Treatment and Outcomes in Diabetic Breast Cancer Patients

描述（由申请人提供）：2014年估计有超过23万女性被诊断患有乳腺癌，其中五分之一将患有II型糖尿病。两种疾病患者的预后明显较差，总死亡率增加52%。即使有如此高的共发率，关于乳腺癌和糖尿病患者的预后是否以及为什么比仅患有乳腺癌的女性更差的信息仍然有限；考虑到疾病及其治疗的相互作用，关于如何最好地治疗这些患者的信息甚至更少。例如，用于乳腺癌的辅助化疗药物，税金和卡铂，可能会加重糖尿病神经病变。糖尿病患者伤口愈合延迟可能影响化疗的最佳时机。化疗期间使用皮质类固醇控制呕吐可能会升高血糖，使糖尿病治疗复杂化。患有糖尿病的女性较少使用乳房x光检查。二甲双胍治疗糖尿病可能改善乳腺癌的治疗效果。显然，当病人有不止一种严重的健康状况时，护理决定会更加复杂，他们之间的相互作用需要系统的评估。因此，我们的目的和相关假设是：1)确定糖尿病如何影响乳腺癌的护理质量；2)确定乳腺癌护理中糖尿病相关差异对复发、乳腺癌特异性死亡率和总体死亡率的影响；3)确定乳腺癌如何影响乳腺癌合并糖尿病患者的糖尿病护理质量。我们将收集受这两种疾病影响的大样本患者的全面和细致的数据，从而最大限度地评估上述目标和假设的潜力。为了改善对多病患者的护理，并更好地了解乳腺癌和糖尿病患者的预后如何以及为什么比无糖尿病患者差，我们将分析两个互补的乳腺癌受试者队列：相关的SEER-Medicare数据，包括66-85岁女性的医院、门诊、医生和药物索赔；以及来自华盛顿州西部50-85岁女性群体健康综合输送系统的丰富详细的临床数据。采用创新的统计方法对两个数据集，一个具有广泛的概括性，另一个具有高度详细的临床信息，我们将评估哪些因素对乳腺癌患者的健康结果影响最大，糖尿病是否介导乳腺癌治疗和结果的种族/民族不平等。分析将使用创新的统计方法来梳理同时发生的疾病管理的复杂性。这项创新研究将有助于优化护理协调和循证干预措施，以减少乳腺癌和糖尿病可避免的发病率和死亡率。这项工作还为评估癌症与其他繁重共存的合并症之间的相互作用建立了一个平台。

DESCRIPTION (provided by applicant): Over 230,000 women are estimated to be diagnosed with breast cancer in 2014, and one in five will have Type II diabetes. Poorer outcomes are apparent for patients with both conditions, with a 52% increased risk of overall mortality. Even with such high prevalence of co-occurrence, there is limited information about whether and why outcomes may be worse in women with both breast cancer and diabetes versus only breast cancer; there is even less information for how best to treat these patients considering the interaction of the diseases and their treatments. For example, taxes and carboplatin, adjuvant chemotherapy agents for breast cancer, may worsen diabetic neuropathy. Delayed wound healing in patients with diabetes may impact chemotherapy optimal timing. Corticosteroids to control vomiting during chemotherapy may elevate blood sugar and complicate diabetes management. Women with diabetes use mammography screening less. Metformin for diabetes may improve therapeutic response in breast cancer. Clearly, care decisions are more complex when patients have more than one serious health condition, and their interaction begs for a systematic evaluation. Accordingly, our Aims and associated hypotheses are: 1) to determine how diabetes impacts the breast cancer quality of care; 2) to determine the impact of diabetes-related variations in breast cancer care on recurrence and breast-cancer-specific and overall mortality; and 3) to determine how breast cancer affects diabetes quality of care in breast cancer patients with diabetes. We will collect comprehensive and granular data on a large sample of patients affected by both diseases, and therefore maximize the potential for evaluating the above Aims and Hypotheses. In order to improve care for multimorbid patients and to better understand how and why patients with breast cancer and diabetes have worse outcomes than those without diabetes, we will analyze two complementary cohorts of subjects with breast cancer: the linked SEER-Medicare data including hospital, outpatient, physician, and medication claims for women ages 66-85 years; and richly-detailed clinical data from an integrated delivery system, Group Health in Western Washington State for women ages 50-85 years. Employing innovative statistical methods on two datasets, one with broad generalizability and one with highly-detailed clinical information, we will evaluate what factors most impact health outcomes in breast cancer patients with and without pre-existing diabetes and whether diabetes mediates racial/ethnic inequities in breast cancer treatment and outcomes. The analyses will use innovative statistical methods to tease apart the complexities of simultaneous disease management. This innovative study will help inform optimal care coordination and evidence-based interventions in order to reduce avoidable morbidity and mortality from breast cancer and diabetes. This work also builds a platform for evaluating the interaction between cancer and other burdensome co-existing comorbidities.