Diabetes and cancer (2): Evaluating the impact of diabetes on mortality In patients with cancer

A. G. Renehan, H. C. Yeh, J. A. Johnson, S. H. Wild, E. A.M. Gale, H. Møller

Research output: Contribution to journalReview article

Abstract

In this paper we address methodological aspects of aetiological importance in the link between diabetes and mortality in patients with cancer. We identified nine key points on the cancer pathway at which confounding may arise-cancer screening use, stage at diagnosis, cancer treatment selection, cancer treatment complications and failures, peri-treatment mortality, competing risks for long-term mortality, effects of type 2 diabetes on anti-cancer therapies, effects of glucoselowering treatments on cancer outcome and differences in tumour biology. Two types ofmortality studies were identified: (1) inception cohort studies that evaluate the effect of baseline diabetes on cancer-related mortality in general populations, and (2) cohorts of patients with a cancer diagnosis and preexisting type 2 diabetes.We demonstrate, with multiple examples from the literature, that pre-existing diabetes affects presentation, cancer treatment, and outcome of several common cancer types, often to varying extents. Diabetes is associated with increased all-cause mortality in cancer patients, but the evidence that it influences cancer-specific mortality is inconsistent. In the absence of data that address the potential biases and confounders outlined in the above framework, we caution against the reporting of cancer-related mortality as a main endpoint in analyses determining the impact of diabetes and glucose-lowering medications on risk of cancer.

Original languageEnglish (US)
Pages (from-to)1619-1632
Number of pages14
JournalDiabetologia
Volume55
Issue number6
DOIs
StatePublished - Jun 1 2012

Keywords

  • Bias
  • Cancer
  • Confounding
  • Diabetes
  • Epidemiology
  • Review
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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