Diabetes raises Risk of Death in Cancer
Surgery Patients
Newswise — People with diabetes who undergo cancer surgery
are more likely to die in the month
following their operations than those who
have cancer but not diabetes, an analysis by
Johns Hopkins researchers suggests.
The study, to be published in the April issue of the
journal Diabetes Care, finds that
newly diagnosed cancer patients —
particularly those with colorectal or
esophageal tumors — who also have Type 2
diabetes have a 50 percent greater risk of
death following surgery. Roughly 20 million
Americans — about 7 percent of the
population — are believed to have diabetes
and the numbers continue to grow.
“Diabetic patients, their oncologists and their surgeons
should be aware of the increased risk when
they have cancer surgery,” says Hsin-Chieh
“Jessica” Yeh, Ph.D., assistant professor of
general internal medicine and epidemiology
at the Johns Hopkins University School of
Medicine, and one of the study’s leaders.
“Care of diabetes before, during and after
surgery is very important. It should be part
of the preoperative discussion.
“When people are diagnosed with cancer, the focus often is
exclusively on cancer, and diabetes
management may be forgotten,” Yeh says.
“This research suggests the need to keep a
dual focus.”
The risk picture presented by Yeh and her colleagues
emerged from a systematic review and
meta-analysis of 15 previously published
medical studies that included information
about diabetes status and mortality among
patients after cancer surgery. The size of
the studies ranged from 70 patients to
32,621 patients, with a median of 427
patients.
Yeh says the analysis could not say why cancer patients
with diabetes are at greater risk of death
after surgery.
One culprit could be infection; diabetes is a
well-established risk factor for infection
and infection-related mortality in the
general population, and any surgery can
increase the risk of infections. Another
cause may be cardiovascular compromise.
Diabetes raises the risk of atherosclerosis
and is a strong predictor of heart attack
and death from cardiovascular disease.
“The ultimate question of whether better diabetes
management in people with cancer increases
their survival after surgery can’t be
answered by this study,” she says. “More
research will be needed to figure this out.”
Yeh says the Johns Hopkins study is part of a growing
volume of research under way at the
intersection of diabetes and cancer, two
leading causes of death in the United
States. Diabetes appears to increase risk
for some types of cancer, and risk factors
such as physical inactivity, unhealthy
lifestyles and obesity are believed to be
shared by both diseases.
Other Johns Hopkins researchers on the study include:
Bethany B. Barone, S.C.M.; Claire F. Snyder,
Ph.D.; Kimberly S. Peairs, M.D.; Kelly B.
Stein, M.D.; Rachel L. Derr, M.D.; Antonio
C. Wolff, M.D.; and Frederick L. Brancati,
M.D., M.H.S.
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