In 2007, I was a co-author of a summary of data comparing diabetic foot complications to cancer.1 Since then, we know more about mortality and costs of care associated with these complications. Accordingly, my team and I set out to update the 2007 information with all new data in a recently published study.2
We evaluated five-year mortality data from studies after 2007, including that from studies looking at diabetic foot ulcers (DFUs), Charcot arthropathy and lower extremity amputation. We then compared this data with cancer mortality reported by the American Cancer Society and the National Cancer Institute.
In this comparison, we found that five-year mortality for Charcot, DFU, minor and major amputations were 29.0, 30.5, 46.2 and 56.6 percent respectively.2 This is in comparison to 9.0 percent for breast cancer and 80.0 percent for lung cancer. Five-year pooled mortality for all reported cancer was 31.0 percent.
We were not surprised by this data. What we're seeing is that people are living longer with non-communicable diseases such as diabetes. Therefore, the risk for getting end-stage complications like DFUs, PAD, Charcot and chronic kidney disease all set the stage for an increased risk for higher mortality when these complications present.
In addition, we found that the direct costs of care for diabetes was nearly three times the amount for cancer within a two-year time frame.2 When combining this finding with the mortality data, it could be fair to say that clinicians and patients alike should perhaps adjust their perspective on the severity of diabetes and its related complications.
Hopefully, this data will drive home the importance and impact of these complications, and inspire efforts at prevention and diabetic foot ulcer remission. I think continuing to develop robust collaborative research consortia for diabetic foot care like we currently have in the management and treatment of cancer is an important next step. This is starting to happen in the lower extremity and I could not be more excited!
Dr. Armstrong is a Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).
Editor’s Note: This blog originally appeared at:
https://diabeticfootonline.com/2020/03/25/five-year-mortality-and-direct-costs-of-care-for-people-with-diabetic-foot-complications-are-comparable-to-cancer-diabeticfoot/ . It is adapted with permission from the author.
- Armstrong DG, Wrobel J, Robbins JM. Are diabetes-related wounds and amputations worse than cancer? Int Wound J. 2007;4(4):286-7.
- Armstrong DG, Swerdlow MA, Armstrong AA, Conte MS, Padula WV, Bus SA. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13:16. Available at: https://link.springer.com/epdf/10.1186/s13047-020-00383-2?author_access_token=kVIJxBuTGkQxyEgTLv84q2_BpE1tBhCbnbw3BuzI2RNIeBB8EuTnqBbRv3prbaBesEAqgZtOxrAbhZrcSgV7z4O1lmgGW51wX3p0cBfTMM19tJwxSauDh9DP1bnCfMadjemlq4WIunvNz7jgSt6s2g%3D%3D. Accessed April 27, 2020.