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    Diabetes and cancer (2): evaluating the impact of diabetes on mortality in patients with cancer.

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    Authors
    Renehan, Andrew G
    Yeh, H
    Johnson, J
    Wild, S
    Gale, E
    Møller, H
    Affiliation
    School of Cancer and Enabling Sciences, Department of Surgery, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK, arenehan@picr.man.ac.uk.
    Issue Date
    2012-06
    
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    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 glucose-lowering treatments on cancer outcome and differences in tumour biology. Two types of mortality 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 pre-existing 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.
    Citation
    Diabetes and cancer (2): evaluating the impact of diabetes on mortality in patients with cancer. 2012, 55 (6):1619-1632 Diabetologia
    Journal
    Diabetologia
    URI
    http://hdl.handle.net/10541/230176
    DOI
    10.1007/s00125-012-2526-0
    PubMed ID
    22476948
    Type
    Article
    Language
    en
    ISSN
    1432-0428
    ae974a485f413a2113503eed53cd6c53
    10.1007/s00125-012-2526-0
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