Quality of diabetes care in breast, colorectal, and prostate cancer

Robert I Griffiths,Clare R Bankhead,Richard J Stevens,Nada F Khan,Emily C Mcfadden,Jose M Valderas,Bernadette A Lavery,Nancy L Keating

doi:10.1007/s11764-018-0717-5

Abstract

PurposeOverlooking other medical conditions during cancer treatment and follow-up could result in excess morbidity and mortality, thereby undermining gains associated with early detection and improved treatment of cancer. We compared the quality of care for diabetes patients subsequently diagnosed with breast, colorectal, or prostate cancer to matched, diabetic non-cancer controls.MethodsLongitudinal cohort study using primary care records from the Clinical Practice Research Datalink, United Kingdom. Patients with pre-existing diabetes were followed for up to 5 years after cancer diagnosis, or after an assigned index date (non-cancer controls). Quality of diabetes care was estimated based on Quality and Outcomes Framework indicators. Mixed effects logistic regression analyses were used to compare the unadjusted and adjusted odds of meeting quality measures between cancer patients and controls, overall and stratified by type of cancer.Results3382 cancer patients and 11,135 controls contributed 44,507 person-years of follow-up. In adjusted analyses, cancer patients were less likely to meet five of 14 quality measures, including: total cholesterol ≤ 5 mmol/L (odds ratio [OR] = 0.82; 95% confidence interval [CI], 0.75–0.90); glycosylated hemoglobin ≤ 59 mmol/mol (adjusted OR = 0.77; 95% CI, 0.70–0.85); and albumin creatinine ratio testing (adjusted OR = 0.83; 95% CI, 0.75–0.91). However, cancer patients were as likely as their matched controls to meet quality measures for other diabetes services, including retinal screening, foot examination, and dietary review.ConclusionsAlthough in the short-term, cancer patients were less likely to achieve target thresholds for cholesterol and HbA1c, they continued to receive high-quality diabetes primary care throughout 5 years post diagnosis.Implications for Cancer SurvivorsThese findings are important for cancer survivors with pre-existing diabetes because they indicate that high-quality diabetes care is maintained throughout the continuum of cancer diagnosis, treatment, and follow-up.

Highlights

Detection and advances in therapy and supportive care have substantially improved the relative survival of many of the most common types of cancer [1]
There were no discernable differences between the proportions of cancer patients and controls meeting other quality measures for retinal screening, foot examination, dietary review (Fig. 2), ACE-I or ARB use for nephropathy/micro-albuminuria, or those for erectile dysfunction
The results of the primary multilevel logistic regression analyses (Table 1) show that in the combined cohort, after adjustment for baseline characteristics and for multiple comparisons, cancer patients were statistically significantly (p ≤ 0.05) less likely than non-cancer controls to meet five of 14 quality measures examined, including: total cholesterol ≤5 mmol/L; HbA1c ≤ 59 mmol/mol; and albumin creatinine ratio testing

Summary

Introduction

Detection and advances in therapy and supportive care have substantially improved the relative survival of many of the most common types of cancer [1]. Overall morbidity and mortality in cancer depend increasingly on the quality and outcomes of primary care for underlying conditions [2]. Cancer could have an adverse impact on many underlying conditions, and vice-versa, the quality and outcomes of diabetes care in cancer deserve specific attention for the following reasons. Diabetes and some types of cancer, including breast and colorectal, co-occur at rates that are higher than expected by chance alone. This implies shared risk factors and, possibly, causal mechanisms [5]. Diabetes is associated with excess morbidity and mortality in cancer [7]

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