title: Diabetes management before and after cancer diagnosis: missed opportunity.
abstract: BACKGROUND
  Few studies have examined the management of comorbidities in cancer patients. This study used population-based data to estimate the guideline concordance rates for diabetes management before and after cancer diagnosis and examined if diabetes management services among cancer patients was associated with characteristics of the hospital where the patient was treated.
  
  
  METHODS
  We linked 2005-2009 Medicare claims data to information on 2,707 breast and colorectal cancers patients in state cancer registry files. Multivariate logistic regression models examined hospital characteristics associated with receipt of diabetes management care after cancer diagnosis.
  
  
  RESULTS
  The rates of HbAlc testing, LDL-C testing, and retinal eye exam decreased from 72.7%, 79.6%, and 57.9% before cancer diagnosis to 58.3%, 69.5%, and 55.8% after diagnosis. The pre- and post-diagnosis diabetes management care was not significantly different by hospital characteristics in the bivariate analysis except for that the distance between residence and hospital was negatively related to retinal eye exam after diagnosis (P<0.05). The multivariate analysis did not identify any significant differences in diabetes management care after cancer diagnosis by hospital characteristics.
  
  
  CONCLUSIONS
  Cancer patients received fewer diabetes management care after diagnosis than prior to diagnosis, even for those who were treated in large comprehensive centers. This may reflect a missed opportunity to connect diabetic cancer patients to diabetes care. This study provides benchmarks to measure improvements in comorbidity management among cancer patients.
authors.affiliation: 1 Department of Healthcare Policy and Research, Virginia Commonwealth University, College of Medicine, Richmond, VA 23298, USA ; 2 College of Medicine, University of Virginia, Charlottesville, VA, USA ; 3 College of Public Health, University of Kentucky, Lexington, KY 40506, USA.
authors.forename: Nengliang
authors.initials: N
authors.lastname: Yao
authors.affiliation: 1 Department of Healthcare Policy and Research, Virginia Commonwealth University, College of Medicine, Richmond, VA 23298, USA ; 2 College of Medicine, University of Virginia, Charlottesville, VA, USA ; 3 College of Public Health, University of Kentucky, Lexington, KY 40506, USA.
authors.forename: Fabian T
authors.initials: FT
authors.lastname: Camacho
authors.affiliation: 1 Department of Healthcare Policy and Research, Virginia Commonwealth University, College of Medicine, Richmond, VA 23298, USA ; 2 College of Medicine, University of Virginia, Charlottesville, VA, USA ; 3 College of Public Health, University of Kentucky, Lexington, KY 40506, USA.
authors.forename: Askar S
authors.initials: AS
authors.lastname: Chukmaitov
authors.affiliation: 1 Department of Healthcare Policy and Research, Virginia Commonwealth University, College of Medicine, Richmond, VA 23298, USA ; 2 College of Medicine, University of Virginia, Charlottesville, VA, USA ; 3 College of Public Health, University of Kentucky, Lexington, KY 40506, USA.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Fleming
authors.affiliation: 1 Department of Healthcare Policy and Research, Virginia Commonwealth University, College of Medicine, Richmond, VA 23298, USA ; 2 College of Medicine, University of Virginia, Charlottesville, VA, USA ; 3 College of Public Health, University of Kentucky, Lexington, KY 40506, USA.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
keywords: Cancer; care coordination; comorbidity