in patients with diabetes. Of 22 studies, 21 assessing all-cause mortality indicated a statistically significant increased overall mortality for patients with diabetes (hazard ratios: 0.33–5.40), with meta-analysis of eligible studies indicating a 52 % increased risk. Nine studies assessing breast cancer-specific mortality had inconsistent results, with five showing significantly increased risk for diabetes patients. Results were inconsistent for recurrence and metastases. The majority of studies reported detrimental associations between diabetes and optimal treatment or all-cause mortality among women with breast cancer. Divergence in variable and outcomes inclusion and definitions, potential participation bias in individual studies, and differing analytic methods make inferences difficult. This review illuminates the importance of the impact of diabetes on breast cancer patients and explicitly recognizes that co-management of conditions is necessary to prevent excess morbidity and mortality.

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Notes

  1. Search 1 is the screening and evaluation process for studies evaluating impact of pre-existing diabetes on treatment patterns and health care utilization; Search 2 is the screening and evaluation process for studies evaluating recurrence, breast cancer-specific, and all-cause mortality in breast cancer patients with pre-existing diabetes.

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Acknowledgments

NP was supported by American Cancer Society Research Scholar Grant No. RSG-12-005-01-CNE.

Conflict of interest

The authors have no financial conflicts of interest.

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Affiliations

  1. Department of Population Heath, New York University School of Medicine, 550 First Ave, VZ30, Ste 611, New York, NY, 10016, USA

    Heather Taffet Gold & Niyati Parekh

  2. Department of Medicine, New York University School of Medicine, New York, NY, USA

    Heather Taffet Gold

  3. New York University Cancer Institute, New York, NY, USA

    Heather Taffet Gold

  4. Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA

    Nour Makarem & Niyati Parekh

  5. NYU Health Sciences Libraries, New York University School of Medicine, New York, NY, USA

    Joseph M. Nicholson

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  1. Heather Taffet Gold
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  2. Nour Makarem
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  4. Niyati Parekh
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Correspondence to Heather Taffet Gold.

Appendix

Appendix

See Table 3

Table 3 Study quality assessment for studies evaluating breast cancer outcomes (recurrence, breast cancer-specific mortality, and all-cause mortality) based on the strengthening the reporting of observational studies in epidemiology (STROBE) criteria
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Gold, H.T., Makarem, N., Nicholson, J.M. et al. Treatment and outcomes in diabetic breast cancer patients. Breast Cancer Res Treat 143, 551–570 (2014). https://doi.org/10.1007/s10549-014-2833-x

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Keywords

  • Diabetes
  • Breast cancer
  • Healthcare utilization
  • Mortality