Improving outcome predictions – patients with diabetes

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Background:

Up to 20% of people with cancer also have diabetes. Patients with both cancer and diabetes are more likely to have worse outcomes after surgery. For patients with bowel cancer and diabetes there is also a poorer chance of receiving treatment to cure the cancer, a higher rate of chemotherapy related toxicity as well as an increased risk of dying after surgery. In order to understand what the relationship is between diabetes and the outcomes for patients with cancer, it is first important to understand the difference between patients with complicated (a person with other underlying health conditions which are caused by the diabetes) and uncomplicated diabetes (a person who has no other underlying health conditions that are linked to their diabetes). This would then lead to a better understanding of whether diabetes itself is associated with a higher risk or whether it is the complications that arise from diabetes that cause more risks for patients.

The aim of this study is to identify a reliable and practical system to categorise people with complicated and uncomplicated diabetes in order to better predict outcomes for patients with diabetes following bowel cancer surgery.

What did we do?

We looked at individuals who had been diagnosed with primary bowel cancer in England between 2005 and 2016 who underwent surgery to remove some or all of their bowel. From this group of people we then identified the individuals with diabetes. The status of the individual’s diabetes was determined using a measure called the adapted Diabetes Complications Severity Index (aDCSI) which is designed to measure how severe a patient’s diabetes is. We put individuals into three categories, no diabetes, uncomplicated diabetes and complicated diabetes and looked at the outcomes of patients in each of the three categories.

What did we find?

We found that patients with complicated diabetes have worse outcomes after bowel cancer surgery than patients with uncomplicated diabetes. We also found that patients with uncomplicated diabetes have similar outcomes as patients who do not have diabetes. This finding suggests that poor outcomes after surgery are linked to the complications arising from diabetes rather than from the diabetes itself. The results of this study show the importance of accurately defining diabetes complications when assessing the risks associated with bowel cancer surgery for patients.

Project Outputs:

Publication: Rebecca J Birch, Amy Downing, Paul J Finan, Simon Howell, Ramzi A Aijan, Eva JA Morris Improving outcome prediction in individuals with colorectal cancer and diabetes by accurate assessment of vascular complications: Implications for clinical practice European Journal of Surgical Oncology