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.
|Original language||English (US)|
|Number of pages||6|
|Journal||American Journal of Clinical Oncology: Cancer Clinical Trials|
|State||Published - Feb 1 2020|
- breast cancer
- clinical guidelines
- health services research
- Multivariate Analysis
- Age Factors
- Diabetes Mellitus, Type 2/epidemiology
- United States/epidemiology
- Mastectomy, Segmental
- Aged, 80 and over
- Chemotherapy, Adjuvant
- Radiotherapy, Adjuvant
- Antineoplastic Agents, Hormonal/therapeutic use
- SEER Program
- Breast Neoplasms/epidemiology
- Guideline Adherence
- Neoplasm Staging
- Practice Guidelines as Topic
ASJC Scopus subject areas
- Cancer Research