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Title: Quality and outcomes of diabetes care in patients diagnosed with cancer
Author: Griffiths, Robert Ian
ISNI:       0000 0004 7652 1152
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2017
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Background and Rationale: 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. Objective: This thesis examined the quality and outcomes of diabetes care in patients diagnosed with cancer. Methods of Research: The methods included a systematic review of the quality of diabetes care in cancer, and primary research on the quality-including diabetes control and the provision of services-and outcomes of diabetes care in breast, colorectal, or prostate cancer using the Clinical Practice Research Datalink. Results of the Systematic Review: There were 15 studies from five countries, with 88 comparisons of quality measures between cancer patients and controls, including cholesterol and glycosylated haemoglobin (HbA1c) control, diabetes education, and eye examinations. Of these 88, 47 (53%; 95% Confidence Interval [CI], 43%-64%) were no different, 12 (14%; 95% CI, 6%-21%) were better, and 29 (33%; 95% CI, 23%-43%) were worse in cancer patients. Results of the Primary Research: The primary research included 3,382 diabetic cancer patients and 11,135 matched, diabetic, non-cancer controls, who were followed from two years before, up to 10 years after, cancer or a matched date in controls. Cancer patients were less likely to meet 5/14 quality measures examined, including total cholesterol ≤5 mmol/L (adjusted odds ratio [OR], 0.82; 95% CI, 0.75-0.90) and HbA1c ≤59 mmol/mol (adjusted OR=0.77; 95%; CI, 0.70-0.85). However, differences in actual levels were small, and lasted <1 year after diagnosis. Cancer patients were no less likely to meet quality measures for retinal screening, foot examination, or dietary review. Cancer was not associated with increased rates of microvascular or macrovascular complications, or diabetes-related mortality. Conclusions and Implications: Overall, the findings indicate that diabetes is not overlooked in older breast, colorectal, or prostate cancer patients. Any short-term deficits in cholesterol and HbA1c control do not result in increased diabetes complications or excess diabetes-related mortality over the long-term.
Supervisor: Bankhead, Clare R. ; Keating, Nancy L. Sponsor: Cancer Research UK
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Primary Health Care ; Quality of Care ; Outcomes of Care ; Cancer ; Diabetes