TY - JOUR
T1 - Association of Diabetes and Other Clinical and Sociodemographic Factors with Guideline-concordant Breast Cancer Treatment for Breast Cancer
AU - Gold, Heather T.
AU - Shao, Huibo
AU - Oratz, Ruth
AU - Yu, Onchee
AU - Hammer, Marilyn
AU - Richardson, Stephen
AU - Boudreau, Denise
N1 - Funding Information:
Supported by the National Institutes of Health, National Cancer Institute, through grant numbers R01CA188353 (Gold) and R01CA120562 (Boudreau).
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - BACKGROUND: Women with breast cancer have worse health outcomes with co-occurring type 2 diabetes, possibly due to suboptimal breast cancer treatment.METHODS: We created a cohort of women ages 66 to 85 y with stage I to III breast cancer from 1993 to 2012 from an integrated health care delivery system (n=1612) and fee-for-service Medicare beneficiaries (n=98,915), linked to Surveillance, Epidemiology, and End Results (SEER) data (total n=100,527). We evaluated associations between type 2 diabetes and other factors with undergoing guideline-concordant cancer treatment. We estimated χ tests for univariate analysis and relative risks (RRs) using multivariable log-binomial models for outcomes of (1) overall guideline-concordant treatment, (2) definitive surgical therapy (mastectomy or lumpectomy with radiation), (3) chemotherapy if indicated, and (4) endocrine therapy.RESULTS: Our cohort included 60% of subjects with stage 1 tumors, one quarter below 70 years old, 23% had diabetes, 35% underwent overall guideline-concordant treatment, 24% chemotherapy, and 83% endocrine therapy. Women with diabetes were less likely to undergo overall guideline-concordant treatment (RR: 0.96; 95% confidence interval: 0.94-0.98), and only slightly less likely to undergo guideline-concordant definitive surgical therapy (RR: 0.99; 95% confidence interval: 0.99-1.00). No differences were found for chemotherapy or endocrine therapy. Other factors significantly associated with a lower risk of guideline-concordant care were cancer stages II to III (vs. I; RR=0.47-0.69, P<0.0001), older age (vs. 66 to 69 y; RR=0.56-0.90, P<0.0001), higher comorbidity burden, and Medicaid dual-eligibility.CONCLUSIONS: Diabetes was associated with lower adherence to overall guideline-concordant breast cancer treatment. However, higher stage, older age, higher comorbidity burden, and Medicaid insurance were more strongly associated with lower use of guideline-concordant treatment. Given the heavy burden of breast cancer and diabetes, long-term outcomes analysis should consider guideline-concordant treatment.IMPACT: Other factors besides diabetes are more strongly associated with guideline-concordant breast cancer treatment.
AB - BACKGROUND: Women with breast cancer have worse health outcomes with co-occurring type 2 diabetes, possibly due to suboptimal breast cancer treatment.METHODS: We created a cohort of women ages 66 to 85 y with stage I to III breast cancer from 1993 to 2012 from an integrated health care delivery system (n=1612) and fee-for-service Medicare beneficiaries (n=98,915), linked to Surveillance, Epidemiology, and End Results (SEER) data (total n=100,527). We evaluated associations between type 2 diabetes and other factors with undergoing guideline-concordant cancer treatment. We estimated χ tests for univariate analysis and relative risks (RRs) using multivariable log-binomial models for outcomes of (1) overall guideline-concordant treatment, (2) definitive surgical therapy (mastectomy or lumpectomy with radiation), (3) chemotherapy if indicated, and (4) endocrine therapy.RESULTS: Our cohort included 60% of subjects with stage 1 tumors, one quarter below 70 years old, 23% had diabetes, 35% underwent overall guideline-concordant treatment, 24% chemotherapy, and 83% endocrine therapy. Women with diabetes were less likely to undergo overall guideline-concordant treatment (RR: 0.96; 95% confidence interval: 0.94-0.98), and only slightly less likely to undergo guideline-concordant definitive surgical therapy (RR: 0.99; 95% confidence interval: 0.99-1.00). No differences were found for chemotherapy or endocrine therapy. Other factors significantly associated with a lower risk of guideline-concordant care were cancer stages II to III (vs. I; RR=0.47-0.69, P<0.0001), older age (vs. 66 to 69 y; RR=0.56-0.90, P<0.0001), higher comorbidity burden, and Medicaid dual-eligibility.CONCLUSIONS: Diabetes was associated with lower adherence to overall guideline-concordant breast cancer treatment. However, higher stage, older age, higher comorbidity burden, and Medicaid insurance were more strongly associated with lower use of guideline-concordant treatment. Given the heavy burden of breast cancer and diabetes, long-term outcomes analysis should consider guideline-concordant treatment.IMPACT: Other factors besides diabetes are more strongly associated with guideline-concordant breast cancer treatment.
KW - breast cancer
KW - clinical guidelines
KW - diabetes
KW - health services research
KW - Multivariate Analysis
KW - Age Factors
KW - Humans
KW - Diabetes Mellitus, Type 2/epidemiology
KW - United States/epidemiology
KW - Mastectomy, Segmental
KW - Aged, 80 and over
KW - Mastectomy
KW - Female
KW - Chemotherapy, Adjuvant
KW - Medicaid
KW - Radiotherapy, Adjuvant
KW - Antineoplastic Agents, Hormonal/therapeutic use
KW - SEER Program
KW - Medicare
KW - Comorbidity
KW - Breast Neoplasms/epidemiology
KW - Guideline Adherence
KW - Aged
KW - Neoplasm Staging
KW - Practice Guidelines as Topic
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U2 - 10.1097/COC.0000000000000638
DO - 10.1097/COC.0000000000000638
M3 - Article
C2 - 31850918
AN - SCOPUS:85077124541
VL - 43
SP - 101
EP - 106
JO - American Journal of Clinical Oncology
JF - American Journal of Clinical Oncology
SN - 0277-3732
IS - 2
ER -