Results of General Internal Medicine Consultations for Diabetes Mellitus in 283 Cancer Patients

Liu, Wenli; Vyas, Ajit; Escalante, Carmelita P; Weiser, Mary Ann; Wang, Jing; Geraci, Jane M.

doi:10.1097/maj.0b013e31805340d4

Cited by 7 publications

(6 citation statements)

References 16 publications

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“…As with cancer-specific mortality, this difference was greatest in women with a longer duration of diabetes and in those with cardiovascular disease. A reason for this finding may be that diabetes and cardiovascular disease are less aggressively managed in the setting of cancer treatments and surveillance, leading to higher noncancer mortality (26). Future studies to evaluate diabetes care patterns in patients with cancer may help to guide strategies to lessen this disparity in noncancer mortality.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Diabetes on Breast Cancer Treatments and Outcomes: A Population-Based Study

et al. 2018

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Section: Discussionmentioning

confidence: 99%

The Impact of Diabetes on Breast Cancer Treatments and Outcomes: A Population-Based Study

et al. 2018

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“…radiation and chemotherapy) causing heart, respiratory, kidney and memory problems but also of hormone suppressing therapy in BC patients [95]. Compounding on this problem, cancer survivors fail to receive the same level of care for their comorbid condition compared to the general population [96] and this is especially true for type two diabetes [97]. Hence it may become even more relevant to implement cost-effective lifestyle risk reduction strategies.…”

Section: Discussionmentioning

confidence: 99%

Low glycemic index diet, exercise and vitamin D to reduce breast cancer recurrence (DEDiCa): design of a clinical trial

et al. 2017

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BackgroundMechanisms influencing breast cancer (BC) development and recurrence include hyperglycemia, hyperinsulinemia, high insulin-like growth factor-1, high circulating estrogen, inflammation and impaired cellular differentiation/apoptosis. A lifestyle program that targets all the above mechanisms may be warranted. Low glycemic index (GI) foods produce lower post-prandial glucose and insulin responses and have been associated with lower BC risk. Moderate physical activity post-diagnosis reduces BC recurrence and mortality, partly explained by reduced insulin and estrogen levels. Vitamin D increases cell differentiation/apoptosis and high serum vitamin D levels improve BC survival. Yet no trial has evaluated the combined effect of a low GI diet, moderate physical activity and vitamin D supplementation on BC recurrence in the context of a Mediterranean lifestyle setting.MethodsWomen (30-74 yr) who had undergone surgery for primary histologically confirmed BC (stages I-III) within the previous 12 months, in cancer centres in Italy, will be randomized to follow, for a maximum of 33 months, either a high intensity treatment (HIT) composed of low GI diet + exercise + vitamin D (60 ng/mL serum concentration) or a lower intensity treatment (LITE) with general advice to follow a healthy diet and exercise pattern + vitamin D to avoid insufficiency. Both interventions are on a background of a Mediterranean diet. Considering a 20% recurrence rate within 3 years for BC cases and a predicted rate of 10% in the HIT group, with power of 80% and two-sided alpha of 0.05, the subject number required will be 506 (n = 253 in each arm). Clinic visits will be scheduled every 3 months. Dietary and exercise counselling and vitamin D supplements will be given at each clinic visit when blood samples, anthropometric measures and 7-day food records will be collected.DiscussionDEDiCa study aims to reduce BC recurrence in women with BC using a lifestyle approach with additional vitamin D and to investigate possible cardio-metabolic benefits as well as epigenetic modifications according to lifestyle changes. Given the supporting evidence and safety of the components of our intervention we believe it is feasible and urgent to test it in cancer patients.Trial registrationMay 11, 2016; NCT02786875. EudraCT Number2015-005147-14

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“…Examples are diabetes care [17], cardiopulmonary rehabilitation programs [18] or outpatient management of antithrombotic treatment [19,20]. Health care professionals seem to be more focused on cancer-related care compared to non-cancer related health care needs.…”

Section: Discussionmentioning

confidence: 99%

Excess of health care use in general practice and of comorbid chronic conditions in cancer patients compared to controls

2012

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Background The number of cancer patients and the number of patients surviving initial treatments is expected to rise. Traditionally, follow-up monitoring takes place in secondary care. The contribution of general practice is less visible and not clearly defined. This study aimed to compare healthcare use in general practice of patients with cancer during the follow-up phase compared with patients without cancer. We also examined the influence of comorbid conditions on healthcare utilisation by these patients in general practice. Methods We compared health care use of N=8,703 cancer patients with an age and gender-matched control group of patients without cancer from the same practice. Data originate from the Netherlands Information Network of General Practice (LINH), a representative network consisting of 92 general practices with 350,000 enlisted patients. Health care utilisation was assessed using data on contacts with general practice, prescription and referral rates recorded between 1/1/2001 and 31/12/2007. The existence of additional comorbid chronic conditions (ICPC coded) was taken into account. Results Compared to matched controls, cancer patients had more contacts with their GP-practice (19.5 vs. 11.9, p<.01), more consultations with the GP (3.5 vs. 2.7, p<.01), more home visits (1.6 vs. 0.4, p<.01) and they got more medicines prescribed (18.7 vs. 11.6, p<.01) during the follow-up phase. Cancer patients more often had a chronic condition than their matched controls (52% vs. 44%, p<.01). Having a chronic condition increased health care use for both patients with and without cancer. Cancer patients with a comorbid condition had the highest health care use. Conclusion We found that cancer patients in the follow-up phase consulted general practice more often and suffered more often from comorbid chronic conditions, compared to patients without cancer. It is expected that the number of cancer patients will rise in the years to come and that primary health care professionals will be more involved in follow-up care. Care for comorbid chronic conditions, communication between specialists and GPs, and coordination of tasks then need special attention.

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Results of General Internal Medicine Consultations for Diabetes Mellitus in 283 Cancer Patients

Cited by 7 publications

References 16 publications

The Impact of Diabetes on Breast Cancer Treatments and Outcomes: A Population-Based Study

The Impact of Diabetes on Breast Cancer Treatments and Outcomes: A Population-Based Study

Low glycemic index diet, exercise and vitamin D to reduce breast cancer recurrence (DEDiCa): design of a clinical trial

Excess of health care use in general practice and of comorbid chronic conditions in cancer patients compared to controls

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