Association between Metformin Use and Cancer Stage at Diagnosis among Elderly Medicare Beneficiaries with Preexisting Type 2 Diabetes Mellitus and Incident Prostate Cancer Diabetes, diabetes treatment and breast cancer prognosis Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40-64 years. Diabetes as a risk factor for poorer early postoperative outcomes after shoulder arthroplasty. Effects of physical activity on cancer survival: a systematic review. Leanness and Lung Cancer Risk: Fact or Artifact? Early complications in surgical treatment of lung cancer: a prospective, multicenter study. Grupo Cooperativo de Carcinoma Broncogénico de la Sociedad Española de Neumología y Cirugía Torácica. Multivitamin use and the risk of mortality and cancer incidence: the multiethnic cohort study.
Objective . To examine the association between metformin use and cancer stage at diagnosis among elderly men with preexisting diabetes mellitus and incident prostate cancer . Methods . This study used a population -based observational cohort of elderly men ( ≥66 years ) with preexisting diabetes and incident prostate cancer between 2008 and 2009 ( N = 2,652 ) . Cancer stage at diagnosis ( localized versus advanced ) was based on the American Joint Cancer Committee classification . Metformin use and other independent variables were measured during the one year before cancer diagnosis . Logistic regressions with inverse probability treatment weights were used to control for the observed selection bias . Results . A significantly lower percentage of metformin users were diagnosed with advanced prostate cancer as compared to nonusers ( 4.7 % versus 6.7 % , p < 0.03 ) . After adjusting for the observed selection bias and other independent variables , metformin use was associated with a 32 % reduction in the risk of advanced prostate cancer ( adjusted odds ratio , AOR : 0.68 , 95 % confidence interval , CI : 0.48 , 0.97 ) . Conclusions . This is the first epidemiological study to support the role of metformin in reducing the risk of advanced prostate cancer . R and omized clinical trials are needed to confirm the causal link between metformin use and prostate cancer diagnosis stage The objectives of this study are to assess the impact of pre-existing diabetes and diabetes treatment on breast cancer prognosis . 8,108 women with central ly confirmed invasive breast cancer in the Women ’s Health Initiative diagnosed between 1998 and 2013 were followed through the date of death or September 20 , 2013 . Information on diabetes and diabetes therapy were obtained via self-report and face-to-face review of current medication containers , respectively . Cox proportional hazard regression was used to estimate adjusted relative hazard ratios for overall mortality . The proportional subdistribution hazard model was used to estimate hazard ratios for breast cancer-specific mortality . Compared with women without diabetes , women with diabetes had significantly increased risk of overall mortality ( HR 1.26 95 % CI 1.06–1.48 ) , especially among those who took insulin or had longer duration of diabetes . However , diabetes was not associated with increased risk of breast cancer-specific mortality , regardless of type of treatment and duration of diabetes , despite the significant association of diabetes with unfavorable tumor characteristics . Our large prospect i ve cohort study provides additional evidence that pre-existing diabetes increases risk of total mortality among women with breast cancer . The increased total mortality associated with diabetes was mainly driven by increased risk of dying from diseases other than breast cancer . Thus , the continuum of care for breast cancer patients with diabetes should include careful attention to CVD risk factors and other non-cancer conditions Although 40 % of US women indicate they are currently trying to lose weight , the association between intentional weight loss and longevity is unknown . The authors analyzed prospect i ve data from 43,457 overweight , never-smoking US white women aged 40 - 64 years who in 1959 - 1960 completed a question naire  that included questions on weight change direction , amount , time interval , and intentionality . Vital status was determined in 1972 . Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight . Women who died within the first 3 years of follow-up were excluded . Analyses were stratified by preexisting illness and adjusted for age , beginning body mass index , alcohol intake , education , physical activity , and health conditions . In women with obesity-related health conditions ( n = 15,069 ) , intentional weight loss  of any amount was associated with a 20 % reduction in all-cause mortality , primarily due to a 40 - 50 % reduction in mortality from obesity-related cancers ; diabetes-associated mortality was also reduced by 30 - 40 % in those who intentionally lost weight . In women with no preexisting illness ( n = 28,388 ) ,  intentional weight loss  of > or = 20 lb ( > or = 9.1 kg ) that occurred within the previous year was associated with about a 25 % reduction in all-cause , cardiovascular , and cancer mortality ; however , loss of < 20 lb ( < 9.1 kg ) or loss that occurred over an interval of > or = 1 year was generally associated with small to modest increases in mortality . The association between  intentional weight loss  and longevity in middle-aged overweight women appears to depend on their health status . Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality , whereas among women with no preexisting illness , the association is equivocal BACKGROUND Although diabetes has been associated with increased perioperative morbidity and mortality after hip and knee arthroplasty , its impact on early postoperative outcomes after shoulder replacement remains relatively unexplored . The purpose of the study was to determine the association of diabetes with in-hospital death , complications , length of stay , non-homebound disposition , and cost in patients undergoing shoulder arthroplasty . METHODS By use of the Nationwide Inpatient Sample data base for the year 2011 , an estimated 66,485 patients having undergone shoulder arthroplasty were identified and separated into groups with ( 21 % ) and without ( 79 % ) diabetes mellitus . Comparisons of specific outcome measures between diabetic and nondiabetic cohorts were performed by bivariate and multivariable analyses with logistic regression modeling . RESULTS Diabetes mellitus was independently associated with in-hospital death , a number of perioperative complications , prolonged hospital stay , and increased non-homebound disposition after shoulder arthroplasty . The presence of diabetes was not associated with increased hospital cost . CONCLUSION Patients with preexisting diabetes are at higher risk for perioperative morbidity and mortality after shoulder arthroplasty . Future prospect i ve research should explore in more detail the relationship between diabetes and shoulder arthroplasty outcomes PURPOSE Physical activity ( PA ) has been suggested to help increase the survival of individuals with cancer . The objective of this review was to systematic ally evaluate and summarize the available evidence investigating the effect of PA on the survival of individuals with cancer . METHODS Electronic data bases ( CINAHL , EMBASE , and MEDLINE ) were systematic ally search ed for r and omized controlled trials and cohort studies . Selected studies were assessed by two independent investigators for method ological quality , using the PEDro scale . RESULTS Ten prospect i ve cohort studies met the inclusion criteria . Quality - assessment scores averaged 5/10 on the PEDro scale , with two articles obtaining a score of 6/10 . The majority of studies found that individuals participating in higher levels of physical activity had a reduced risk of cancer-related mortality . This trend was observed specifically for breast , colon , and colorectal cancers . On average , it appears that engaging in higher levels of metabolic equivalent hours per week may help to improve survival rates among individuals diagnosed with cancer . CONCLUSION Patients diagnosed with cancer demonstrated a trend toward increased survival with greater levels of PA . However , because only prospect i ve cohort studies were included in the study , the conclusions drawn should be regarded with caution Background . More than a dozen studies have examined the association between leanness and increased lung cancer risk . None of the prospect i ve studies has been large enough to allow exclusion of smokers or persons with preexisting disease , two factors that cause both leanness and poor survival and thus may cause a spurious association between low body mass index and fatal lung cancer . Methods . Using Cox proportional hazards models , we examined this issue in a cohort of 941,105 U.S. adults enrolled in an American Cancer Society prospect i ve study in 1982 . During 14 years of follow-up , 14,066 people died of lung cancer . Results . In analyses restricted to lifelong nonsmokers who did not report preexisting disease , leanness was not substantially associated with lung cancer mortality in men ( rate ratio = 0.9 ; 95 % confidence interval = 0.3–3.1 ) or in women ( rate ratio = 1.2 ; 95 % confidence interval = 0.7–2.1 ) . However , leanness was associated with increased lung cancer risk in analyses that attempted to control for , rather than exclude , smokers and persons with preexisting disease . Conclusions . These data suggest that the association between leanness and lung cancer mortality is not causal but rather is an artifact of the effects of smoking and preexisting disease BACKGROUND We prospect ively analyzed the postoperative morbidity , mortality rate , and risk factors in 605 patients who underwent thoracotomy for bronchogenic carcinoma . METHODS Patients were categorized by postsurgical tumor stage : I , 287 patients ( 47.4 % ) ; II , 49 patients ( 8.1 % ) ; IIIA , 154 patients ( 25.5 % ) ; IIIB , 80 patients ( 13.2 % ) ; IV , 16 patients ( 2.7 % ) ; unavailable , 19 patients ( 3.1 % ) . Two hundred ninety-four patients ( 48.6 % ) underwent lobectomy  , 172 ( 28.4 % )  pneumonectomy  , 20 ( 3.3 % ) bilobectomy , 29 ( 4.8 % ) segmentectomy , 27 ( 4.5 % ) wedge resection , and 63 ( 10.4 % ) exploratory thoracotomy . The importance of the factors that influence the morbidity and mortality rates was calculated from their relative risks . Univariate and multivariate methods for a logistic regression model were used for this analysis . RESULTS Postoperative complications developed in 196 patients ( 32.4 % ) ; there were 165 ( 27.3 % ) cases of operation-related complications and 152 ( 25.1 % ) cases of respiratory and cardiovascular complications . The morbidity rate was highest in patients with preexisting vascular disease ( 50.9 % ; odds ratio [ OR ] , 2.20 ) or insulin-dependent diabetes mellitus ( 52.4 % ; OR , 2.77 ) and in patients who underwent pneumonectomy ( 40.1 % ; OR , 1.82 ) . Forty patients ( 6.6 % ) died postoperatively , most commonly of respiratory failure ( 67.5 % ) . The mortality rate was highest in patients with postoperative morbidity ( OR , 31.9 ) or vascular disease ( 15.8 % ; OR , 2.83 ) and in patients who underwent pneumonectomy ( 13.4 % ; OR , 4.9 ) . CONCLUSIONS Postoperative complications are more likely to develop in patients with peripheral vascular disease or insulin-dependent diabetes mellitus , or both . Postoperative mortality was found to be significantly higher in patients with vascular disease and those who underwent pneumonectomy Although multivitamin/mineral supplements are commonly used in the United States , the efficacy of these supplements in preventing chronic disease or premature death is unclear . To assess the relation of multivitamin use with mortality and cancer , the authors prospect ively examined these associations among 182,099 participants enrolled in the Multiethnic Cohort Study between 1993 and 1996 in Hawaii and California . During an average 11 years of follow-up , 28,851 deaths were identified . In Cox proportional hazards models controlling for tobacco use and other potential confounders , no associations were found between multivitamin use and mortality from all causes ( for users vs. nonusers : hazard ratio = 1.07 , 95 % confidence interval : 0.96 , 1.19 for men ; hazard ratio = 0.96 , 95 % confidence interval : 0.85 , 1.09 for women ) , cardiovascular diseases , or cancer . The findings did not vary across subgroups by ethnicity , age , body mass index , preexisting illness , single vitamin/mineral supplement use , hormone replacement therapy use , and smoking status . There also was no evidence indicating that multivitamin use was associated with risk of cancer , overall or at major sites , such as lung , colorectum , prostate , and breast . In conclusion , there was no clear decrease or increase in mortality from all causes , cardiovascular disease , or cancer and in morbidity from overall or major cancers among multivitamin supplement users
Compared with their nondiabetic counterparts , cancer patients with preexisting diabetes are ∼50 % more likely to die after surgery .
OBJECTIVE Diabetes appears to increase risk for some cancers , but the association between preexisting diabetes and  postoperative mortality in cancer patients is less clear .
Our objective was to systematic ally review postoperative mortality in cancer patients with and without preexisting diabetes and summarize results using meta- analysis .