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dc.contributor.authorRenehan, Andrew G
dc.contributor.authorYeh, H
dc.contributor.authorJohnson, J
dc.contributor.authorWild, S
dc.contributor.authorGale, E
dc.contributor.authorMøller, H
dc.date.accessioned2012-06-22T10:32:25Z
dc.date.available2012-06-22T10:32:25Z
dc.date.issued2012-06
dc.identifier.citationDiabetes and cancer (2): evaluating the impact of diabetes on mortality in patients with cancer. 2012, 55 (6):1619-1632 Diabetologiaen_GB
dc.identifier.issn1432-0428
dc.identifier.pmid22476948
dc.identifier.doi10.1007/s00125-012-2526-0
dc.identifier.urihttp://hdl.handle.net/10541/230176
dc.description.abstractIn 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.
dc.languageENG
dc.language.isoenen
dc.rightsArchived with thanks to Diabetologiaen_GB
dc.titleDiabetes and cancer (2): evaluating the impact of diabetes on mortality in patients with cancer.en
dc.typeArticleen
dc.contributor.departmentSchool 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.en_GB
dc.identifier.journalDiabetologiaen_GB
refterms.dateFOA2020-04-21T12:12:57Z
html.description.abstractIn 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.


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