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

  • Epidemiology
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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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway MS-F76, Atlanta, GA, 30341, USA

    Susan A. Sabatino & Trevor D. Thompson

  2. Epidemiology Program, School of Public Health, LSU Health Sciences Center, New Orleans, LA, USA

    Xiao-Cheng Wu

  3. Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA

    Steven T. Fleming

  4. Internal Medicine, Medical Oncology, Multidisciplinary Breast Program, Duke University Medical Center, Durham, NC, USA

    Gretchen G. Kimmick

  5. Department of Population Health Sciences and Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI, USA

    Amy Trentham-Dietz

  6. Public Health Institute, Cancer Registry of Greater California, Sacramento, CA, USA

    Rosemary Cress

  7. Department of Public Health Sciences, UC Davis School of Medicine, Davis, CA, USA

    Rosemary Cress

  8. Pennsylvania State College of Medicine, Hershey, PA, USA

    Roger T. Anderson

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  1. Susan A. Sabatino
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Correspondence to Susan A. Sabatino.

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Sabatino, S.A., Thompson, T.D., Wu, XC. et al. The influence of diabetes severity on receipt of guideline-concordant treatment for breast cancer. Breast Cancer Res Treat 146, 199–209 (2014). https://doi.org/10.1007/s10549-014-2998-3

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