Pre- and Post-diagnosis Diabetes as a Risk Factor for All-Cause and Cancer-Specific Mortality in Breast, Prostate, and Colorectal Cancer Survivors: a Prospective Cohort Study

Abstract

Objective: The relationship between diabetes and all-and cause-specific mortality in individuals with common cancers (breast, colorectal, and prostate) remains both under-researched and poorly understood.Methods: Cancer survivors (N = 37,993) from the National Health Interview Survey with linked data retrieved from the National Death Index served as our study participants. Cox proportional-hazards models were used to assess associations between pre-and post-diabetes and all-cause and cause-specific mortality.Results: Over a median follow-up period of 13 years, 2,350 all-cause, 698 cancer, and 506 CVD deaths occurred. Among all cancer survivors, patients with diabetes had greater risk of: all-cause mortality [hazard ratio (HR) 1.35, 95% CI = 1.27-1.43], cancer-specific mortality (HR: 1.14, 95% CI = 1.03-1.27), CVD mortality (HR: 1.36, 95% CI = 1.18-1.55), diabetes related mortality (HR: 17.18, 95% CI = 11.51-25.64), and kidney disease mortality (HR: 2.51, 95% CI = 1.65-3.82), compared with individuals without diabetes. The risk of all-cause mortality was also higher amongst those with diabetes and specific types of cancer: breast cancer (HR: 1.28, 95% CI = 1.12-1.48), prostate cancer (HR: 1.20, 95% CI = 1.03-1.39), and colorectal cancer (HR: 1.29, 95% CI = 1.10-1.50). Diabetes increased the risk of cancer-specific mortality among colorectal cancer survivors (HR: 1.36, 95% CI = 1.04-1.78) compared to those without diabetes. Diabetes was associated with higher risk of diabetes-related mortality when compared to non-diabetic breast (HR: 9.20, 95% CI = 3.60-23.53), prostate (HR: 18.36, 95% CI = 6.01-56.11), and colorectal cancer survivors (HR: 12.18, 95% CI = 4.17-35.58). Both pre-and post-diagnosis diabetes increased the risk of all-cause mortality among Tao et al.Diabetes Reduces Cancer Survival all cancer survivors. Cancer survivors with diabetes had similar risk of all-cause and CVD mortality during the second 5 years of diabetes and above 10 years of diabetes as compared to non-diabetic patients.Conclusions: Diabetes increased the risk of all-cause mortality among breast, prostate, and colorectal cancer survivors, not for pre-or post-diagnosis diabetes. Greater attention on diabetes management is warranted in cancer survivors with diabetes.

Effect of glycated hemoglobin A1c on the survival of patients with oral squamous cell carcinoma: A multi-institutional database cohort study

“…Finally, adipose tissue has been described as an active endocrine organ that produces a variety of factors such as monocyte chemoattractant protein, interleukin-6, tumor necrosis factor-a, free fatty acids, adiponectin, and leptin, which might be associated with the regulation of malignant transformation or cancer progression (19). Those hypotheses partly explains why the patients with type 2 DM had an increased risk for some cancers and why DM itself can be a risk factor for cancer-specific mortality in multiple studies, including this one (20).…”

Increased Expressions of Matrix Metalloproteinases (MMPs) in Prostate Cancer Tissues of Men with Type 2 Diabetes

“…Furthermore, among men with diabetes undergoing radical prostatectomy, an elevated HbA1c value was associated with a higher risk for metastatic PCa [ 25 ]. In line, PCa patients with concomitant T2D were also characterized by increased mortality [ 8 , 9 , 26 , 27 , 28 ]. Although the association between advanced PCa and T2D is already reported, the underlying molecular mechanisms are poorly understood.…”

Impact of Cardiovascular Diseases on Mortality in Gastric Cancer Patients with Preexisting Chronic Disease

“…Although the risk of developing CVD may be exaggerated by diabetes, hyper-tension, or dyslipidemia and although cancer and chronic diseases, such as diabetes, commonly co-occur in aging populations, 17 few studies have investigated the relationship between CVD and mortality in cancer patients with diabetes, hypertension, or dyslipidemia. Therefore, this study aimed to investigate whether recent history of CVD affects the 5-year mortality of patients with gastric cancer and these three chronic diseases.…”