Diabetes is known to increase the risk of developing a number of cancers and is associated with poorer outcomes in several, including breast cancer and bowel cancer. Despite the fact that diabetes is common in people with lung cancer, affecting up to 20% of those with lung cancer, it remains unclear if having diabetes has an affect on how long people with lung cancer live after their diagnosis. Although this has been studied before the findings from different studies have not all shown the same thing which makes it hard to know how to recommend doctors manage people with both lung cancer and diabetes. In this study, we will explore whether people who have lung cancer and diabetes live for a shorter time than those with lung cancer without diabetes and see if we can find any specific factors about diabetes that may increase the probability of dying such as how well diabetes is managed.
Type 2 diabetes mellitus (T2DM) and cancer are significant health burdens that contribute to high morbidity and mortality globally. In the UK, DM affects a substantial proportion of the population, with over 4.7 million people affected, while cancer accounts for over 160,000 deaths annually. Emerging evidence suggests there may be a link between Type 2 Diabetes mellitus (T2DM) and an increased risk of cancer, particularly breast, cholangiocarcinoma (both intrahepatic and extrahepatic), colorectal, endometrial, and gallbladder cancers. Although several epidemiological studies have suggested patients with DM may experience higher cancer-related mortality, establishing a causal relationship is challenging due to various shared risk factors, the most prominent being obesity. Studies exploring the relationship between DM and lung cancer have had conflicting results. Our aim is to determine if people with T2DM are at increased risk of death following lung cancer diagnosis than people without DM. If they are, we will then explore if certain factors are associated with increased risk of death e.g. DM control. We will use linked CPRD Aurum with HES APC, ONS data as well as IMD data. The ONS data will be used to determine our study outcome (death). HES APC data will be used alongside primary care data for diabetes complication e.g. dialysis, peripheral vascular disease. Our primary endpoint is all cause mortality but we will also explore cause specific mortality. We will use Cox Proportional Hazard models. This study will benefit patients by helping us to better understand risk of death following a lung cancer diagnosis in people with T2DM and if there are factors associated with that risk. This will guide future studies around possible interventions to reduce mortality.
1. Mortality – all cause and cause specific
Jennifer Quint - Chief Investigator - Imperial College London
Sarah Cook - Corresponding Applicant - Imperial College London
Bodini Dharmasekara - Collaborator - Imperial College London
Eseosa Igbinosa - Collaborator - Imperial College London
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation