ASPO Abstracts
Incident diabetes by obesity-related cancer status and cancer treatment type: A prospective study using electronic medical records data.
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2023
Abstract Body:
Background: Diabetes has been associated with an increased risk of the development of multiple cancers, however evidence for development of diabetes after cancer diagnosis is limited. Methods: Using data on 7,702 cancer patients treated at the Huntsman Cancer Institute, a comprehensive cancer center in Utah, we examined the association of systemic cancer treatments (chemotherapy, immunotherapy, hormone therapy, and corticosteroids) and obesity-related cancer (ORC) status with the development of diabetes after cancer diagnosis. Cox proportional-hazards models adjusting for relevant covariates [age, sex, race, body mass index at cancer diagnosis, and ORC status (in treatment– related models only)] were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Diabetes, cancer treatments, and cancer sites were identified using ICD codes and tumor histology. Results: 975(12.7%) cancer patients had incident diabetes (723 type-2 diabetes), and the mean time to diabetes diagnosis was 4.4 years after cancer diagnosis. 35.1% cancer patients received chemotherapy, 11.8% received immunotherapy, 19.5% received hormone therapy, 38.8% received corticosteroids, and 40.8% were diagnosed with an ORC. ORC patients and corticosteroid users had a statistically significant elevated risk of new-onset diabetes [HR(95% CI) =1.43(1.24-1.65) and 1.29(1.13-1.47), respectively] compared to patients with a non-ORC and non-users of corticosteroids. Interestingly, patients who received chemotherapy or hormone therapy had a statistically significant lower risk of new-onset diabetes [HR(95% CI) =0.69(0.60-0.79) and 0.68(0.58-0.81), respectively] compared to patients who did not receive these treatments. Stratified analyses evaluating death as a competing risk factor are ongoing. Conclusion: We observed statistically significant 1.43-times and 1.29-times increased risk of incident diabetes after cancer diagnosis in ORC patients and corticosteroid users. These results suggest that certain cancer treatments may increase diabetes risk. As monitoring cancer patients for new onset diabetes is currently not a clinical standard, understanding diabetes risk in cancer patients can inform strategies for monitoring cancer patients to prevent diabetes development.
Keywords: Cancer, diabetes, treatment, obesity, epidemiology