title: Associations between Diabetes and Quality of Life among Breast Cancer Survivors.
abstract: OBJECTIVE
  We aimed to investigate the associations between diabetes and quality of life (QOL) among breast cancer survivors.
  
  
  METHODS
  A cross-sectional survey was conducted at 34 Cancer Recovery Clubs across China from May 2014 to January 2015. Quality of life was measured by the Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the Quality of Life Questionnaire-Breast Cancer Module 23 (QLQ-BR23, simplified Chinese version). Information on social-demography, diagnosis and treatment of tumors, and diabetes mellitus were collected by self-reported questionnaires. Univariate analyses of covariance (ANCOVA) was performed to assess the difference in QOL between patients with or without diabetes mellitus, and multiple linear regression models were used to examine the associations after controlling for confounders.
  
  
  RESULTS
  Diabetes, both of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) significantly reduced QOL. This effect of diabetes on QOL is independent of tumor size, regional lymph node metastasis, distant metastasis and tumor stage index (TNM). After adjusting for different social-demography, diagnosis and treatment of the tumor, the tumor's stage and other chronic comorbidities, breast cancer survivors with diabetes got significantly lower scores in functional dimensions (including physical, role, emotional and social functionings measured by EORTC QLQ-C30; body image (BRBI) and future perspective (BRFU) measured by QLQ-BR23, as well as economic difficulties than those without diabetes (Padjusted<0.05). Diabetic patients also obtained higher scores in symptom dimensions, including fatigue, nausea and vomiting, pain, dyspnoea, insomnia, constipation and diarrhoea measured by EORTC QLQ-C30; side effects, breast symptoms and upset by hair loss measured by QLQ-BR23 (Padjusted<0.05). Compared to patients with T1DM, those with T2DM are likely to suffer more by loss of functioning.
  
  
  CONCLUSIONS
  Diabetes was associated with the decreased QOL for breast cancer survivors.
authors.affiliation: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai 200032, China.|Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Tang
authors.affiliation: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai 200032, China.
authors.forename: Jiwei
authors.initials: J
authors.lastname: Wang
authors.affiliation: Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, 180 Feng-Lin Road, Shanghai, China.|Shanghai Key Laboratory Kidney and Blood Purification, Shanghai 200032, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai 200032, China.
authors.forename: Li
authors.initials: L
authors.lastname: Sun
authors.affiliation: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai 200032, China.
authors.forename: Furong
authors.initials: F
authors.lastname: Tang
authors.affiliation: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai 200032, China.
authors.forename: Qinglong
authors.initials: Q
authors.lastname: Deng
authors.affiliation: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai 200032, China.|Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000473:pathology / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D014943:Global Health; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D017741:Survivors / Q000523:psychology*