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

Abstract

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.

Pathomechanismen von Diabetes und Krebs

“…Das Auftreten bestimmter Krebsarten und einer erhöhten Krebssterblichkeit ist mit Diabetes mellitus Typ 2 (DM2) eindeutig assoziiert [2]. Menschen mit Diabetes und einer Krebserkrankung vernachlässigen die Behandlung des Diabetes und tragen damit vielleicht zum schlechteren Outcome der Krebserkrankung bei [3].…”

Diabetes and Cancer Co-management Education: Leveraging the Patient Activated Learning System (PALS) for Patients with Breast Cancer

“…Our team analyzed a series of interviews with women who were diagnosed with breast cancer and either type 2 diabetes or prediabetes to better characterize the barriers to effective diabetes and breast cancer co-management. Patients mentioned that they did not receive any information or guidance on how to manage the two conditions or the side effects of chemotherapy [ 11 ]. Furthermore, they felt frustrated with the lack of attention paid to their DM during cancer treatment and felt the need to take a more active role in their DM management [ 11 ], which can be overwhelming.…”

“…Patients mentioned that they did not receive any information or guidance on how to manage the two conditions or the side effects of chemotherapy [ 11 ]. Furthermore, they felt frustrated with the lack of attention paid to their DM during cancer treatment and felt the need to take a more active role in their DM management [ 11 ], which can be overwhelming. Building on this work, we recently conducted additional interviews among 15 women with breast cancer who had prediabetes or type 2 DM and underwent chemotherapy [ 11 ].…”

“…Furthermore, they felt frustrated with the lack of attention paid to their DM during cancer treatment and felt the need to take a more active role in their DM management [ 11 ], which can be overwhelming. Building on this work, we recently conducted additional interviews among 15 women with breast cancer who had prediabetes or type 2 DM and underwent chemotherapy [ 11 ]. In this study, we confirmed that > 60% of women experienced high glucose during chemotherapy regimens (50% had glucose levels < 200 mg/dL).…”