Improving Coordination of Care Among Healthcare Professionals and Patients With Diabetes and Cancer

Goebel, J; Valinski, Sarah; Hershey, Denise Soltow

doi:10.1188/16.cjon.645-651

Cited by 22 publications

(34 citation statements)

References 17 publications

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“…Cancer April 15, 2020 whose focus is cancer, and the majority view the management of noncancer conditions such as diabetes as beyond their scope. 7 Five prior quantitative studies [38][39][40][41][42] have supported this hypothesis, because diabetes medication adherence was found to decline considerably from before to after a cancer diagnosis, with 1 study reporting 75% adherence in the year before diagnosis to 25% adherence in the year after. 38 To the best of our knowledge, the current study is the first to describe diabetes process measure changes from before to after a cancer diagnosis.…”

Section: Discussionmentioning

confidence: 96%

“…Prior qualitative work hypothesized that diabetes management becomes sidelined during this acute cancer care phase as the demands of cancer care overwhelm patients . Furthermore, oncologists are subspecialists whose focus is cancer, and the majority view the management of noncancer conditions such as diabetes as beyond their scope . Five prior quantitative studies have supported this hypothesis, because diabetes medication adherence was found to decline considerably from before to after a cancer diagnosis, with 1 study reporting 75% adherence in the year before diagnosis to 25% adherence in the year after .…”

Section: Discussionmentioning

confidence: 99%

“…Comorbid diabetes puts patients with cancer at an increased risk of infections, hospitalizations, and mortality . Insufficient attention to diabetes during active cancer care may explain why diabetic patients with cancer have worse outcomes compared with their nondiabetic cancer counterparts . To our knowledge, few studies to date have documented diabetes management patterns among patients with cancer before and after their cancer diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Insufficient attention to diabetes during active cancer care may explain why diabetic patients with cancer have worse outcomes compared with their nondiabetic cancer counterparts. 6,7 To our knowledge, few studies to date have documented diabetes management patterns among patients with cancer before and after their cancer diagnosis. This is important, because hyperglycemia and hyperinsulinemia may stimulate malignant tumor growth and thus cancer recurrence.…”

Section: Introductionmentioning

confidence: 99%

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Diabetes care management patterns before and after a cancer diagnosis: A SEER‐Medicare matched cohort study

Pinheiro

Soroka

Kern

et al. 2020

Cancer

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Background Diabetes places patients with cancer at an increased risk of infections, hospitalizations, and mortality. The objective of the current study was to characterize diabetes care management patterns among patients with cancer in the year before and, separately, after cancer diagnosis. The authors hypothesized that diabetes care declines after a diagnosis of cancer. Methods The Surveillance, Epidemiology, and End Results (SEER) cancer registry linked to Medicare claims data was used. The authors included diabetic beneficiaries aged ≥65 years who were diagnosed with incident, nonmetastatic breast, prostate, or colorectal cancer between 2008 and 2013. Controls were diabetic Medicare beneficiaries in SEER regions who did not have cancer. Cases were matched to controls based on age, sex, Charlson Comorbidity Index, and diabetes severity. Primary outcomes were diabetes care received over 12 months: 1) hemoglobin A1c testing; 2) eye examination; and 3) low‐density lipoprotein testing. Using a difference‐in‐difference (DID) approach, the authors examined use differences 12 months before to after diagnosis for patients with cancer and controls. To avoid capturing testing related to diagnosis and not diabetes management, the authors implemented a 90‐day washout period (45 days before and/or after diagnosis). Results A total of 32,728 diabetic patients with cancer and 32,728 matched noncancer controls were included. After diagnosis, patients with cancer were found to have modest, but significantly lower, rates of diabetes care use compared with controls. Patients with cancer had greater declines in hemoglobin A1c testing (DID, 2.4%; 95% CI, 1.7%‐3.0%), low‐density lipoprotein testing (DID, 4.3%; 95% CI, 3.6%‐5.0%), and receipt of all diabetes indicators (DID, 2.7%; 95% CI, 1.8%‐3.5%) 12 months before to after diagnosis. Conclusions Compared with controls, less diabetes care use was observed among patients with cancer in the year after diagnosis. Understanding and addressing the reasons for this may improve outcomes in this population.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diabetes care management patterns before and after a cancer diagnosis: A SEER‐Medicare matched cohort study

Pinheiro

Soroka

Kern

et al. 2020

Cancer

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“…[ 18 ] In addition, oncologists and patients’ primary care providers may not focus on diabetes management while chemotherapy is being administered. [ 18 19 ] Despite this lack of attention, glycemic control levels can play an important role in improving outcomes for cancer patients with diabetes.…”

Section: Glycemic Controlmentioning

confidence: 99%

Importance of glycemic control in cancer patients with diabetes: Treatment through end of life

Hershey

2017

Asia-Pacific Journal of Oncology Nursing

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Cancer patients with diabetes are at increased risk for developing infections, being hospitalized, and requiring chemotherapy reductions or stoppages. While it has been hypothesized that glycemic control increases the risk for these adverse events, few studies have explored this hypothesis. The purpose of this paper is to discuss the importance of glycemic control in patients with diabetes and cancer during treatment through end of life. Glycemic control was found to play a role; the overall level of health-related quality of life experienced by patients with cancer and diabetes, level of symptom severity experienced and can impact the overall survival of the individual. Evidence-based policies and practice guidelines also need to be developed to help clinicians manage these patients during all phases of care. Using diabetes educators and advance practice, nurses to provide management and care coordination services need to be considered. Survivorship care plans should address both cancer and diabetes management. Finally, glycemic control should continue through end of life, with the main goal of avoiding hypoglycemic events.

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The association of diabetes mellitus and routinely collected patient‐reported outcomes in patients with cancer. A real‐world cohort study

Ose,

Adediran,

Mark

et al. 2024

Cancer Medicine

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ObjectiveCurrent studies have indicated that diabetes mellitus (DM) is highly prevalent in patients with cancer, but there is little research on consequences on the well‐being of patients during cancer treatment. This analysis evaluates the relationship between DM and patient‐reported outcomes (PRO) in patients with cancer, using a large and well‐characterized cohort.MethodsThis study utilized the Total Cancer Care protocol at the University of Utah Huntsman Cancer Institute. For this analysis, we integrated data from electronic health records, the Huntsman Cancer Registry, and routinely collected PRO questionnaires. We assessed the association between DM in patients with cancer and PRO scores for anxiety, depression, fatigue, pain interference, and physical function using multiple linear regression and t‐tests.ResultsThe final cohort comprised 3512 patients with cancer, with a mean age of 57.8 years at cancer diagnosis. Of all patients, 49.1% (n = 1724) were female, with 82.0% (n = 2879) patients reporting PROs at least at one time point. Compared with patients who responded, nonresponders were more often female (p = 0.0035), less frequently non‐Hispanic White (p = 0.0058), and had a higher BMI (p = 0.0759). Patients with cancer and diabetes had worse PRO scores for anxiety (p = 0.0003), depression (p < 0.0001), fatigue (p < 0.0001), pain interference (p < 0.0001), and physical function (p < 0.0001) compared to patients with cancer without diabetes. Significant associations between diabetes and PRO scores were observed for anxiety (β ± SE: 1.27 ± 0.48; p = 0.0076), depression (β ± SE: 1.46 ± 0.45; p = 0.0011), fatigue (β ± SE: 2.11 ± 0.52; p < 0.0001), pain interference (β ± SE: 1.42 ± 0.50; p = 0.0046), and physical function (β ± SE: −2.74 ± 0.48; p < 0.0001).ConclusionsThe results of this study suggest that patients with cancer and diabetes may be at greater risk for anxiety, depression, fatigue, higher pain interference, and reduced physical function. Strengthening diabetes management is imperative to address the negative impact of diabetes on PROs. In particular, this may be true for patients with skin, breast, prostate, and kidney cancer.

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Improving Coordination of Care Among Healthcare Professionals and Patients With Diabetes and Cancer

Abstract: Three overarching themes were identified by patients, nurses, and oncologists.

Cited by 22 publications

References 17 publications

Diabetes care management patterns before and after a cancer diagnosis: A SEER‐Medicare matched cohort study

Diabetes care management patterns before and after a cancer diagnosis: A SEER‐Medicare matched cohort study

Importance of glycemic control in cancer patients with diabetes: Treatment through end of life

The association of diabetes mellitus and routinely collected patient‐reported outcomes in patients with cancer. A real‐world cohort study

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