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Health Services Research
May 20, 2013

The influence of diabetes severity on guideline-concordant treatment for stage I-III breast cancer in the National Program of Cancer Registries (NPCR) patterns of care for breast and prostate cancer study (POCBP).


Background: Little is known about whether diabetes status or severity affects receipt of guideline-concordant breast cancer treatment, which may impact outcomes. Methods: We used data from a Centers for Disease Control and Prevention NPCR funded 7 state Patterns of Care study for 6912 stage I-III breast cancer cases diagnosed in 2004. We determined diabetes status and severity using the Adult Comorbidity Evaluation Index (ACE 27). We used National Comprehensive Cancer Network guidelines to define guideline concordant locoregional treatment (LR), adjuvant chemotherapy (CTX) and hormonal therapy. Using logistic regression models, we examined the association of diabetes severity with each treatment modality adjusting for age, race/ethnicity, area-level education and income, insurance, registry, BMI, comorbidity, tumor size, nodal status, histology, ER/PR status, HER2 status and grade. Results: Over 10% of women had diabetes (8.6% mild, 1.6% moderate/severe). Before adjustment, diabetes status was associated with lower guideline concordance for both LR treatment (82.1% vs. 86.3%, p=.01) and CTX (56.4% vs. 69.4%, p<.0001), and increasing diabetes severity was associated with decreasing guideline concordance for LR (86.3%, 82.7% and 79.3% for none, mild and moderate/severe respectively, p=.028) and CTX (69.4%, 57.5% and 50.4% respectively, p<.0001). After adjusting for all factors, diabetes severity was not significantly associated with LR treatment (OR 0.93 (95% CI 0.73 - 1.19) for mild and 0.74 (0.46 - 1.20) for moderate/severe vs. none, p=.43) or CTX (0.91 (0.73 - 1.13) for mild and 0.67 (0.41 - 1.10) for moderate/severe vs. none, p=.23). After adjusting first for sociodemographic factors, then adding comorbidity and BMI, and finally tumor characteristics, significance of diabetes severity was lost after adjusting for sociodemographic factors, largely due to age. Conclusions: Breast cancer patients with diabetes are less likely to receive guideline concordant LR treatment and CTX, with increasing severity associated with lower receipt. However differences appear largely due to age.

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Published In

Journal of Clinical Oncology
Pages: 6606


Published online: May 20, 2013
Published in print: May 20, 2013


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Susan A. Sabatino
Centers for Disease Control and Prevention, DCPC/EARB, Atlanta, GA
Trevor Thompson
Centers for Disease Control, Atlanta, GA
Xiao-cheng Wu
Louisiana State University, Baton Rouge, LA
Gretchen Genevieve Kimmick
Duke Cancer Institute, Durham, NC
Steven Fleming
University of Kentucky, Lexington, KY
Amy Trentham-Dietz
University of Wisconsin Carbone Cancer Center, Madison, WI
Rosemary Cress
University of California, Davis, School of Medicine, Davis, CA
Roger T. Anderson
Penn State College of Medicine, Hershey, PA
Centers for Disease Control and Prevention, DCPC/EARB, Atlanta, GA; Centers for Disease Control, Atlanta, GA; Louisiana State University, Baton Rouge, LA; Duke Cancer Institute, Durham, NC; University of Kentucky, Lexington, KY; University of Wisconsin Carbone Cancer Center, Madison, WI; University of California, Davis, School of Medicine, Davis, CA; Penn State College of Medicine, Hershey, PA


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Susan A. Sabatino, Trevor Thompson, Xiao-cheng Wu, Gretchen Genevieve Kimmick, Steven Fleming, Amy Trentham-Dietz, Rosemary Cress, Roger T. Anderson
Journal of Clinical Oncology 2013 31:15_suppl, 6606-6606

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