The DOI matches its Crossref record, with a small difference in title or year; 90 of the 90 references it cites were found in a registry or an index; none of the 32 sources its claims cite is checked for support yet.
Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus: A Systematic Review and Meta-analysis
Open accessAbstract
CONTEXT: Diabetes mellitus appears to be a risk factor for some cancers, but the effect of preexisting diabetes on all-cause mortality in newly diagnosed cancer patients is less clear. OBJECTIVE: To perform a systematic review and meta-analysis comparing overall survival in cancer patients with and without preexisting diabetes. DATA SOURCES: We searched MEDLINE and EMBASE through May 15, 2008, including references of qualifying articles. STUDY SELECTION: English-language, original investigations in humans with at least 3 months of follow-up were included. Titles, abstracts, and articles were reviewed by at least 2 independent readers. Of 7858 titles identified in our original search, 48 articles met our criteria. DATA EXTRACTION: One reviewer performed a full abstraction and other reviewers verified accuracy. We contacted authors and obtained additional information for 3 articles with insufficient reported data. RESULTS: Studies reporting cumulative survival rates were summarized qualitatively. Studies reporting Cox proportional hazard ratios (HRs) or Poisson relative risks were combined in a meta-analysis. A random-effects model meta-analysis of 23 articles showed that diabetes was associated with an increased mortality HR of 1.41 (95% confidence interval [CI], 1.28-1.55) compared with normoglycemic individuals across all cancer types. Subgroup analyses by type of cancer showed increased risk for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41). CONCLUSIONS: Patients diagnosed with cancer who have preexisting diabetes are at increased risk for long-term, all-cause mortality compared with those without diabetes.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
In cancer patients with preexisting diabetes, pooled long-term all-cause mortality was significantly higher than in normoglycemic patients (HR 1.41; 95% CI, 1.28-1.55) across 23 studies. Significant site-specific increases were found for endometrial, breast, and colorectal cancers.
Key findings
- Meta-analysis of 23 studies found preexisting diabetes associated with increased all-cause mortality after cancer diagnosis: HR 1.41 (95% CI, 1.28-1.55).
- Site-specific pooled estimates were significant for endometrium (HR 1.76; 95% CI, 1.34-2.31), breast (HR 1.61; 95% CI, 1.46-1.78), and colorectum (HR 1.32; 95% CI, 1.24-1.41).
- Nonsignificant increases were reported for prostate (HR 1.51; 95% CI, 0.94-2.43), gastric (HR 1.36; 95% CI, 0.92-2.01), hepatocellular (HR 1.30; 95% CI, 0.99-1.70), lung (HR 1.15; 95% CI, 0.99-1.34), and pancreatic cancer (HR 1.09; 95% CI, 0.70-1.69).
- Sensitivity analyses excluding univariate estimates gave HR 1.40 (95% CI, 1.29-1.52); excluding analyses not adjusting/restricting for age and disease severity gave HR 1.42 (95% CI, 1.28-1.56). No significant publication bias was observed by Begg test (P = .92) or Egger plot (P = .34).
Methods
- Systematic review and meta-analysis searching MEDLINE and EMBASE through May 15, 2008; 7,858 titles identified, 48 articles met criteria for the systematic review of long-term all-cause mortality, and 23 studies met criteria for meta-analysis.
- Included English-language human original investigations with at least 3 months follow-up; meta-analysis required risk estimates (HR/RR) and precision estimates, with authors contacted for additional data.
- Random-effects meta-analysis using DerSimonian-Laird method; heterogeneity assessed with Cochran Q and I²; publication bias assessed with Begg funnel plot and Egger plot; sensitivity analyses and nonparametric sign test performed.
Limitations
- The paper states substantial heterogeneity across studies in demographics, diabetes ascertainment, and confounder adjustment; heterogeneity was significant by Q statistic (205 on 24 df, P < .001) and I² (88.3%, P < .001).
- The paper states studies spanned many decades (published 1969-2008), follow-up time was not always reported, and differences in follow-up may limit interpretation.
- Evident from the text: 9 studies with regression models had insufficient reporting for meta-analysis, only 3 of 12 contacted authors provided additional information, and many studies did not adjust for age and cancer severity; power was low (<50%) for prostate, gastric, hepatocellular, lung, and pancreatic cancer estimates.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
30 Own result · 17 Not checked yet · 11 Own method · 7 Own interpretation · 1 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Subgroup analyses by type of cancer showed increased risk for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41).”
- Also stated in: § Sensitivity Analyses · plain
“Preexisting diabetes was significantly associated with increased long-term, all-cause mortality for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Sensitivity Analyses · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We performed a nonparametric sign test and found no association between diabetes and increased cancer-specific mortality (P=.69).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Cancer-Specific and Noncancer Mortality
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes was associated with a nonsignificant increase in risk in prostate (HR, 1.51; 95% CI, 0.94-2.43), gastric (HR, 1.36; 95% CI, 0.92-2.01), hepatocellular (HR, 1.30; 95% CI, 0.99-1.70), lung (HR, 1.15; 95% CI, 0.99-1.34), and pancreatic cancer (HR, 1.09; 95% CI, 0.70-1.69).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In our analysis, however, stage at diagnosis appeared not to be a major explanatory factor.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No study included in this systematic review reported that diabetes was associated with significantly better survival.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Systematic Review of Evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The large I2 value (88%) indicates that the range of plausible risk estimates is wide”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“population-based studies (8 estimates) had a pooled HR of 1.39 (95% CI, 1.27-1.52)”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes was associated with a nonsignificant increase in risk in prostate (HR, 1.51; 95% CI, 0.94-2.43), gastric (HR, 1.36; 95% CI, 0.92-2.01), hepatocellular (HR, 1.30; 95% CI, 0.99-1.70), lung (HR, 1.15; 95% CI, 0.99-1.34), and pancreatic cancer (HR, 1.09; 95% CI, 0.70-1.69).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes was associated with a nonsignificant increase in risk in prostate (HR, 1.51; 95% CI, 0.94-2.43), gastric (HR, 1.36; 95% CI, 0.92-2.01), hepatocellular (HR, 1.30; 95% CI, 0.99-1.70), lung (HR, 1.15; 95% CI, 0.99-1.34), and pancreatic cancer (HR, 1.09; 95% CI, 0.70-1.69).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We also calculated separate estimates for the 9 studies that considered diabetes as the primary exposure (HR, 1.42; 95% CI, 1.30-1.56)”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“but we found no evidence that preexisting diabetes might be protective.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Even though we had to exclude about half of the apparently relevant articles from our meta-analysis for lack of regression models or insufficient reporting, the excluded articles were generally consistent with pooled, quantitative results.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The remaining studies had a pooled HR of 1.37 (95% CI, 1.24-1.51).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes was associated with a nonsignificant increase in risk in prostate (HR, 1.51; 95% CI, 0.94-2.43), gastric (HR, 1.36; 95% CI, 0.92-2.01), hepatocellular (HR, 1.30; 95% CI, 0.99-1.70), lung (HR, 1.15; 95% CI, 0.99-1.34), and pancreatic cancer (HR, 1.09; 95% CI, 0.70-1.69).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and the pooled estimate was stable when restricted to these articles.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The earlier group had an HR of 1.45 (95% CI, 1.26-1.67) and the more recent group had an HR of 1.37 (95% CI, 1.26-1.46).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelationaln = 13- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“After excluding univariate estimates (n = 3),32,35,45 the HR remained 1.40 (95% CI, 1.29-1.52).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Subgroup analyses by type of cancer showed increased risk for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41).”
- Also stated in: § Sensitivity Analyses · plain
“Preexisting diabetes was significantly associated with increased long-term, all-cause mortality for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Sensitivity Analyses · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes was associated with a nonsignificant increase in risk in prostate (HR, 1.51; 95% CI, 0.94-2.43), gastric (HR, 1.36; 95% CI, 0.92-2.01), hepatocellular (HR, 1.30; 95% CI, 0.99-1.70), lung (HR, 1.15; 95% CI, 0.99-1.34), and pancreatic cancer (HR, 1.09; 95% CI, 0.70-1.69).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The estimated HR in this sensitivity analysis was 1.42 (95% CI, 1.28-1.56).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: Age and disease severity at cancer diagnosis are particularly important potential confounders.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Subgroup analyses by type of cancer showed increased risk for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41).”
- Also stated in: § Sensitivity Analyses · plain
“Preexisting diabetes was significantly associated with increased long-term, all-cause mortality for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Sensitivity Analyses · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The earlier group had an HR of 1.45 (95% CI, 1.26-1.67) and the more recent group had an HR of 1.37 (95% CI, 1.26-1.46).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelationaln = 12- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and the 14 studies that considered diabetes among prognostic factors (HR, 1.36; 95% CI, 1.20-1.55).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“clinic-based studies (17 estimates) had a pooled HR of 1.46 (95% CI, 1.21-1.78).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Patients with diabetes often have other diabetes-related comorbid conditions, such as ischemic heart disease, chronic kidney disease, and neuropathy, that may influence clinical decisions.10”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [10] Richardson LC Pollack LA Therapy insight: influence of type 2 diabetes on the development, treatment and outcomes of cancer Nat Clin Pract Oncol 2005 2 1 48 53 16264856
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“First, the studies showed great heterogeneity in terms of population demographics, ascertainment methods for diabetes, and measurement and adjustment for confounders.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, multiple sensitivity analyses found the risk estimate was robust across various quality components.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Despite this, point estimates for earlier and more recent studies were similar.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Despite the use of appropriate meta-analytic techniques with random-effect models, we are unable to account for these differences.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This estimate was robust across sensitivity analyses that accounted for population source, diabetes and mortality ascertainment, and statistical adjustment.”
- Also stated in: § Comment · plain
“Finally, a meta-analysis was performed on 23 articles that addressed the specific research question, and influence and sensitivity analyses confirmed the robustness of the main results.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Comment · plain
In the paper
“The study by van de Poll-Franse et al40 found that patients with esophageal, colon, breast, and ovarian cancer and diabetes were treated less aggressively than those without diabetes after controlling for age, stage, and sex in the Eindhoven Cancer Registry of the Netherlands.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites van de Poll-Franse et al40
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, the consistency of results across studies, cancer sites, follow-up time, and continents supports the main findings.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, differences in cancer treatment between patients with and without diabetes may contribute to increased cancer-related mortality.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“No significant publication bias was observed according to the Begg test (P = .92) or Egger plot (P = .34) (eFigure).”
- Also stated in: § Comment · plain
“Moreover, there was no evidence of publication bias.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Meta-analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Comment · plain
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Attention to all-cause mortality tends to reduce bias due to misattribution.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 19
- Probably not a substantial claim. 17
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A random-effects model meta-analysis of 23 articles showed that diabetes was associated with an increased mortality HR of 1.41 (95% confidence interval [CI], 1.28-1.55) compared with normoglycemic individuals across all cancer types.”
- Also stated in: § Meta-analysis · plain
“Preexisting diabetes was associated with an increase in all-cause mortality following cancer diagnosis (HR = 1.41; 95% CI, 1.28-1.55).”
- Also stated in: § Comment · plain
“Preexisting diabetes in cancer patients at the time of diagnosis was associated with an HR of 1.41 for the risk of all-cause mortality compared with individuals without diabetes when pooled across 23 studies of various types of cancer.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Meta-analysis · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of 9 estimates from 8 articles reporting the association of diabetes with cancer-specific mortality, 2 estimates found significantly higher risk,48,78 2 estimates found a nonsignificantly higher risk,36,77 2 estimates found a nonsignificantly lower risk,42,77 and 3 articles did not report a direction of effect.47,68,76”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Cancer-Specific and Noncancer Mortality
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The sign test rejected the null hypothesis of equal mortality in patients with and without preexisting diabetes whether we excluded studies that did not report a direction of effect (P = .001) or assumed studies that did not report a direction of effect fell evenly in either category (5 each side, P=.005).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Systematic Review of Evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: In the sign test, studies that did not report a direction of effect fell evenly in either category.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The omission of any one study did not appreciably change the pooled HR, and the estimates in each case were well within the confidence limits of the overall estimate.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Heterogeneity was significant by the Q statistic (205 on 24 df, P < .001) and by I2 (88.3%, P < .001).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Meta-analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our subsidiary analysis of studies that distinguished between cancer and noncancer mortality was inconclusive, so this possibility cannot be excluded.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Of the 3 studies evaluating noncancer mortality, 2 found a significant association with increased risk among patients with preexisting diabetes36,79 and 1 article reported a nonsignificant association with no direction of effect.67”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Cancer-Specific and Noncancer Mortality
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, 32 study estimates found diabetes was associated with increased risk of mortality, 7 found diabetes was associated with decreased risk of mortality, 1 found a null effect, and 10 did not report a direction of effect.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Systematic Review of Evidence
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“It is possible that high insulin or insulin-like growth factor levels may promote cancer cell and tumor growth.10”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [10] Richardson LC Pollack LA Therapy insight: influence of type 2 diabetes on the development, treatment and outcomes of cancer Nat Clin Pract Oncol 2005 2 1 48 53 16264856
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Because some cancers—including cancers of the breast,2 colorectum,3 endometrium,4 liver,5 and pancreas6—occur more commonly in individuals with diabetes”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Conclusions
What the sources say
- Not checked yetcites [2] Larsson SC Mantzoros CS Wolk A Diabetes mellitus and risk of breast cancer: a meta-analysis Int J Cancer 2007 121 4 856 862 17397032
- Not checked yetcites [3] Larsson SC Orsini N Wolk A Diabetes mellitus and risk of colorectal cancer: a meta-analysis J Natl Cancer Inst 2005 97 22 1679 1687 16288121
- Not checked yetcites [4] Friberg E Orsini N Mantzoros CS Wolk A Diabetes mellitus and risk of endometrial cancer: a meta-analysis Diabetologia 2007 50 7 1365 1374 17476474
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Using the method described by Cohn and Becker,27 post hoc power calculations based on the overall and site-specific pooled HRs revealed excellent power (≥95%) for overall, endometrial, breast, and colorectal cancer estimates and low power (<50%) for prostate, gastric, hepatocellular, lung, and pancreatic cancer estimates.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Methods > Data Synthesis and Statistical Analysis
What the sources say
- Not checked yetcites Cohn and Becker,27
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Diabetes is a well-established risk factor for cardiovascular mortality in adults without cancer,86”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [86] Morrish NJ Wang SL Stevens LK Fuller JH Keen H Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes Diabetologia 2001 44 suppl 2 S14 S21 11587045
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Third, patients with preexisting diabetes may have poorer response to cancer treatment, including increased infection risk and intraoperative mortality.39,81”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [39] Meyerhardt JA Catalano PJ Haller DG Impact of diabetes mellitus on outcomes in patients with colon cancer J Clin Oncol 2003 21 3 433 440 12560431
- Not checked yetcites [81] Weiser MA Cabanillas ME Konopleva M Relation between the duration of remission and hyperglycemia during induction chemotherapy for acute lymphocytic leukemia with a hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone/methotrexatecytarabine regimen Cancer 2004 100 6 1179 1185 15022284
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the 12 authors contacted, 3 were able to provide additional information, 4 were unable to furnish the necessary information, and 5 did not respond to our request.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Methods > Data Synthesis and Statistical Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Cancer patients with diabetes may receive less aggressive cancer treatment or less aggressive diabetes care, both of which could compromise survival.10”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Conclusions
What the sources say
- Not checked yetcites [10] Richardson LC Pollack LA Therapy insight: influence of type 2 diabetes on the development, treatment and outcomes of cancer Nat Clin Pract Oncol 2005 2 1 48 53 16264856
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“Fleming et al83 found that women older than 67 years with preexisting diabetes had a 17% greater risk of being diagnosed with late vs early stage breast cancer in the SEER database compared with normoglycemic women.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites Fleming et al83
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Fourth, patients with preexisting diabetes may present with later-stage disease because of suboptimal cancer screening practices.82”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [82] Beckman TJ Cuddihy RM Scheitel SM Naessens JM Killian JM Pankratz VS Screening mammogram utilization in women with diabetes Diabetes Care 2001 24 12 2049 2053 11723081
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Adults with diabetes experienced increased cancer mortality in the American Cancer Society Cancer Prevention Study II,8 but not in the Second National Health and Nutrition Examination Survey Mortality Follow-Up.9”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Conclusions
What the sources say
- Not checked yetcites [8] Coughlin SS Calle EE Teras LR Petrelli J Thun MJ Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults Am J Epidemiol 2004 159 12 1160 1167 15191933
- Not checked yetcites [9] Saydah SH Loria CM Eberhardt MS Brancati FL Abnormal glucose tolerance and the risk of cancer death in the United States Am J Epidemiol 2003 157 12 1092 1100 12796045
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Quality was assessed using elements of the STROBE checklist for cohort studies considered important for quality in these studies.11”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Methods > Data Extraction and Quality Assessment
What the sources say
- Not checked yetcites [11] von Elm E Altman DG Egger M Pocock SJ Gøtzsche PC Vandenbroucke JP STROBE initiative: the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies J Clin Epidemiol 2008 61 4 344 349 18313558
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“While the association of diabetes and site-specific mortality risk reached statistical significance only for cancers of the endometrium, breast, and colorectum, diabetes appeared to be associated with some additional mortality risk for all types of cancer.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The majority of the studies included in the review evaluated multiple prognostic variables, which likely decreased the risk of publication bias with respect to the relationship between diabetes and mortality in this patient population”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, differences in follow-up time, which was not always reported, may also limit interpretation of the results.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“One reviewer performed a full abstraction and other reviewers verified accuracy.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Data Extraction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“However, experts in cancer epidemiology recognize that attribution of cause of death is often problematic and that undue reliance on attributed cause can bias estimates of risk related to cancer treatment.87-90”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [87] Begg CB Schrag D Attribution of deaths following cancer treatment J Natl Cancer Inst 2002 94 14 1044 1045 12122090
- Not checked yetcites [88] Ederer F Geisser MS Mongin SJ Church TR Mendel JS Colorectal cancer deaths as determined by expert committee and from death certification: a comparison J Clin Epidemiol 1999 52 5 447 452 10360340
- Not checked yetcites [89] Welch HG Black WC Are deaths within 1 month of cancer-directed surgery attributed to cancer? J Natl Cancer Inst 2002 94 14 1066 1070 12122097
- Not checked yetcites [90] Lu TH Shih TP Lee MC Chou MC Lin CK Diversity in death certification: a case vignette approach J Clin Epidemiol 2001 54 11 1086 1093 11675159
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fifth, the diagnosis and treatment of cancer may distract both the patient and the health care team from appropriate management of glycemia, blood pressure, and lipids, proven to reduce morbidity and mortality in diabetic adults.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Titles, abstracts, and articles were reviewed by at least 2 independent readers.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Study Selection
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and the microvascular and macrovascular damage it causes likely accumulates to some extent regardless of cancer status.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
In the paper
“First, cancer patients with diabetes may have increased tumor cell proliferation and metastases in a physiologic environment of hyperinsulinemia and hyperglycemia.10”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [10] Richardson LC Pollack LA Therapy insight: influence of type 2 diabetes on the development, treatment and outcomes of cancer Nat Clin Pract Oncol 2005 2 1 48 53 16264856
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“If several estimates were reported in the same article, we chose the most fully adjusted estimate (ie, multivariate regression was selected over univariate regression, which was selected over unadjusted Kaplan-Meier analysis).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Methods > Data Synthesis and Statistical Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Another potential pathway is that acute exposure to hyperglycemia may increase endothelial cell permeability due to increased generation of reactive oxidative species and structural changes in the basement membrane, increasing the likelihood of metastasis.80”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [80] Morss AS Edel ER Glucose modulates basement membrane fibroblast growth factor-2 via alterations in endothelial cell permeability J Biol Chem 2007 282 19 14635 14644 17327226
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“To avoid overlapping patient populations, we compared data on recruitment years, data source, and geographic location. If a patient population was found to overlap, we included the article with the most comprehensive population or most adjusted estimate of risk associated with preexisting diabetes. This resulted in the exclusion of 12 articles from our systematic review.12-23”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Methods > Data Synthesis and Statistical Analysis
What the sources say
- Not checked yetcites [12] Janssen-Heijnen ML Maas HA Houterman S Lemmens VE Rutten HJ Coebergh JW Comorbidity in older surgical cancer patients: influence on patient care and outcome Eur J Cancer 2007 43 15 2179 2193 17681780
- Not checked yetcites [13] Lemmens VE Janssen-Heijnen ML Verheij CD Houterman S Repelaer van Driel OJ Coebergh JW Co-morbidity leads to altered treatment and worse survival of elderly patients with colorectal cancer Br J Surg 2005 92 5 615 623 15779071
- Not checked yetcites [14] Tanisada K Teshima T Ikeda H Prognostic factors for patients with esophageal cancer treated with radiation therapy in PCS: a preliminary study Radiat Med 1998 16 6 461 468 9929147
- Not checked yetcites [15] Nagasue N Kohno H Tachibana M Yamanoi A Ohmori H El-Assal ON Prognostic factors after hepatic resection for hepatocellular carcinoma associated with Child-Turcotte class B and C cirrhosis Ann Surg 1999 229 1 84 90 9923804 PMC1191612
- Not checked yetcites [16] Huo TI Wu JC Lui WY Diabetes mellitus is a recurrence-independent risk factor in patients with hepatitis B virus-related hepatocellular carcinoma undergoing resection Eur J Gastroenterol Hepatol 2003 15 11 1203 1208 14560154
- Not checked yetcites [17] Hanbali A Al-Khasawneh K Cole-Johnson C Divine G Ali H Protective effect of diabetes against metastasis in patients with non-small cell lung cancer Arch Intern Med 2007 167 5 513 17353502
- Not checked yetcites [18] Merrick GS Butler WM Wallner KE Galbreath RW Allen ZA Adamovich E Androgen-deprivation therapy does not impact cause-specific or overall survival after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 2006 65 3 669 677 16682149
- Not checked yetcites [19] Kouvaris J Kouloulias V Loghis C Sykiotis C Balafouta M Vlahos L Prognostic factors for survival in invasive squamous cell vulvar carcinoma: a univariate analysis Gynecol Obstet Invest 2001 51 4 262 265 11408738
- Not checked yetcites [20] Janssen-Heijnen ML Lemmens VE van den Borne BE Biesma B Oei SB Coebergh JW Negligible influence of comorbidity on prognosis of patients with small cell lung cancer: a population-based study in the Netherlands Crit Rev Oncol Hematol 2007 62 2 172 178 17197191
- Not checked yetcites [21] Maas HA Kruitwagen RF Lemmens VE Goey SH Janssen-Heijnen ML The influence of age and co-morbidity on treatment and prognosis of ovarian cancer: a population-based study Gynecol Oncol 2005 97 1 104 109 15790445
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
The association of preexisting diabetes in newly diagnosed cancer patients with long-term, all-cause mortality has not been systematically assessed.
“However, the association of preexisting diabetes in newly diagnosed cancer patients with long-term, all-cause mortality has not been systematically assessed.”
The authors state this as an assumption.
Age and disease severity at cancer diagnosis are particularly important potential confounders.
“because we believe these are particularly important potential confounders.”
The authors state this as an assumption.
In the sign test, studies that did not report a direction of effect fell evenly in either category.
“assumed studies that did not report a direction of effect fell evenly in either category (5 each side, P=.005)”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Results of some, but not all, epidemiological studies suggest that diabetes may significantly increase mortality in patients with cancer (8).”
From Diabetes and Cancer (2010) · cites this paper as [8]
Citations
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040296 · Cited by 23,020
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2008) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2007.11.008 · Cited by 17,893
Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes
and the WHO Multinational Study Group, Morrish, N. J., Wang, S.-L., Stevens, L. K., Fuller, J. H., & Keen, H. (2001) · Diabetologia · doi:10.1007/pl00002934 · Cited by 1,288
Type-II diabetes and pancreatic cancer: a meta-analysis of 36 studies
Huxley, R., Ansary-Moghaddam, A., Berrington de González, A., Barzi, F., & Woodward, M. (2005) · British Journal of Cancer · doi:10.1038/sj.bjc.6602619 · Cited by 1,105
Diabetes Mellitus and Risk of Colorectal Cancer: A Meta-Analysis
Larsson, S. C., Orsini, N., & Wolk, A. (2005) · JNCI: Journal of the National Cancer Institute · doi:10.1093/jnci/dji375 · Cited by 1,038
Effect of Age and Comorbidity in Postmenopausal Breast Cancer Patients Aged 55 Years and Older
Yancik, R. (2001) · JAMA · doi:10.1001/jama.285.7.885 · Cited by 897
Diabetes mellitus and risk of breast cancer: A meta‐analysis
Larsson, S. C., Mantzoros, C. S., & Wolk, A. (2007) · International Journal of Cancer · doi:10.1002/ijc.22717 · Cited by 884
El‐Serag, H. B., Hampel, H., & Javadi, F. (2006) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2005.12.007 · Cited by 831 · cited 1×
“Hepatocellular 3 (5)30,37,44 3724 848b 1.”
Research works printed but not linked: 1
- [24]Rosner B Fundamentals of Biostatistics Sixth Belmont, CA Duxbury Press 2006 361 366
Cited by
Sorted by citations
Giovannucci, E., Harlan, D. M., Archer, M. C., Bergenstal, R. M., Gapstur, S. M., Habel, L. A., Pollak, M., Regensteiner, J. G., & Yee, D. (2010) · Diabetes Care · doi:10.2337/dc10-0666 · Cited by 2,366
“Results of some, but not all, epidemiological studies suggest that diabetes may significantly increase mortality in patients with cancer (8).”
Diabetes in Asia: Epidemiology, Risk Factors, and Pathophysiology
Chan, J. C. N., Malik, V., Jia, W., Kadowaki, T., Yajnik, C. S., Yoon, K.-H., & Hu, F. B. (2009) · JAMA · doi:10.1001/jama.2009.726 · Cited by 1,997
Diabetes and Cancer: A Consensus Report
Giovannucci, E. L., Harlan, D. M., Archer, M. C., Bergenstal, R. M., Gapstur, S. M., Habel, L. A., Pollak, M., Regensteiner, J. G., & Yee, D. (2010) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.20078 · Cited by 1,078
Vigneri, P., Frasca, F., Sciacca, L., Pandini, G., & Vigneri, R. (2009) · Endocrine Related Cancer · doi:10.1677/erc-09-0087 · Cited by 1,009
Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis
Protani, M. M., Coory, M. D., & Martin, J. H. (2010) · Breast Cancer Research and Treatment · doi:10.1007/s10549-010-0990-0 · Cited by 985
Metadata
- Authors
- Barone, B. B.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Barone, Bethany B.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2008-12-17
- Volume
- 300
- Issue
- 23
- Pages
- 2754
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3093051
- OpenAlex
- W1968234252
- Cited by
- 881
- References
- 89
- Citations by year
- 2026: 22 · 2025: 35 · 2024: 67 · 2023: 42 · 2022: 53 · 2021: 52 · 2020: 62 · 2019: 53 · 2018: 50 · 2017: 53 · 2016: 46 · 2015: 47 · 2014: 53 · 2013: 60 · 2012: 57
- FWCI
- 17.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5p60dk079637-02)
- U.S. Public Health Service (T32HP10025-14)
- National Institute of Diabetes and Digestive and Kidney Diseases (P60 DK-079637, K24-DK62222, K24DK062222, P30DK079637, T32DK062707)
- National Center for Research Resources (UL1RR025005)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetes mellitus, cancer, all-cause mortality, overall survival, endometrial cancer, breast cancer, colorectal cancer, comorbidities, cancer risk factors
- MeSH terms
- Cause of Death, Diabetes Mellitus, Humans, Neoplasms, Risk Factors, Comorbidity, Survival Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
