Determining the Impact of a Cancer Diagnosis on Diabetes Management

Pinheiro, Laura C.; Kaur, Harveen; Nilo, Daniela; Safford, Monika M.; DeRosa, Antonio; Kern, Lisa M.

doi:10.1097/coc.0000000000000612

Cited by 13 publications

(9 citation statements)

References 56 publications

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“…Our study has important clinical implications. The impact of cancer diagnosis and treatment on diabetes management has drawn less attention, possibly because both clinicians and cancer patients may prioritise cancer over glycaemic control after a cancer diagnosis [ 60 ]. Based on current evidence, clinicians should continue to ensure glycaemic control in people with cancer and pre-existing diabetes, and it should be integral to clinical cancer care.…”

Section: Discussionmentioning

confidence: 99%

Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis

et al. 2022

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Aims To assess whether glycaemic control is associated with prognosis in people with cancer and pre-existing diabetes. Methods In this pre-registered systematic review (PROSPERO: CRD42020223956), PubMed and Web of Science were searched on 25th Nov 2021 for studies investigating associations between glycosylated haemoglobin (HbA1c) and prognosis in people with diabetes and cancer. Summary relative risks (RRs) and 95% Confidence Intervals (CIs) for associations between poorly controlled HbA1c or per 1-unit HbA1c increment and cancer outcomes were estimated using a random-effects meta-analysis. We also investigated the impact of potential small-study effects using the trim-and-fill method and potential sources of heterogeneity using subgroup analyses. Results Fifteen eligible observational studies, reporting data on 10,536 patients with cancer and pre-existing diabetes, were included. Random-effects meta-analyses indicated that HbA1c ≥ 7% (53 mmol/mol) was associated with increased risks of: all-cause mortality (14 studies; RR: 1.14 [95% CI: 1.03–1.27]; p-value: 0.012), cancer-specific mortality (5; 1.68 [1.13–2.49]; p-value: 0.011) and cancer recurrence (8; 1.68 [1.18–2.38; p-value: 0.004]), with moderate to high heterogeneity. Dose-response meta-analyses indicated that 1-unit increment of HbA1c (%) was associated with increased risks of all-cause mortality (13 studies; 1.04 [1.01–1.08]; p-value: 0.016) and cancer-specific mortality (4; 1.11 [1.04–1.20]; p-value: 0.003). All RRs were attenuated in trim-and-fill analyses. Conclusions Our findings suggested that glycaemic control might be a modifiable risk factor for mortality and cancer recurrence in people with cancer and pre-existing diabetes. High-quality studies with a larger sample size are warranted to confirm these findings due to heterogeneity and potential small-study effects. In the interim, it makes clinical sense to recommend continued optimal glycaemic control.

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Section: Discussionmentioning

confidence: 99%

Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis

et al. 2022

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“…A semi-structured topic guide was used to guide each patient interview. The topic guide was developed using insights from our group’s prior work [ 10 , 16 ], as well as discussions with clinical experts in endocrinology, primary care, and oncology. First, patients were asked to describe their overall experiences co-managing diabetes and breast cancer.…”

Section: Methodsmentioning

confidence: 99%

“…Prior work has shown that patients with cancer have difficulty finding time for diabetes management during cancer treatment, which they say demands their full attention [ 8 , 10 ]. We have also heard from oncologists that diabetes management is not their clinical priority or expertise [ 9 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Diabetes and cancer co-management: patient-reported challenges, needs, and priorities

Pinheiro

Cho

Rothman

et al. 2023

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Introduction Twenty percent of breast cancer survivors have co-occurring diabetes and face a 50% greater risk of 10-year mortality compared to survivors without diabetes. Individuals with cancer are often overwhelmed during cancer treatment and have less time for their diabetes, contributing to worse outcomes. We elicited perspectives of breast cancer survivors with diabetes regarding their specific needs for diabetes and cancer co-management. Methods We conducted semi-structured interviews with women with breast cancer aged 40 + years at three New York City hospitals from May 2021 to March 2022. Eligible participants had type 2 diabetes or pre-diabetes. Interviews were audio-recorded, professionally transcribed, and coded by two independent reviewers. Results We conducted interviews with 15 females with breast cancer of mean age 61.5 years (SD 7.2); 70% were Black, Hispanic, or Asian/Pacific Islander, and 20% had only a high school education. Most (73%) patients were insured by Medicaid or Medicare, and 73% underwent chemotherapy as part of their cancer care. Of the 15 participants, 60% reported that their glucose levels were of control during cancer treatment and nearly 50% reported glucose levels > 200 mg/dL. We identified distinct themes that reflect patient-reported challenges (worse glucose control after initiation of cancer treatment, lack of information on co-managing diabetes, negative psychosocial effects, burden of diabetes management during cancer care) and needs/priorities (designated provider to help, educational resources specific to diabetes and cancer, and individualized care plans). Conclusions Patients co-managing diabetes and cancer face challenges and have unmet needs that should be addressed to improve diabetes control during cancer treatment. Our findings can directly inform interventions aimed at improving glucose control in this population.

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“…Though results are mixed, studies collectively indicate a deleterious effect of cancer and its treatment on diabetes management and control, which for many people is suboptimal even before diagnosis of cancer 13 14. Research shows that during cancer treatment many people with diabetes have reduced adherence to diabetes medications and self-care behaviours that contribute to glycaemic control (eg, blood glucose monitoring, eating healthily, exercising), and have poorer glycaemic control (eg, increased HbA1c levels, diabetes treatment escalations), than pre-cancer diagnosis 20 21. Studies have also noted that, following a cancer diagnosis, some people with diabetes undergo less diabetes-related screening aimed at mitigation of diabetic complications (eg, retinal screening, low-density lipoprotein tests) 22–24…”

Section: Introductionmentioning

confidence: 99%

Identifying ways to improve diabetes management during cancer treatments (INDICATE): protocol for a qualitative interview study with patients and clinicians

et al. 2022

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IntroductionA large and growing number of patients with cancer have comorbid diabetes. Cancer and its treatment can adversely impact glycaemic management and control, and there is accumulating evidence that suboptimal glycaemic control during cancer treatment is a contributory driver of worse cancer-related outcomes in patients with comorbid diabetes. Little research has sought to understand, from the perspective of patients and clinicians, how and why different aspects of cancer care and diabetes care can complicate or facilitate each other, which is key to informing interventions to improve diabetes management during cancer treatments. This study aims to identify and elucidate barriers and enablers to effective diabetes management and control during cancer treatments, and potential intervention targets and strategies to address and harness these, respectively.Methods and analysisQualitative interviews will be conducted with people with diabetes and comorbid cancer (n=30–40) and a range of clinicians (n=30–40) involved in caring for this patient group (eg, oncologists, diabetologists, specialist nurses, general practitioners). Semistructured interviews will examine participants’ experiences of and perspectives on diabetes management and control during cancer treatments. Data will be analysed using framework analysis. Data collection and analysis will be informed by the Theoretical Domains Framework, and related Theory and Techniques Tool and Behaviour Change Wheel, to facilitate examination of a comprehensive range of barriers and enablers and support identification of pertinent and feasible intervention approaches. Study dates: January 2021–January 2023.Ethics and disseminationThe study has approval from National Health Service (NHS) West Midlands—Edgbaston Research Ethics Committee. Findings will be presented to lay, clinical, academic and NHS and charity service–provider audiences via dissemination of written summaries and presentations, and published in peer-reviewed journals. Findings will be used to inform development and implementation of clinical, health services and patient-management intervention strategies to optimise diabetes management and control during cancer treatments.

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Determining the Impact of a Cancer Diagnosis on Diabetes Management

Cited by 13 publications

References 56 publications

Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis

Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis

Diabetes and cancer co-management: patient-reported challenges, needs, and priorities

Identifying ways to improve diabetes management during cancer treatments (INDICATE): protocol for a qualitative interview study with patients and clinicians

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