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 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.
Highlights
Diabetes is a major public health burden
Diabetes increased the risk of cancer-specific mortality among colorectal cancer survivors (HR: 1.36, 95% confidence intervals (CI) = 1.04– 1.78) compared to non-diabetic survivors, but not in breast and prostate cancer survivors
Exclusion of individuals with possible type 1 diabetes did not largely affect the hazard ratios (HRs) indicating the robustness of results. This large prospective study showed that compared to cancer survivors without diabetes, cancer survivors with diabetes had higher risk of all-cause, cancer-specific, and Cardiovascular disease (CVD) mortality
Summary
Diabetes is a major public health burden. The prevalence of diabetes is projected to increase to 439 million adults by 2030. Diabetes mellitus (DM) and cancer are two common diseases affecting aging populations worldwide, which commonly cooccur. These associations are complex and may be cancer specific [3]. Previous studies have reported that diabetes increased the all-cause and cancer-specific mortality for cancer survivors compared to those without diabetes [7], including breast [8], colorectal [7,8,9], and prostate cancer survivors [10, 11] Individuals with both diabetes and a history of cancer have higher rates of cardiovascular mortality when compared to those without diabetes among the general population [12, 13]. 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
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