Breast and Prostate Cancer Survivors in a Diabetic Cohort: Results from the Living With Diabetes Study

Abstract

Objective: Diabetes is more common in cancer survivors than in the general population. The objective of the present study was to determine cancer frequency in a cohort of patients with diabetes and to examine demographic, clinical, and quality of life differences between cancer survivors and their cancer-free peers to inform better individualized care. Methods:Self-reported survey data from 3,466 registrants with type 2 diabetes from Australia's National Diabetes Services Scheme (NDSS) were analyzed to compare relevant variables between cancer survivors and cancer-free patients. Analyses were focused on breast and prostate cancer to reflect the most common cancers in women and men, respectively.Results: Five percent of diabetic women reported a history of breast cancer and 4.2% of men reported a history of prostate cancer. Diabetic patients with a history of breast or prostate cancer were older at time of survey and diabetes diagnosis, less likely to report metformin use (women), and more likely to have two or more comorbidities than their cancer-free peers. More diabetic prostate cancer survivors also reported problems with mobility and performing usual tasks. However, cancerfree diabetic subjects reported a lower diabetes-dependent quality of life than diabetic cancer survivors. There was no association between cancer survivorship and duration of diabetes, indices of glycemic control, obesity, or diabetic complications. Conclusions:Cancer survivors comprise a significant minority of diabetic patients that are particularly vulnerable and may benefit from interventions to increase screening and treatment of other comorbidities and promote a healthy lifestyle.

Prospectively measured lifestyle factors and BMI explain differences in health-related quality of life between colorectal cancer patients with and without comorbid diabetes

“…The validated European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire (EORTC-QLQ)-C30 was used to assess HRQoL [ 29 , 30 ]. As previous research shows that cancer patients with diabetes mainly score lower on physical function [ 7 , 10 , 11 ], general HRQoL [ 6 , 9 ], and vitality [ 9 ] as compared to those without diabetes, and to prevent type 1 errors as a result of multiple testing, only the global QoL, physical function, and fatigue scales were included in these analyses. All items were answered on a 4-point Likert scale ranging from ‘not at all’ to ‘very much’, while the questions regarding global QoL were scored on a 7-point scale.…”

“…Previous studies mainly reported a lower general HRQoL [ 6 , 9 ], physical function or mobility [ 7 , 10 ] and vitality [ 9 ] among cancer patients with diabetes, compared to cancer patients without diabetes. However, the majority of these studies focused on prostate cancer patients [ 8 , 9 , 11 , 12 ] and had a cross-sectional study design [ 6 , 7 , 9 – 11 ]. More importantly, only three studies adjusted their analyses for lifestyle factors [ 6 , 8 , 10 ], of which two only included body mass index (BMI) and no other lifestyle factors such as physical activity, smoking, or alcohol use [ 8 , 10 ].…”

Quality of diabetes care in cancer: a systematic review

“…After applying the title keyword exclusion criteria, eliminating duplicates and excluding non-English language articles, 989 remained for preliminary review, of which 20 were retrieved for full review, and one additional article was identified from a search of the bibliographies. Upon full review, six were found not to include either the patient population or an outcome of interest, leaving 15 articles [ 13 – 20 , 24 – 30 ] for inclusion (Fig. 1 ).…”

“…There were six (40%; 95% CI, 34–46%) longitudinal cohort studies in which patients with pre-existing diabetes were followed from before to after incident diagnosis of cancer [ 15 , 16 , 24 – 27 ], six (40%; 95% CI, 34–46%) longitudinal cohort studies in which patients with diabetes were followed only after cancer [ 13 , 14 , 17 , 18 , 20 , 28 ] and three (20%; 95% CI, 15–25%) retrospective cross-sectional studies in which patients with historical diagnoses of diabetes and cancer were assessed for quality of care during a fixed window of time (usually one calendar year) after both diagnoses [ 19 , 29 , 30 ] ( Supplemental Materials, Table A ). The majority of studies (10/15: 67%; 95% CI, 61–73%) were from the USA [ 13 – 16 , 18 – 20 , 24 , 25 , 27 ], with two from the Netherlands [ 26 , 28 ], and one each from Australia [ 30 ], Korea [ 29 ] and the UK [ 17 ]. The most common types of cancers studied were breast (8/15: 53%; 95% CI, 47–60%) [ 13 , 15 , 17 , 18 , 24 , 25 , 27 , 30 ], colorectal (5/15: 33%; 95% CI, 27–39%) [ 13 , 15 – 17 , 20 ] and prostate (4/15: 27%; 95% CI, 21–32%) [ 13 , 15 , 17 , 30 ].…”

When fat becomes an ally of the enemy: adipose tissue as collaborator in human breast cancer

“…Interestingly, a retrospective study showed higher pathological response rates after neo-adjuvant chemotherapy in diabetic breast cancer patients treated with metformin compared to diabetic patients not treated with metformin Brought to you by | New York University Bobst Library Technical Services Authenticated Download Date | 7/12/15 5:14 PM [166]. Others, however, fail to show this favorable association [167,168]. The potential of metformin as an anticancer drug lies in its capacity to activate AMP-activated protein kinase leading to downregulation of mTOR and subsequent inhibition of protein synthesis, cell proliferation, and growth [169].…”