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

Abstract

Purpose: Overlooking 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.

Methods: Longitudinal 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.

Results: 3382 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.

Conclusions: Although 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 survivors: These 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.

Keywords: Diabetes mellitus; Neoplasms; Primary health care; Quality indicators; Quality of health care.

Fig. 1

Unadjusted proportions of patients meeting quality measures based on testing. Unadjusted proportions (dots) and 95% confidence intervals (bars) of cancer patients (red) and controls (blue) meeting select quality measures based on testing (Fig. 1) and services (Fig. 2), from 2 years before, up to 5 years after, the date of cancer diagnosis or matched date in the control group (index date). Plots for other quality measures not shown here (blood pressure ≤ 150/90 mmHg, diagnosis of nephropathy or micro-albuminuria who were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker, HbA1c ≤ 64 mmol/mol, HbA1c ≤ 75 mmol/mol, asked about erectile dysfunction, received advice about erectile dysfunction) are provided in Appendix B

Fig. 2

Unadjusted proportions of patients meeting quality measures based on services. Unadjusted proportions (dots) and 95% confidence intervals (bars) of cancer patients (red) and controls (blue) meeting select quality measures based on testing (Fig. 1) and services (Fig. 2), from 2 years before, up to 5 years after, the date of cancer diagnosis or matched date in the control group (index date). Plots for other quality measures not shown here (blood pressure ≤ 150/90 mmHg, diagnosis of nephropathy or micro-albuminuria who were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker, HbA1c ≤ 64 mmol/mol, HbA1c ≤ 75 mmol/mol, asked about erectile dysfunction, received advice about erectile dysfunction) are provided in Appendix B