Glucose Intolerance During Adjuvant Chemotherapy for Breast Cancer

Hickish, Tamas; Astras, George; Thomas, Peter; Penfold, Sally A.; Purandare, Laura; Hickish, T.; Kerr, David

doi:10.1093/jnci/djp025

Cited by 34 publications

(28 citation statements)

References 7 publications

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“…Oestrogen suppression as a result of chemotherapy may further promote diabetes; however, this factor may be less of an issue within the postmenopausal population [8,9,19]. In addition, to reduce nausea associated with chemotherapy, glucocorticoids are often simultaneously used [20] and this has been associated with acute hyperglycaemia, although no long-term impact on diabetes risk has been shown [20][21][22][23]. The transient nature of diabetes resulting from the glucocorticoids [18,21] may account for the higher odds initially following breast cancer diagnosis and its subsequent decrease, due to a depletion of susceptible individuals from the at-risk population [24].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, to reduce nausea associated with chemotherapy, glucocorticoids are often simultaneously used [20] and this has been associated with acute hyperglycaemia, although no long-term impact on diabetes risk has been shown [20][21][22][23]. The transient nature of diabetes resulting from the glucocorticoids [18,21] may account for the higher odds initially following breast cancer diagnosis and its subsequent decrease, due to a depletion of susceptible individuals from the at-risk population [24]. Finally, it is possible that patients receiving chemotherapy are monitored more closely and thus more likely to be screened for diabetes than nontreated patients.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of diabetes among postmenopausal breast cancer survivors

et al. 2012

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Aims/hypothesis Evidence is emerging of an association between breast cancer and diabetes; however, it is uncertain whether diabetes incidence is increased in postmenopausal breast cancer survivors compared with women without breast cancer. The objective of this study was to determine whether postmenopausal women who develop breast cancer have a higher incidence of diabetes than those who do not develop breast cancer. Methods We used population-based data from Ontario, Canada to compare the incidence of diabetes among women with breast cancer, aged 55 years or older, from 1996 to 2008, with that of age-matched women without breast cancer. We used Cox proportional hazard models to estimate the effect of breast cancer on the cause-specific hazard of developing diabetes overall and in the subgroup of women who received adjuvant chemotherapy. Results Of 24,976 breast cancer survivors and 124,880 controls, 9.7% developed diabetes over a mean follow-up of 5.8 years. The risk of diabetes among breast cancer survivors compared with women without breast cancer began to increase 2 years after diagnosis (HR 1.07 [95% CI, 1.02, 1.12]), and rose to an HR of 1.21 (95% CI, 1.09, 1.35) after 10 years. Among those who received adjuvant chemotherapy (n04,404), risk was highest in the first 2 years after diagnosis (HR 1.24 [95% CI 1.12, 1.38]) and then declined. Conclusions/interpretation We found a modest increase in the incidence of diabetes among postmenopausal breast cancer survivors that varied over time. In most women the risk began to increase 2 years after cancer diagnosis but the highest risk was in the first 2 years in those who received adjuvant therapy. Our study suggests that greater diabetes screening and prevention strategies among breast cancer survivors may be warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence of diabetes among postmenopausal breast cancer survivors

et al. 2012

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“…The amount of FDG uptake in the tumor will decrease with increasing blood glucose level and correspondingly lower SUV and Ki values, as described in Lindholm et al (1993). Blood glucose levels could be elevated as result of chemotherapy, which has been reported to cause glucose intolerance (Hickish et al 2009). They reported a maximum blood glucose level of 8 mmol l −1 , which is beyond the acceptable limit for FDG PET imaging as recommended in Boellaard et al (2010).…”

Section: Discussionmentioning

confidence: 99%

A virtual clinical trial comparing static versus dynamic PET imaging in measuring response to breast cancer therapy

et al. 2017

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We developed a method to evaluate variations in the PET imaging process in order to characterize the relative ability of static and dynamic metrics to measure breast cancer response to therapy in a clinical trial setting. We performed a virtual clinical trial by generating 540 independent and identically distributed PET imaging study realizations for each of 22 original dynamic fluorodeoxyglucose (18F-FDG) breast cancer patient studies pre- and post-therapy. Each noise realization accounted for known sources of uncertainty in the imaging process, such as biological variability and SUV uptake time. Four definitions of SUV were analyzed, which were SUVmax, SUVmean, SUVpeak, and SUV50%. We performed a ROC analysis on the resulting SUV and kinetic parameter uncertainty distributions to assess the impact of the variability on the measurement capabilities of each metric. The kinetic macro parameter, Ki, showed more variability than SUV (mean CV Ki = 17%, SUV = 13%), but Ki pre- and post-therapy distributions also showed increased separation compared to the SUV pre- and post-therapy distributions (mean normalized difference Ki = 0.54, SUV = 0.27). For the patients who did not show perfect separation between the pre- and post-therapy parameter uncertainty distributions (ROC AUC < 1), dynamic imaging outperformed SUV in distinguishing metabolic change in response to therapy, ranging from 12 to 14 of 16 patients over all SUV definitions and uptake time scenarios (p < 0.05). For the patient cohort in this study, which is comprised of non-high-grade ER+ tumors, Ki outperformed SUV in an ROC analysis of the parameter uncertainty distributions pre- and post-therapy. This methodology can be applied to different scenarios with the ability to inform the design of clinical trials using PET imaging.

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“…It is considered that steroids affect post-meal glucose much more so than morning fasting sugars and glucocorticoid administration is associated with impairment of insulin sensitivity, elevations in peripheral glucose levels, and the suppression of the hypothalamic – pituitary – adrenal axis [31]. It was reported that glucocorticosteroids (steroids) and chemotherapy had profound effects on glucose metabolism, particularly on postprandial hyperglycemia [10], [11]. Our results indicate that, the overall incidence of total diabetes (33.3%) in breast cancer patients during chemotherapy increased more obviously than that (25.3%) in breast cancer patients at initial diagnosis and the incidence of previously undiagnosed diabetes (84.4%) in diabetic breast cancer patients during chemotherapy were also much higher than that (80.0%) in breast cancer patients at initial diagnosis, but without statistical difference ( p>0.05 ).…”

Section: Discussionmentioning

confidence: 99%

“…Breast cancer patients often receive steroids as a component of their chemotherapy. It was believed that steroids and chemotherapeutics had profound effects on glucose metabolism, particularly on postprandial hyperglycemia [10], [11]. It was reported that, in the United States, impaired glucose tolerance was an independent predictor for cancer mortality [12] and even a few days of hyperglycemia had deleterious effects on the immune system [13].…”

Section: Introductionmentioning

confidence: 99%

On the Status and Comparison of Glucose Intolerance in Female Breast Cancer Patients at Initial Diagnosis and during Chemotherapy through an Oral Glucose Tolerance Test

et al. 2014

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AimsThis study is to estimate the status and comparison of glucose intolerance in female breast cancer patients at initial diagnosis and during chemotherapy through an oral glucose tolerance test (OGTT), as well as to learn the effect of chemotherapy on the glucose metabolism of breast cancer patients.MethodsAll the 79 breast cancer patients at initial diagnosis, with the mean age of 53.2 years, and 96 breast cancer patients before the 5th or 6th cycle of chemotherapy, with the mean age of 51.5 years, participated in the study from December 2012 to October 2013. After an overnight fast, participants underwent OGTT test, and fasting and 2-hour glucose levels were measured to identify undiagnosed diabetes and prediabetes (i.e., impaired fasting glucose or impaired glucose tolerance) in them. Previously diagnosed diabetes among the female breast cancer patients was determined on the self-report and the medical record.ResultsThe overall incidences of total normal glucose tolerance, prediabetes, diabetes in female breast cancer patients at initial diagnosis and during chemotherapy were 24.1% and 38.5% (p<0.05), 50.6% and 28.1% (p<0.05), and 25.3% and 33.3% (p>0.05), respectively, and the differences of normal glucose tolerance and prediabetes instead of diabetes between the two groups were statistically significant. About 84% of the total diabetes and prediabetes in the female breast cancer patients at initial diagnosis and 79.7% of those during chemotherapy need to be diagnosed with OGTT.ConclusionsBreast cancer patients have high incidences of diabetes and prediabetes. After chemotherapy even with steroids, some breast cancer patients with abnormal glucose metabolism may even become normal. Isolated hyperglycemia 2 hours after glucose loading is common, and OGTT should be made for breast cancer patients at initial diagnosis and during chemotherapy.

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Glucose Intolerance During Adjuvant Chemotherapy for Breast Cancer

Cited by 34 publications

References 7 publications

Incidence of diabetes among postmenopausal breast cancer survivors

Incidence of diabetes among postmenopausal breast cancer survivors

A virtual clinical trial comparing static versus dynamic PET imaging in measuring response to breast cancer therapy

On the Status and Comparison of Glucose Intolerance in Female Breast Cancer Patients at Initial Diagnosis and during Chemotherapy through an Oral Glucose Tolerance Test

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