Healthcare Delivery Research Program, National Cancer Institute, 9609 Medical Center Drive, 3E502, Rockville, MD, 20850, USA.
Rutgers School of Public Health, Piscataway, NJ, USA.
Cancer Causes Control. 2021 Feb;32(2):157-168. doi: 10.1007/s10552-020-01370-5. Epub 2021 Jan 6.
Diabetes and hypertension are two common comorbidities that affect breast cancer patients, particularly Black women. Disruption of chronic disease management during cancer treatment has been speculated. Therefore, this study examined the implementation of clinical practice guidelines and health outcomes for these comorbidities before and during cancer treatment.
We used a population-based, prospective cohort of Black women diagnosed with breast cancer (2012-2016) in New Jersey (n = 563). Chronic disease management for diabetes and hypertension was examined 12 months before and after breast cancer diagnosis and compared using McNemar's test for matched paired and paired t tests.
Among this cohort, 18.1% had a co-diagnosis of diabetes and 47.2% had a co-diagnosis of hypertension. Implementation of clinical practice guidelines and health outcomes that differed in the 12 months before and after cancer diagnosis included lipid screening (64.5% before versus 50.0% after diagnosis; p = 0.004), glucose screening (72.7% versus 90.7%; p < 0.001), and blood pressure control < 140/90 mmHg (57.6% versus 71.5%; p = 0.004) among patients with hypertension-only. For patients with diabetes, eye and foot care were low (< 35%) and optimal HbA1c < 8.0% was achieved for less than 50% of patients in both time periods.
Chronic disease management continued during cancer treatment; however, eye and foot exams for patients with diabetes and lipid screening for patients with hypertension-only were inadequate. Given that comorbidities may account for half of the Black-White breast cancer survival disparity, strategies are needed to improve chronic disease management during cancer, especially for Black women who bear a disproportionate burden of chronic diseases.
糖尿病和高血压是两种常见的合并症，会影响乳腺癌患者，尤其是黑人女性。有人推测，在癌症治疗过程中，慢性病管理会中断。因此，本研究检查了在癌症治疗前后这些合并症的临床实践指南的实施情况和健康结果。
我们使用了新泽西州（2012-2016 年）确诊为乳腺癌的黑人女性的基于人群的前瞻性队列（n=563）。在乳腺癌诊断前后的 12 个月内检查了糖尿病和高血压的慢性病管理情况，并使用配对 McNemar 检验和配对 t 检验进行比较。
在该队列中，18.1%的患者合并诊断为糖尿病，47.2%的患者合并诊断为高血压。在癌症诊断前后的 12 个月内，临床实践指南的实施和健康结果存在差异，包括血脂筛查（诊断前为 64.5%，诊断后为 50.0%；p=0.004）、血糖筛查（诊断前为 72.7%，诊断后为 90.7%；p<0.001）和高血压患者的血压控制<140/90mmHg（诊断前为 57.6%，诊断后为 71.5%；p=0.004）。对于糖尿病患者，眼部和足部检查率较低（<35%），两个时期的患者中不到 50%的患者实现了理想的糖化血红蛋白<8.0%。
在癌症治疗期间，慢性病管理仍在继续；然而，糖尿病患者的眼部和足部检查以及高血压患者仅有的血脂筛查不足。鉴于合并症可能占黑人和白人乳腺癌生存差异的一半，因此需要制定策略来改善癌症期间的慢性病管理，尤其是对于那些慢性病负担不成比例的黑人女性。
