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Andersson E, Brådvik G, Nilsson FOL, Arpegård J, Strambi A, Kollberg P, Carlsson KS. Prevalence of diabetes and hospitalization due to poor glycemic control in people with bladder cancer or renal cell carcinoma in Sweden. BMC Urol 2024; 24:148. [PMID: 39020360 PMCID: PMC11253448 DOI: 10.1186/s12894-024-01536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 07/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Bladder cancer (BC) and Renal cell carcinoma (RCC) are the most common urogenital cancers among both sexes, with a yearly global incidence of around 500 000 each. Both BC and RCC have been linked to diabetes. Poor glycemic control (malglycemia) is a serious consequence of diabetes and a possible consequence of systemic treatments used in BC and RCC. The objective of this study was to investigate the prevalence of diabetes and use of hospital-based care for malglycemia in people with BC or RCC. METHODS This Swedish retrospective population-based register study used national health-data registers for longitudinal data on cancer incidence covering 15 years, use of hospital-based health care, and filled prescriptions of outpatient medications. Study endpoints included co-prevalence of diabetes in individuals with BC/RCC, healthcare resource utilization due to malglycemia, use of systemic corticosteroids, and changes in diabetes management for people with concomitant type 2 diabetes. RESULTS We identified 36,620 and 15,581 individuals diagnosed with BC and RCC, respectively, between 2006 and 2019. The proportion of individuals registered with diabetes was 24% in BC and 23% in RCC. An association between BC/RCC and poor glycemic control was found, although the number of malglycemic events in hospital-based care were few (65/59 per 1000 individuals with diabetes and BC/RCC respectively with at least one event). An earlier switch to insulin-based diabetes management was observed in BC/RCC compared to matched individuals with type 2 diabetes but no cancer. The results also indicated an association between steroid treatment and poor glycemic control, and that systemic corticosteroids were more common among people with BC/RCC compared to diabetes controls. CONCLUSION The high prevalence of diabetes and increased use of systemic corticosteroid treatment observed in this large national study highlights the need for specific clinical management, risk-assessment, and monitoring of individuals with BC/RCC and diabetes.
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Affiliation(s)
- Emelie Andersson
- The Swedish Institute for Health Economics, Råbyvägen 2, 223 61, Lund, Sweden.
| | - Gunnar Brådvik
- The Swedish Institute for Health Economics, Råbyvägen 2, 223 61, Lund, Sweden
| | | | | | - Angela Strambi
- Pfizer AB, Solnavägen 3H, 113 63, Stockholm, Sweden
- Present address: Fondazione Toscana Life Sciences, Siena, Italy
| | - Petter Kollberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden
| | - Katarina Steen Carlsson
- The Swedish Institute for Health Economics, Råbyvägen 2, 223 61, Lund, Sweden
- Department of Clinical Sciences, Malmö, Health Economics, Lund University, BMC F12, 221 84, Lund, Sweden
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2
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Natalicchio A, Marrano N, Montagnani M, Gallo M, Faggiano A, Zatelli MC, Argentiero A, Del Re M, D'Oronzo S, Fogli S, Franchina T, Giuffrida D, Gori S, Ragni A, Marino G, Mazzilli R, Monami M, Morviducci L, Renzelli V, Russo A, Sciacca L, Tuveri E, Cortellini A, Di Maio M, Candido R, Perrone F, Aimaretti G, Avogaro A, Silvestris N, Giorgino F. Glycemic control and cancer outcomes in oncologic patients with diabetes: an Italian Association of Medical Oncology (AIOM), Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Italian Society of Endocrinology (SIE), Italian Society of Pharmacology (SIF) multidisciplinary critical view. J Endocrinol Invest 2024:10.1007/s40618-024-02417-z. [PMID: 38935200 DOI: 10.1007/s40618-024-02417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Increasing evidence suggests that diabetes increases the risk of developing different types of cancer. Hyperinsulinemia, hyperglycemia and chronic inflammation, characteristic of diabetes, could represent possible mechanisms involved in cancer development in diabetic patients. At the same time, cancer increases the risk of developing new-onset diabetes, mainly caused by the use of specific anticancer therapies. Of note, diabetes has been associated with a ∼10% increase in mortality for all cancers in comparison with subjects who did not have diabetes. Diabetes is associated with a worse prognosis in patients with cancer, and more recent findings suggest a key role for poor glycemic control in this regard. Nevertheless, the association between glycemic control and cancer outcomes in oncologic patients with diabetes remains unsettled and poorly debated. PURPOSE The current review seeks to summarize the available evidence on the effect of glycemic control on cancer outcomes, as well as on the possibility that timely treatment of hyperglycemia and improved glycemic control in patients with cancer and diabetes may favorably affect cancer outcomes.
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Affiliation(s)
- A Natalicchio
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, I-70124, Bari, Italy
| | - N Marrano
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, I-70124, Bari, Italy
| | - M Montagnani
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Pharmacology, University of Bari Aldo Moro, Bari, Italy
| | - M Gallo
- Endocrinology and Metabolic Diseases Unit, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, Italy
| | - A Faggiano
- Endocrinology Unit, Department of Clinical & Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - M C Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - A Argentiero
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - M Del Re
- Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - S D'Oronzo
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - S Fogli
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - T Franchina
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - D Giuffrida
- Department of Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | - S Gori
- Oncologia Medica, IRCCS Don Calabria-Sacro Cuore Hospital, Negrar, Verona, Italy
| | - A Ragni
- Endocrinology and Metabolic Diseases Unit, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, Italy
| | - G Marino
- Internal Medicine Department, Ospedale dei Castelli, Asl Roma 6, Ariccia, Rome, Italy
| | - R Mazzilli
- Endocrinology Unit, Department of Clinical & Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - M Monami
- Diabetology, Careggi Hospital and University of Florence, Florence, Italy
| | - L Morviducci
- Diabetology and Nutrition Unit, Department of Medical Specialties, ASL Roma 1 - S. Spirito Hospital, Rome, Italy
| | - V Renzelli
- Diabetologist and Endocrinologist, Italian Association of Clinical Diabetologists, Rome, Italy
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - L Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy
| | - E Tuveri
- Diabetology, Endocrinology and Metabolic Diseases Service, ASL-Sulcis, Carbonia, Italy
| | - A Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Universitá Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - M Di Maio
- Department of Oncology, University of Turin, AOU Città Della Salute e della Scienza di Torino, Turin, Italy
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy
| | - F Perrone
- Clinical Trials Unit, National Cancer Institute, Naples, Italy
| | - G Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - A Avogaro
- Department of Medicine, Section of Diabetes and Metabolic Diseases, University of Padova, Padua, Italy
| | - N Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - F Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, I-70124, Bari, Italy.
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Kim JY, Han JM, Yun B, Yee J, Gwak HS. Machine learning-based prediction of risk factors for abnormal glycemic control in diabetic cancer patients receiving nutrition support: a case-control study. Hormones (Athens) 2023; 22:637-645. [PMID: 37755659 DOI: 10.1007/s42000-023-00492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To date, risk factors affecting abnormal glycemic control have not been investigated. This study aimed to analyze risk factors for hypoglycemia or hyperglycemia in diabetic cancer patients receiving nutritional support by using machine learning methods. METHODS This retrospective two-center study was performed using medical records. Odds ratios and adjusted odds ratios were estimated from univariate and multivariate analyses, respectively. Machine learning algorithms, including five-fold cross-validated multivariate logistic regression, elastic net, and random forest, were developed to predict risk factors for hypoglycemia and hyperglycemia. RESULTS Data from 127 patients were analyzed. The use of sulfonylurea (SU) and blood urea nitrogen (BUN) level > 20 mg/dL increased hypoglycemia by 6.3-fold (95% CI 1.30-30.47) and 5.0-fold (95% CI 1.06-23.46), respectively. In contrast, patients who received an actual energy intake/total energy expenditure (TEE) ≥ 120% and used dipeptidyl peptidase-4 (DPP-4) inhibitors had a higher risk of hyperglycemia by 19.3- (95% CI 1.46-254.78) and 3.3-fold (95% CI 1.23-8.61), respectively. An initial blood glucose level ≥ 182.5 mg/dL also increased the risk of hyperglycemia by 15.3-fold. AUROC values for all machine learning methods indicated acceptable and excellent performance for hypoglycemia and hyperglycemia. CONCLUSION The use of SU and BUN level > 20 mg/dL increased the risk of hypoglycemia, whereas an initial blood glucose level ≥ 182.5 mg/dL, a supplied actual energy intake/ TEE ≥ 120%, and the use of DPP-4 inhibitors increased the risk of hyperglycemia.
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Affiliation(s)
- Jee Yun Kim
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Korea
- Department of Pharmacy, Catholic Kwandong University International St. Mary's Hospital, Incheon, 22711, Korea
| | - Ji Min Han
- College of Pharmacy, Chungbuk National University, Cheongju-Si, 28160, Korea
| | - Bona Yun
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul, 03760, Korea
- Department of Pharmacy, Korea Institute of Radiological & Medical Sciences, Seoul, 01812, Korea
| | - Jeong Yee
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Korea
| | - Hye Sun Gwak
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Korea.
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Lee WC, Digbeu BDE, Serag H, Sallam H, Kuo YF. Utilization of diabetes self-management program among breast, prostate, and colorectal cancer survivors: Using 2006-2019 Texas Medicare data. PLoS One 2023; 18:e0289268. [PMID: 37498914 PMCID: PMC10374119 DOI: 10.1371/journal.pone.0289268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Cancer treatment is associated with inferior health outcomes such as diabetes. Medicare provides Diabetes Self-Management Training (DSMT) program to beneficiaries to achieve normal metabolic control and reduce the risk of micro and macro-vascular complications. This study aimed to examine the trend of DSMT utilization among cancer survivors and assess individual characteristics associated with it. METHODS The data for this study was from Texas Cancer Registry-Medicare linkage data of patients with prostate, breast, or colorectal cancer diagnosed in 1999-2017. Outcome variables include the number of first-time DSMT users, the number of total users, and the average number of DSMT utilization in minutes. We performed logistic regression and gamma regression to obtain a multivariable-adjusted odds ratio for the association between DSMT utilization and individual characteristics. RESULTS The number of first-time users has slowly increased over the years (from 99 to 769 per 1,000) but suddenly dropped after 2016. The number of all users (first-time and follow-up users) has increased (from 123 to 1,201 per 1,000) and plateaued after 2016. Determinants including Hispanic ethnicity (O.R. = 1.10) and Medicare-Medicaid dual eligibility (O.R. = 1.25) are positively associated with both the initiation and retention of the DSMT. A barrier to both initiation and retention of DSMT is living in a metropolitan area (O.R. = 0.90). CONCLUSIONS Multi-level strategies to enhance accessibility and availability of DSMT programs for Medicare beneficiaries are highly recommended. Examining the determinants of initiation and retention of DSMT over 14 years provides insights on strategies to meet the needs of cancer survivors and reduce the burden of diabetes on them.
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Affiliation(s)
- Wei-Chen Lee
- Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Biai Dominique Elmir Digbeu
- Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Hani Serag
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Hanaa Sallam
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, Texas, United States of America
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Toyoshima MTK, Cukier P, Damascena AS, Batista RL, de Azevedo Correa F, Zanatta Kawahara E, Minanni CA, Hoff AO, Nery M. Fructosamine and glycated hemoglobin as biomarkers of glycemic control in people with type 2 diabetes mellitus and cancer (GlicoOnco study). Clinics (Sao Paulo) 2023; 78:100240. [PMID: 37390617 PMCID: PMC10338289 DOI: 10.1016/j.clinsp.2023.100240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Glycemic control is important to avoid diabetes complications in individuals with cancer. There is no evidence for HbA1c and fructosamine as reliable biomarkers in these conditions. There are particularities in caring for patients with diabetes and cancer that can alter these biomarkers. OBJECTIVE The aim of this study was to evaluate HbA1c and fructosamine as glycemic biomarkers in people with type 2 diabetes and cancer, undergoing clinical or surgical oncological treatment. METHODS The authors conducted a single-center, retrospective analysis with people who have cancer and diabetes. Comparison of glycemic biomarkers (HbA1c, fructosamine, and Self-Monitoring of Blood Glucose [SMBG]) was performed including evaluation in individuals undergoing chemotherapy, using glucocorticoids, with anemia, hypoproteinemia or with reduced estimated Glomerular Filtration Rate (eGFR). RESULTS There was a strong positive correlation between fructosamine and HbA1c (n = 318, r = 0.66, p < 0.001) in people with diabetes and cancer even in those under chemotherapy (n = 101, r = 0.61, p < 0.001) or using glucocorticoids (n = 96, r = 0.67, p<0.001). There was a strong correlation between HbA1c and fructosamine in subjects with anemia (n = 111, r = 0.66, p < 0.001), hypoproteinemia (n = 54, r = 0.67, p < 0.001), or with eGFR ≥ 60 mL/min/1.73 m2 (n = 189, r = 0.70, p < 0.001), and moderate correlation with hypoalbuminemia (n = 21, r = 0.54, p = 0.001) and with reduced eGFR (n = 67, r = 0.57, p < 0.001). The correlations between fructosamine and HbA1c with SMBG were moderate (n = 164, r = 0.49, p < 0.001; n = 111, r = 0.55, p < 0.001, respectively), strong in subjects undergoing chemotherapy, with hypoalbuminemia or hypoproteinemia, and at least moderate, if eGFR < 60 mL/min/1.73 m2 or with anemia. CONCLUSIONS Fructosamine and HbA1c can be used as glycemic biomarkers in people with diabetes and cancer, even in those with anemia, hypoproteinemia, or undergoing chemotherapy.
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Affiliation(s)
- Marcos Tadashi Kakitani Toyoshima
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Priscilla Cukier
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Serviço de Endocrinologia e Metabologia. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aline Santos Damascena
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rafael Loch Batista
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fernanda de Azevedo Correa
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Zanatta Kawahara
- Serviço de Endocrinologia e Metabologia. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carlos André Minanni
- Serviço de Endocrinologia e Metabologia. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ana O Hoff
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcia Nery
- Serviço de Endocrinologia e Metabologia. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Natalicchio A, Montagnani M, Gallo M, Marrano N, Faggiano A, Zatelli MC, Mazzilli R, Argentiero A, Danesi R, D'Oronzo S, Fogli S, Giuffrida D, Gori S, Ragni A, Renzelli V, Russo A, Franchina T, Tuveri E, Sciacca L, Monami M, Cirino G, Di Cianni G, Colao A, Avogaro A, Cinieri S, Silvestris N, Giorgino F. MiRNA dysregulation underlying common pathways in type 2 diabetes and cancer development: an Italian Association of Medical Oncology (AIOM)/Italian Association of Medical Diabetologists (AMD)/Italian Society of Diabetology (SID)/Italian Society of Endocrinology (SIE)/Italian Society of Pharmacology (SIF) multidisciplinary critical view. ESMO Open 2023; 8:101573. [PMID: 37263082 PMCID: PMC10245125 DOI: 10.1016/j.esmoop.2023.101573] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/27/2023] [Accepted: 04/26/2023] [Indexed: 06/03/2023] Open
Abstract
Increasing evidence suggests that patients with diabetes, particularly type 2 diabetes (T2D), are characterized by an increased risk of developing different types of cancer, so cancer could be proposed as a new T2D-related complication. On the other hand, cancer may also increase the risk of developing new-onset diabetes, mainly caused by anticancer therapies. Hyperinsulinemia, hyperglycemia, and chronic inflammation typical of T2D could represent possible mechanisms involved in cancer development in diabetic patients. MicroRNAs (miRNAs) are a subset of non-coding RNAs, ⁓22 nucleotides in length, which control the post-transcriptional regulation of gene expression through both translational repression and messenger RNA degradation. Of note, miRNAs have multiple target genes and alteration of their expression has been reported in multiple diseases, including T2D and cancer. Accordingly, specific miRNA-regulated pathways are involved in the pathogenesis of both conditions. In this review, a panel of experts from the Italian Association of Medical Oncology (AIOM), Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Italian Society of Endocrinology (SIE), and Italian Society of Pharmacology (SIF) provide a critical view of the evidence about the involvement of miRNAs in the pathophysiology of both T2D and cancer, trying to identify the shared miRNA signature and pathways able to explain the strong correlation between the two conditions, as well as to envision new common pharmacological approaches.
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Affiliation(s)
- A Natalicchio
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - M Montagnani
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Pharmacology, Medical School, University of Bari Aldo Moro, Bari, Italy
| | - M Gallo
- Endocrinology and Metabolic Diseases Unit, AO SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, Italy
| | - N Marrano
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - A Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy
| | - M C Zatelli
- Section of Endocrinology, Geriatrics, and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - R Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy
| | - A Argentiero
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S D'Oronzo
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - S Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - D Giuffrida
- Department of Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | - S Gori
- Oncologia Medica, IRCCS Ospedale Don Calabria-Sacro Cuore di Negrar, Verona, Italy
| | - A Ragni
- Endocrinology and Metabolic Diseases Unit, AO SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, Italy
| | - V Renzelli
- Diabetologist and Endocrinologist, Italian Association of Clinical Diabetologists, Rome, Italy
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - T Franchina
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - E Tuveri
- Diabetology, Endocrinology and Metabolic Diseases Service, ASL-Sulcis, Carbonia, Sardinia, Italy
| | - L Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy
| | - M Monami
- Diabetology, Careggi Hospital and University of Florence, Firenze, Italy
| | - G Cirino
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - G Di Cianni
- Diabetes Unit, Livorno Hospital, Livorno, Italy
| | - A Colao
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy; UNESCO Chair, Education for Health and Sustainable Development, Federico II University, Naples, Italy
| | - A Avogaro
- Department of Medicine, University of Padova, Padua, Italy
| | - S Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - N Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - F Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
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Wahid Satar SNA, Norhayati MN, Yaacob LH. Recurrent hypoglycemia in a patient with hepatocellular carcinoma. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hypoglycemia is a common complication of diabetes mellitus. Patients may present with any kind of symptoms, either autonomic or neuroglycopenic. Here, we report a case of a 70-year-old man with type 2 diabetes mellitus with a newly diagnosed hepatocellular carcinoma presenting with recurrent episodes of hypoglycemia. The insulin treatment was withheld initially. However, the patient's diabetic control worsened after starting treatment for his hepatocellular carcinoma. Hence, the insulin treatment was resumed. This case highlighted the challenge in balancing the management of hypoglycaemia and poor diabetic control in a patient who has diabetes mellitus and hepatocellular carcinoma. Primary care practitioners need to have high clinical suspicion to monitor these patients to prevent hypoglycemia and manage them accordingly.
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Affiliation(s)
- Siti Nor Ain Wahid Satar
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
| | - Lili Husniati Yaacob
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
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8
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Murphy L, Sherifali D, Ali MU, Ibrahim S. Influence of Diabetes Mellitus on Oncological Outcomes for Patients Living With Cancer. Sci Diabetes Self Manag Care 2023; 49:163-179. [PMID: 36789641 PMCID: PMC10084523 DOI: 10.1177/26350106231153073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE The purpose of this meta-analysis was to examine the association between preexisting diabetes in persons living with cancer on diabetes and oncology-related health outcomes. Understanding this association is of priority because the incidence of both cancer and diabetes mellitus is increasing worldwide. METHODS A comprehensive review of the literature was conducted in collaboration with an expert health sciences librarian. Two authors independently conducted the screening, data collection, and extraction processes. The risk of bias was assessed using several tools, depending on the study design. Relative risks with 95% confidence intervals were calculated. The alpha threshold was 0.05. All analyses were performed using R statistical software (Metaphor and Demeter packages). RESULTS A total of 45 studies met the selection criteria, but 23 were excluded from the synthesis because they did not have the ranked outcome or correct comparison (persons with and without diabetes), totaling 22 studies included in the meta-analysis. In comparison to participants without preexisting diabetes, participants with preexisting diabetes and cancer were found to have a significantly higher risk of infection and cardiovascular, neurological, gastrointestinal, hepatic, and renal complications. Concurrent preexisting diabetes and cancer were also associated with increased health care service utilization and length of hospital stay. CONCLUSION The findings from this review highlight the importance of optimal concurrent management of both diseases by overcoming the compartmentalization of medical specializations through (1) integrated, multidisciplinary, shared, and coordinated clinical care pathways between oncology and diabetes health care providers/teams and (2) the continued development of evidence-based clinical guidelines.
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Affiliation(s)
- Lara Murphy
- Faculty of Health Sciences, McMaster University, Hamilton, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.,Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Canada.,McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, Canada
| | - Muhammad Usman Ali
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.,Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Canada.,McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, Canada
| | - Sarah Ibrahim
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada.,Centre for Advancing Collaborative Healthcare & Education, University of Toronto, Toronto, Canada
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9
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de Haan-Du J, Groenier KH, Wauben-Spaetgens B, Jalving M, Kleefstra N, Landman GWD, de Bock GH. The Value of Glycemic Control Prior to Cancer Diagnosis on All-Cause Mortality among Patients with Type 2 Diabetes in Dutch Primary Care. Cancer Epidemiol Biomarkers Prev 2023; 32:252-259. [PMID: 36442479 PMCID: PMC9900319 DOI: 10.1158/1055-9965.epi-22-0766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/19/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Poor glycemic control prior to cancer diagnosis for patients with preexisting type 2 diabetes (T2DM) may predict a worse cancer diagnosis. We investigated the association between pre-diagnosis glycemic control and all-cause mortality in patients with T2DM who develop cancer. METHODS This prospective cohort study linked data from three sources covering 1989 to 2019: a T2DM benchmarking database, the Netherlands Cancer Registry, and the Personal Records Database. We included patients with T2DM and incident primary breast, colorectal, or prostate cancer (stage 0-III), with target glycemic control defined according to Dutch guidelines. Analysis involved estimating the association between glycemic control and all-cause mortality with Cox proportional hazard models, accounting for individual expected survival relative to the general population and relevant disease (e.g., diabetes duration and medications) and individual (e.g., age and gender) characteristics. RESULTS Of the 71,648 linked cases, 620 had breast cancer, 774 had colorectal cancer, and 438 had prostate cancer, with follow-up data available for 6.4 (4.2-8.4), 5.6 (2.7-7.6), and 6.3 (4.5-8.2) years, respectively. Compared with patients with pre-diagnosis glycemic control at target, the HRs and 95% confidence intervals for mortality among those with pre-diagnosis glycemic control not at target were 1.40 (1.00-1.96) for breast cancer, 1.45 (1.12-1.88) for colorectal cancer, and 1.39 (0.98-1.98) for prostate cancer. CONCLUSIONS Among patients with T2DM in Dutch primary care, poor glycemic control before diagnosis with breast and colorectal cancer can increase mortality compared with good control. IMPACT Glycemic control prior to cancer diagnosis is of prognostic value.
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Affiliation(s)
- Jing de Haan-Du
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | | | - Brendy Wauben-Spaetgens
- Department of Research and Development, Netherlands Comprehensive Cancer organization (IKNL), Utrecht, the Netherlands
| | - Mathilde Jalving
- Department of Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nanne Kleefstra
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands.,GGZ Drenthe Mental Health Institute, Department of Forensic Psychiatry, Assen, the Netherlands
| | - Gijs W D Landman
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
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10
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Pinheiro LC, Cho J, Rothman J, Zeng C, Wilson M, Kern LM, Tamimi RM, Safford MM. Diabetes and cancer co-management: patient-reported challenges, needs, and priorities. Support Care Cancer 2023; 31:145. [PMID: 36729259 PMCID: PMC9892662 DOI: 10.1007/s00520-023-07604-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
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.
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Affiliation(s)
- Laura C. Pinheiro
- grid.5386.8000000041936877XDivision of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY USA ,grid.5386.8000000041936877XDivision of Epidemiology, Department of Population Health Science, Weill Cornell Medicine, New York, NY USA
| | - Jacklyn Cho
- grid.36425.360000 0001 2216 9681Renaissance School of Medicine at Stony Brook University, NY Stony Brook, USA
| | - Julia Rothman
- grid.5386.8000000041936877XCornell University, Ithaca, NY USA
| | - Caroline Zeng
- grid.5386.8000000041936877XDivision of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY USA
| | - Micayla Wilson
- grid.266093.80000 0001 0668 7243University of California Irvine, Irvine, CA USA
| | - Lisa M. Kern
- grid.5386.8000000041936877XDivision of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY USA
| | - Rulla M. Tamimi
- grid.5386.8000000041936877XDivision of Epidemiology, Department of Population Health Science, Weill Cornell Medicine, New York, NY USA
| | - Monika M. Safford
- grid.5386.8000000041936877XDivision of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY USA
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11
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Ennis CS, Llevenes P, Qiu Y, Dries R, Denis GV. The crosstalk within the breast tumor microenvironment in type II diabetes: Implications for cancer disparities. Front Endocrinol (Lausanne) 2022; 13:1044670. [PMID: 36531496 PMCID: PMC9751481 DOI: 10.3389/fendo.2022.1044670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022] Open
Abstract
Obesity-driven (type 2) diabetes (T2D), the most common metabolic disorder, both increases the incidence of all molecular subtypes of breast cancer and decreases survival in postmenopausal women. Despite this clear link, T2D and the associated dysfunction of diverse tissues is often not considered during the standard of care practices in oncology and, moreover, is treated as exclusion criteria for many emerging clinical trials. These guidelines have caused the biological mechanisms that associate T2D and breast cancer to be understudied. Recently, it has been illustrated that the breast tumor microenvironment (TME) composition and architecture, specifically the surrounding cellular and extracellular structures, dictate tumor progression and are directly relevant for clinical outcomes. In addition to the epithelial cancer cell fraction, the breast TME is predominantly made up of cancer-associated fibroblasts, adipocytes, and is often infiltrated by immune cells. During T2D, signal transduction among these cell types is aberrant, resulting in a dysfunctional breast TME that communicates with nearby cancer cells to promote oncogenic processes, cancer stem-like cell formation, pro-metastatic behavior and increase the risk of recurrence. As these cells are non-malignant, despite their signaling abnormalities, data concerning their function is never captured in DNA mutational databases, thus we have limited insight into mechanism from publicly available datasets. We suggest that abnormal adipocyte and immune cell exhaustion within the breast TME in patients with obesity and metabolic disease may elicit greater transcriptional plasticity and cellular heterogeneity within the expanding population of malignant epithelial cells, compared to the breast TME of a non-obese, metabolically normal patient. These challenges are particularly relevant to cancer disparities settings where the fraction of patients seen within the breast medical oncology practice also present with co-morbid obesity and metabolic disease. Within this review, we characterize the changes to the breast TME during T2D and raise urgent molecular, cellular and translational questions that warrant further study, considering the growing prevalence of T2D worldwide.
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Affiliation(s)
- Christina S. Ennis
- Boston University-Boston Medical Center Cancer Center, Boston University School of Medicine, Boston, MA, United States
- Section of Hematology and Medical Oncology, Boston University School of Medicine, Boston, MA, United States
| | - Pablo Llevenes
- Boston University-Boston Medical Center Cancer Center, Boston University School of Medicine, Boston, MA, United States
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, United States
| | - Yuhan Qiu
- Boston University-Boston Medical Center Cancer Center, Boston University School of Medicine, Boston, MA, United States
| | - Ruben Dries
- Boston University-Boston Medical Center Cancer Center, Boston University School of Medicine, Boston, MA, United States
- Section of Hematology and Medical Oncology, Boston University School of Medicine, Boston, MA, United States
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA, United States
| | - Gerald V. Denis
- Boston University-Boston Medical Center Cancer Center, Boston University School of Medicine, Boston, MA, United States
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, United States
- Shipley Prostate Cancer Research Professor, Boston University School of Medicine, Boston, MA, United States
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12
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Storey S, Luo X, Ofner S, Perkins SM, Von Ah D. Hyperglycemia, symptoms, and symptom clusters in colorectal cancer survivors with type 2 diabetes. Support Care Cancer 2022; 30:10149-10157. [DOI: 10.1007/s00520-022-07442-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/30/2022] [Indexed: 11/15/2022]
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13
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Ko EJ, Lee SJ. A Comparative analysis of type 2 diabetes management quality indicators in cancer survivors. Asia Pac J Oncol Nurs 2022; 9:100116. [PMID: 36158707 PMCID: PMC9500516 DOI: 10.1016/j.apjon.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objective This study aimed to assess indicators of type 2 diabetes mellitus (DM) management, including adequate DM control, and treatment rates, in cancer survivors according to the time of DM diagnosis and to compare them with the DM management indicators of a non-cancer control group. Methods We used the 2013-2019 data of the Korea National Health and Nutrition Examination Survey for this study. To compare their adequate DM control, and treatment rates, we identified 4918 patients with type 2 DM aged ≥ 30 years and classified them into pre-existing diabetes, pre-existing cancer, and diabetes without cancer groups. Predictors of adequate glycemic control and diabetes treatment were analyzed using binary logistic regression. Results Diabetes without cancer group had higher fasting blood glucose and glycosylated hemoglobin A1c levels and lower adequate glycemic control than did the other two groups. The preexisting cancer group had low treatment rates. After adjusting for age, gender, employment status, and duration of diabetes, the preexisting cancer group had 0.51-fold lower odds of receiving treatment, such as insulin injection or oral diabetes medications, than the other two groups (adjusted odds ratio, 0.50; 95% confidence interval, 0.38-0.66). Conclusions Cancer survivors had lower fasting glucose and HbA1c than those with diabetes without cancer. However, as a result of the sub-analysis, the treatment rate of the pre-existing cancer group was significantly lower than that of diabetes without cancer. Based on these results, cancer survivors' care-related healthcare workers should be aware of the need for monitoring blood sugar even in cancer survivors without underlying diabetes mellitus and pay more attention to early detection and active treatment of diabetes.
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Affiliation(s)
- Eun J. Ko
- School of Nursing, Research Institute of Nursing Science, Hallym University, Gangwon-do, Republic of Korea
| | - Su J. Lee
- School of Nursing, Research Institute of Nursing Science, Hallym University, Gangwon-do, Republic of Korea
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14
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Patient-Factors Influencing the 2-Year Trajectory of Mental and Physical Health in Prostate Cancer Patients. Curr Oncol 2022; 29:8244-8260. [PMID: 36354711 PMCID: PMC9689299 DOI: 10.3390/curroncol29110651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
This study aimed to examine the physical and mental Quality of Life (QoL) trajectories in prostate cancer (PCa) patients participating in the Pros-IT CNR study. QoL was assessed using the Physical (PCS) and Mental Component Score (MCS) of Short-Form Health Survey upon diagnosis and two years later. Growth mixture models were applied on 1158 patients and 3 trajectories over time were identified for MCS: 75% of patients had constantly high scores, 13% had permanently low scores and 12% starting with low scores had a recovery; the predictors that differentiated the trajectories were age, comorbidities, a family history of PCa, and the bowel, urinary and sexual functional scores at diagnosis. In the physical domain, 2 trajectories were defined: 85% of patients had constantly high scores, while 15% started with low scores and had a further slight decrease. Two years after diagnosis, the psychological and physical status was moderately compromised in more than 10% of PCa patients. For mental health, the trajectory analysis suggested that following the compromised patients at diagnosis until treatment could allow identification of those more vulnerable, for which a level 2 intervention with support from a non-oncology team supervised by a clinical psychologist could be of help.
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15
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Kleckner AS, Kleckner IR, Culakova E, Shayne M, Belcher EK, Gudina AT, Williams AM, Onitilo AA, Hopkins JO, Gross H, Mustian KM, Peppone LJ, Janelsins MC. The association between cancer-related fatigue and diabetes from pre-chemotherapy to 6 months post-chemotherapy. Support Care Cancer 2022; 30:7655-7663. [PMID: 35678881 PMCID: PMC10079326 DOI: 10.1007/s00520-022-07189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To quantify the relationship between diabetes and fatigue from pre-chemotherapy to 6 months post-chemotherapy for women with breast cancer compared to women without a history of cancer (controls). METHODS This was a secondary analysis from a nationwide prospective longitudinal study of female patients with breast cancer undergoing chemotherapy and controls. Diabetes diagnosis (yes/no) was obtained at baseline, and cancer-related fatigue was measured using the Multidimensional Fatigue Symptom Inventory (MFSI) pre-, post-, and 6 months post-chemotherapy in patients; controls were assessed at equivalent time points. Repeated measures mixed effects models estimated the association between fatigue and diabetes controlling for cancer (yes/no), body mass index, exercise and smoking habits, baseline anxiety and depressive symptoms, menopausal status, marital status, race, and education. RESULTS Among 439 patients and 235 controls (52.8 ± 10.5 years old), diabetes was twice as prevalent among patients as controls (11.6% vs. 6.8%). At baseline, diabetes was associated with worse fatigue (4.1 ± 1.7 points, p = 0.017). Also, diabetes was associated with clinically meaningful worse fatigue throughout the study period among all participants (5.2 ± 1.9 points, p = 0.008) and patients alone (4.5 ± 2.0, p = 0.023). For the MFSI subdomains among patients, diabetes was associated with worse general (p = 0.005) and mental fatigue (p = 0.026). CONCLUSIONS Diabetes was twice as prevalent in women with breast cancer compared to controls, and diabetes was associated with more severe cancer-related fatigue in patients before and after chemotherapy and at 6 months post-chemotherapy. Interventions that address diabetes management may also help address cancer-related fatigue during chemotherapy treatment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01382082, first posted June 27, 2011.
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Affiliation(s)
- Amber S Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, 655 W. Lombard Ave., 7th floor, Baltimore, MD, 21201, USA.
| | - Ian R Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, 655 W. Lombard Ave., 7th floor, Baltimore, MD, 21201, USA
| | - Eva Culakova
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Michelle Shayne
- Department of Medicine, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420658, Rochester, NY, 14642, USA
| | - Elizabeth K Belcher
- Department of Psychological Science, Hobart and William Smith Colleges, Geneva, NY, USA
| | - Abdi T Gudina
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - AnnaLynn M Williams
- Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Judith O Hopkins
- Southeast Clinical Oncology Research (SCOR) Consortium, Winston-Salem, Weston, NC, USA
| | - Howard Gross
- Dayton Clinical Oncology Program, Dayton, OH, USA
| | - Karen M Mustian
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Luke J Peppone
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Michelle C Janelsins
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
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16
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Pinheiro LC, Soroka O, Kern LM, Leonard JP, Safford MM. Racial Disparities in Diabetes-Related Emergency Department Visits and Hospitalizations Among Cancer Survivors. JCO Oncol Pract 2022; 18:e1023-e1033. [PMID: 35133858 PMCID: PMC9797245 DOI: 10.1200/op.21.00684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Black and Hispanic individuals with diabetes receive less recommended diabetes care after cancer diagnosis than non-Hispanic Whites (NHW). We sought to determine whether racial/ethnic minorities with diabetes and cancer were at increased risk of diabetes-related emergency department (ED) visits and hospitalizations compared with NHW. METHODS Using SEER cancer registry data linked to Medicare claims from 2006 to 2014, we included Medicare beneficiaries age 66+ years diagnosed with incident nonmetastatic breast, prostate, or colorectal cancer between 2007 and 2012 who had diabetes. Our primary outcome was any diabetes-related ED visit or hospitalization 366-731 days after cancer diagnosis. Using Fine-Gray subdistribution hazard models, we examined whether risk of ED visits or hospitalizations was higher for racial/ethnic minorities compared with NHW. RESULTS We included 40,059 beneficiaries with mean age 75.5 years (standard deviation 6.3), 45.6% were women, and 28.9% were non-White. Overall, 825 (2.1%) had an ED visit and 3,324 (8.3%) had a hospitalization related to diabetes in the 366-731 days after cancer diagnosis. Compared with NHW, Black individuals were more likely to have ED visits (2.9% v 2.0%; P < .0001) and hospitalizations (11.7% v 7.8%; P < .0001). Adjusting for potential confounders, Black (adjusted hazard ratio, 1.22; 95% CI, 1.12 to 1.35) individuals had a higher risk of any ED visit or hospitalization compared with NHW. CONCLUSION Black individuals with diabetes and cancer were at increased risk for diabetes-related ED visits and hospitalizations in the second year after cancer diagnosis compared with NHW even after accounting for confounders.
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Affiliation(s)
- Laura C. Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY,Laura C. Pinheiro, PhD, MPH, Division of General Internal Medicine Weill Cornell Medicine, 420 East 70th St, 3rd Floor (LH359), New York, NY 10021; e-mail:
| | - Orysya Soroka
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Lisa M. Kern
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - John P. Leonard
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
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Kandil I, Keely E. Glucocorticoid-Induced Hyperglycemia in Oncologic Outpatients: A Narrative Review Using the Quadruple Aim Framework. Can J Diabetes 2022; 46:S1499-2671(22)00023-5. [PMID: 36055914 DOI: 10.1016/j.jcjd.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/04/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
Glucocorticoids are a central part of cancer treatment protocols. Their use in patients receiving chemotherapy increases patient risk of hyperglycemia and associated adverse outcomes. Despite this, there have been few published protocols that guide the management of this patient group. In this narrative review, we use the quadruple aim as a framework to evaluate the current literature, including interventions, on glucocorticoid-induced hyperglycemia in patients receiving oncologic treatment, with a focus on the outpatient setting. Findings were drawn from published review articles, observational studies, qualitative reports and costing data. Results were synthesized using the framework's 4 dimensions of care: population health, provider experience, patient experience and cost. Prospective studies proposing an intervention on oncologic patients receiving glucocorticoids were identified as intervention studies. Management of glucocorticoid-induced hyperglycemia in oncologic patients is a complex problem with no published interventions addressing all components of the quadruple aim. Most evidence on this population is based on retrospective studies. Six prospective intervention studies were identified and highlighted in this review, and only 2 were exclusively in the outpatient context. Challenges included lack of standardization in screening strategies, paucity of interventions that have examined impact on patient and provider experience. There is limited evaluation of the impact of interventions targeting glycemic control on clinical outcomes and cost of care delivery, especially in the outpatient context. We propose a conceptual framework for evaluation of quality improvement programs. Management of glucocorticoid-induced hyperglycemia in the outpatient setting is complex and requires well-designed intervention studies evaluated across the quadruple aim.
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Affiliation(s)
- Ihab Kandil
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada.
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18
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Lin CC, Wu MF, Chang YL, Sheu WHH, Liou WS. Glycemic control was associated with nonprostate cancer and overall mortalities in diabetic patients with prostate cancer. J Chin Med Assoc 2022; 85:331-340. [PMID: 34561410 DOI: 10.1097/jcma.0000000000000623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) can worsen the prognosis or survival in prostate cancer (PC) patients. We investigated whether glycemic control impacts mortality in PC patients with existing diabetes. METHODS All PC patients with or without preexisting DM were enrolled from 2006 to 2017. Mean hemoglobin A1c (HbA1c) values (<7%, 7%-9%, ≥9%) were used to represent glycemic control. Major outcomes included all-cause, PC-specific, and non-PC mortalities. Statistical analyses were performed using Cox regression models with adjusted mean HbA1c and other related confounders. RESULTS A total of 831 PC patients were enrolled (non-DM group, n = 690; DM group with a record of mean HbA1c values, n = 141). Results showed that the DM group with mean HbA1c level ≥ 9% (n = 14) had significantly increased risk for all-cause and non-PC mortality (hazard ratio [HR], 3.09; 95% CIs, 1.15-8.32; p=0.025 and HR, 5.49; 95% CIs, 1.66-18.16; p = 0.005, respectively), but not for PC-specific mortality (HR, 1.03; 95% CIs, 0.13-8.44; p = 0.975), compared with the non-DM group. CONCLUSION Our findings indicate that PC patients with DM who had a mean HbA1c level ≥ 9% had higher risks of all-cause and non-PC mortality compared with non-DM subjects. Further large and long-term studies are needed to verify the effect of glycemic control in PC patients with DM.
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Affiliation(s)
- Chih-Chung Lin
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Ming-Fen Wu
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yen-Lin Chang
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- College of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Institute of Medical Technology, National Chung Hsing University, Taichung, Taiwan, ROC
- College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wen-Shyong Liou
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- School of Pharmacy, China Medical University, Taichung, Taiwan, ROC
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19
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Racial disparities in diabetes care among incident breast, prostate, and colorectal cancer survivors: a SEER Medicare study. J Cancer Surviv 2022; 16:52-60. [PMID: 33661509 PMCID: PMC9789687 DOI: 10.1007/s11764-021-01003-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/06/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many cancer survivors with co-morbid diabetes receive less diabetes management than their non-cancer counterparts. We sought to determine if racial/ethnic disparities exist in recommended diabetes care within 12 months of an incident breast, prostate, or colorectal cancer diagnosis. Because co-morbid diabetes decreases long-term survival, identifying predictors of guideline-concordant diabetes care is important. METHODS Using the Surveillance, Epidemiology, and End Results cancer registry linked to Medicare claims, we included beneficiaries aged 67+ years with diabetes and incident, non-metastatic breast, prostate, or colorectal cancer between 2008 and 2013. Primary outcomes were diabetes care services 12 months after diagnosis: (1) HbA1c test, (2) eye exam, and (3) low-density lipoprotein (LDL) test. Using modified Poisson models with robust standard errors, we examined each outcome separately. RESULTS We included 34,643 Medicare beneficiaries with both diabetes and cancer. Mean age at diagnosis was 76.1 (SD 6.2), 47.2% were women; 35% had breast, 24% colorectal, and 41% prostate cancer. In the 12 months after incident cancer diagnosis, 82.4% received an HbA1c test, 55.3% received an eye exam, 77.8% had an LDL test, and 42.0% received all three tests. Compared to non-Hispanic Whites, Blacks were 3% (95% CI 0.95-0.98) less likely to receive a HbA1c test, 10% (95% CI 0.89-0.92) less likely to receive a LDL test, and 8% (95% 0.89-0.95) less likely to receive an exam eye. Blacks and Hispanics were 16% (95% CI 0.81-0.88) and 7% (0.88-0.98) less likely to receive all three tests, after accounting for confounders. Racial/ethnic differences persisted across cancer types. CONCLUSION Blacks and Hispanics with breast, prostate, and colorectal cancer and diabetes received less diabetes care after cancer diagnosis compared to non-Hispanic Whites. Differences were not explained by socio-economic factors or clinical need. IMPLICATIONS FOR CANCER SURVIVORS Our findings are concerning given the high prevalence of diabetes and poor cancer outcomes among racial/ethnic minorities. The next step in this line of inquiry is to determine why minorities are less likely to receive comprehensive diabetes care in order to develop targeted strategies to increase receipt of appropriate diabetes management for these vulnerable populations.
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Joharatnam-Hogan N, Chambers P, Dhatariya K, Board R. A guideline for the outpatient management of glycaemic control in people with cancer. Diabet Med 2022; 39:e14636. [PMID: 34240470 DOI: 10.1111/dme.14636] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/17/2022]
Abstract
Individuals with cancer are at increased risk of developing new-onset diabetes mellitus and hyperglycaemia, and an estimated 20% of people with cancer already have an underlying diagnosis of diabetes mellitus. People with both cancer and diabetes may have an increased risk of toxicities, hospital admissions and morbidity, with hyperglycaemia potentially attenuating the efficacy of chemotherapy often secondary to dose reductions and early cessation. Numerous studies have demonstrated that hyperglycaemia is prognostic of worse overall survival and risk of cancer recurrence. These guidelines aim to provide the oncology/haemato-oncology and diabetes multidisciplinary teams with the tools to manage people with diabetes commencing anti-cancer/glucocorticoid therapy, as well as identifying individuals without a known diagnosis of diabetes who are at risk of developing hyperglycaemia and new-onset diabetes.
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Affiliation(s)
| | - Pinkie Chambers
- University College London Hospital NHS Foundation Trust, London, UK
| | - Ketan Dhatariya
- Norfolk and Norwich Hospitals NHS Foundation Trust, London, UK
| | - Ruth Board
- Lancashire Teaching Hospitals NHS Foundation Trust, London, UK
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21
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Benedetti R, Benincasa G, Glass K, Chianese U, Vietri MT, Congi R, Altucci L, Napoli C. Effects of novel SGLT2 inhibitors on cancer incidence in hyperglycemic patients: a meta-analysis of randomized clinical trials. Pharmacol Res 2021; 175:106039. [PMID: 34929299 DOI: 10.1016/j.phrs.2021.106039] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 02/06/2023]
Abstract
Epidemiological evidence shows that diabetic patients have an increased cancer risk and a higher mortality rate. Glucose could play a central role in metabolism and growth of many tumor types, and this possible mechanism is supported by the high rate of glucose demand and uptake in cancer. Thus, growing evidence suggests that hyperglycemia contributes to cancer progression but also to its onset. Many mechanisms underlying this association have been hypothesized, such as insulin resistance, hyperinsulinemia, and increased inflammatory processes. Inflammation is a common pathophysiological feature in both diabetic and oncological patients, and inflammation linked to high glucose levels sensitizes microenvironment to tumorigenesis, promoting the development of malignant lesions by altering and sustaining a pathological condition in tissues. Glycemic control is the first goal of antidiabetic therapy, and glucose level reduction has also been associated with favorable outcomes in cancer. Here, we describe key events in carcinogenesis focusing on hyperglycemia as supporter in tumor progression and in particular, related to the role of a specific hypoglycemic drug class, sodium-glucose linked transporters (SGLTs). We also discuss the use of SGLT2 inhibitors as a novel potential cancer therapy. Our meta-analysis showed that SGLT-2 inhibitors were significantly associated with an overall reduced risk of cancer as compared to placebo (RR = 0.35, CI 0.33-0.37, P = 0. 00) with a particular effectiveness for dapaglifozin and ertuglifozin (RR = 0. 06, CI 0. 06-0. 07 and RR = 0. 22, CI 0. 18-0. 26, respectively). Network Medicine approaches may advance the possible repurposing of these drugs in patients with concomitant diabetes and cancer.
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Affiliation(s)
- Rosaria Benedetti
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Naples, Italy
| | - Giuditta Benincasa
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Pz. Miraglia 2, 80138 Naples, Italy.
| | - Kimberly Glass
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ugo Chianese
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Naples, Italy
| | - Maria Teresa Vietri
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Naples, Italy
| | - Raffaella Congi
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Naples, Italy
| | - Lucia Altucci
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Naples, Italy; Biogem Institute of Molecular and Genetic Biology, 83031 Ariano Irpino, Italy.
| | - Claudio Napoli
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Pz. Miraglia 2, 80138 Naples, Italy; Clinical Department of Internal Medicine and Specialistics, Division of Clinical Immunology, Transfusion Medicine and Transplant Immunology, AOU University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Naples, Italy.
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22
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Nikmaneshi MR, Firoozabadi B, Mozafari A. Chemo-mechanistic multi-scale model of a three-dimensional tumor microenvironment to quantify the chemotherapy response of cancer. Biotechnol Bioeng 2021; 118:3871-3887. [PMID: 34133020 DOI: 10.1002/bit.27863] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 02/03/2023]
Abstract
Exploring efficient chemotherapy would benefit from a deeper understanding of the tumor microenvironment (TME) and its role in tumor progression. As in vivo experimental methods are unable to isolate or control individual factors of the TME, and in vitro models often cannot include all the contributing factors, some questions are best addressed with mathematical models of systems biology. In this study, we establish a multi-scale mathematical model of the TME to simulate three-dimensional tumor growth and angiogenesis and then implement the model for an array of chemotherapy approaches to elucidate the effect of TME conditions and drug scheduling on controlling tumor progression. The hyperglycemic condition as the most common disorder for cancer patients is considered to evaluate its impact on cancer response to chemotherapy. We show that combining antiangiogenic and anticancer drugs improves the outcome of treatment and can decrease accumulation of the drug in normal tissue and enhance drug delivery to the tumor. Our results demonstrate that although both concurrent and neoadjuvant combination therapies can increase intratumoral drug exposure and therapeutic accuracy, neoadjuvant therapy surpasses this, especially against hyperglycemia. Our model provides mechanistic explanations for clinical observations of tumor progression and response to treatment and establishes a computational framework for exploring better treatment strategies.
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Affiliation(s)
| | - Bahar Firoozabadi
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Aliasghar Mozafari
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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23
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Cho J, Nilo D, Sterling MR, Kern LM, Safford MM, Pinheiro LC. Eliciting primary care and oncology provider perspectives on diabetes management during active cancer treatment. Support Care Cancer 2021; 29:6881-6890. [PMID: 34018032 DOI: 10.1007/s00520-021-06264-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We sought to elicit the perspectives of primary care providers (PCPs) and oncologists regarding their expectations on who should be responsible for diabetes management, as well as communication mode and frequency about diabetes care during cancer treatment. METHODS In-depth interviews were conducted with PCPs (physicians and nurse practitioners) and oncologists who treat cancer patients with type 2 diabetes. Interviews were audio-recorded and professionally transcribed. A grounded theory approach was used to analyze the qualitative data and identify key themes. RESULTS Ten PCPs and ten oncologists were interviewed between March and July 2019. Two broad themes emerged from our interviews with PCPs: (1) cancer patients pausing primary care during cancer treatments, and (2) patients with poorer prognoses and advanced cancer. The following theme emerged from our interviews with oncologists: (3) challenges in caring for cancer patients with uncontrolled diabetes. Three common themes emerged from our interviews with both PCPs and oncologists: (4) discomfort with providing care outside of respective specialty, (5) the need to individualize care plans, and (6) lack of communication across primary and oncology care. CONCLUSIONS Our findings suggest that substantial barriers to optimal diabetes management during cancer care exist at the provider level. Interventions prioritizing effective communication and educational resources among PCPs, oncologists, and additional members of the patients' care team should be prioritized to achieve optimal outcomes.
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Affiliation(s)
- Jacklyn Cho
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
| | - Daniela Nilo
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
| | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
| | - Lisa M Kern
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
| | - Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA.
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24
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Liao MZ, Lu D, Kågedal M, Miles D, Samineni D, Liu SN, Li C. Model-Informed Therapeutic Dose Optimization Strategies for Antibody-Drug Conjugates in Oncology: What Can We Learn From US Food and Drug Administration-Approved Antibody-Drug Conjugates? Clin Pharmacol Ther 2021; 110:1216-1230. [PMID: 33899934 PMCID: PMC8596428 DOI: 10.1002/cpt.2278] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Abstract
Antibody–drug conjugates (ADCs) combine the specificity of an antibody with the cytotoxicity of a chemical agent. They represent a rapidly evolving area of oncology drug development and hold significant promise. There are currently nine ADCs on the market, more than half of which gained US Food and Drug Administration approval more recently, since 2019. Despite their enormous promise, the therapeutic window for these ADCs remains relatively narrow, especially when compared with other oncology drugs, such as targeted therapies or checkpoint inhibitors. In this review, we provide a detailed overview of the five dosing regimen optimization strategies that have been leveraged to broaden the therapeutic window by mitigating the safety risks while maintaining efficacy. These include body weight cap dosing; treatment duration capping; dose schedule (e.g., dosing frequency and dose fractionation); response‐guided dosing recommendations; and randomized dose‐finding. We then discuss how the lessons learned from these studies can inform ADC development going forward. Informed application of these dosing strategies should allow researchers to maximize the safety and efficacy for next‐generation ADCs.
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Affiliation(s)
| | - Dan Lu
- Genentech Inc., South San Francisco, California, USA
| | - Matts Kågedal
- Genentech Inc., South San Francisco, California, USA
| | - Dale Miles
- Genentech Inc., South San Francisco, California, USA
| | | | | | - Chunze Li
- Genentech Inc., South San Francisco, California, USA
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25
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Al-Taie A, Izzettin FV, Sancar M, Köseoğlu A. Impact of clinical pharmacy recommendations and patient counselling program among patients with diabetes and cancer in outpatient oncology setting. Eur J Cancer Care (Engl) 2020; 29:e13261. [PMID: 32537812 DOI: 10.1111/ecc.13261] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 12/10/2019] [Accepted: 04/16/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The simultaneous occurrence of diabetes and cancer may complicate the management of both conditions resulting in poor prognosis and more deterioration of patient-related outcomes. OBJECTIVE To assess the effective provision of clinical pharmacy services and pharmacist-led counselling program on improving patient-related outcomes among patients with diabetes and newly diagnosed with cancer during chemotherapy administration. METHODS A single-centre, prospective, randomised, controlled study was carried out on patients with diabetes newly diagnosed with cancer during chemotherapy administration at the outpatient oncology setting. Patients were assigned as a normal care group receiving only normal care by the oncology care providers and an intervention group receiving both normal and clinical pharmacy care through an extensive oral and written patient education, pharmacotherapy optimisation and regular recommendations for diabetic self-care activities with three-month follow-up. RESULTS Patients within the intervention group showed a better glycaemic control (p = .049), a significant increase in medication adherence (p = .0049), a significant increase in diabetes self-care activities, including diet (p = .037), self-monitoring of blood glucose (p = .027) and foot care (p = .0085) and reported a lower deterioration in quality of life. CONCLUSION Patients with diabetes and cancer receiving chemotherapy experienced improved patient-related outcomes after clinical pharmacy intervention and counselling program compared to the normal care group.
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Affiliation(s)
- Anmar Al-Taie
- Faculty of Pharmacy, Pharmacy Department, Girne American University, Kyrenia, North Cyprus, Turkey
| | - Fikret V Izzettin
- Faculty of Pharmacy, Clinical Pharmacy Department, Bezmialem Vakıf University, Istanbul, Turkey
| | - Mesut Sancar
- Faculty of Pharmacy, Clinical Pharmacy Department, Marmara University, Istanbul, Turkey
| | - Aygül Köseoğlu
- Oncology Centre, Dr. Lütfi Kırdar Kartal Teaching and Research Hospital, Istanbul, Turkey
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26
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Determining the Impact of a Cancer Diagnosis on Diabetes Management: A Systematic Literature Review. Am J Clin Oncol 2020; 42:870-883. [PMID: 31592804 DOI: 10.1097/coc.0000000000000612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Cancer patients with comorbid diabetes have a 50% increased risk of all-cause mortality compared with cancer patients without diabetes. Less attention to diabetes management (glucose control, medication adherence, and diabetes self-management behaviors) during active cancer treatment is hypothesized as an explanation for worse outcomes among diabetic cancer patients. The objective of this systematic review is to determine and quantify how a cancer diagnosis impacts diabetes management. METHODS Quantitative and qualitative studies evaluating diabetes management among patients were identified by searching 4 databases: MEDLINE, EMBASE, The Cochrane Library, and Web of Science. Two independent reviewers extracted data and summarized results from eligible studies. Study quality was formally assessed. RESULTS Thirty-six studies met all inclusion criteria. We observed heterogeneity across studies in terms of study design, sample size, cancer site, type of diabetes management evaluated, and quality. Numerous articles discussed that overall, glucose control, medication adherence, and diabetes self-management behaviors declined following a cancer diagnosis. However, findings were inconsistent across studies. CONCLUSIONS Although the effects of a cancer diagnosis on diabetes management are mixed, when results across studies were synthesized together, diabetes management appeared to generally decline after a cancer diagnosis. Declines in diabetes management seem to be primarily due to shifts in the priority of care from diabetes management to cancer. A next critical step in this line of work is to identify patient and provider level predictors of better or worse diabetes management to design and test interventions aimed at improving effective diabetes management for cancer patients.
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Improving Care Coordination for Comorbidity and Cancer: A Necessity for Patients With Cancer. Cancer Nurs 2019; 43:86-87. [PMID: 31800530 DOI: 10.1097/ncc.0000000000000780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Abstract
PURPOSE OF REVIEW Many patients experience hyperglycemia during cancer treatment, either as a new-onset condition or as an exacerbation of existing diabetes. This can impact treatment and outcomes, increasing the risk of complications and worsening health-related quality of life (HRQoL). These issues may be particularly significant when patients are hospitalized and/or acutely ill. The purpose of this review is to identify common barriers and strategies specific to the inpatient setting to improve glycemic control and minimize complications both while patients are hospitalized and after discharge. RECENT FINDINGS Hyperglycemia in patients who are hospitalized during cancer treatment is common, but there is a lack of consensus on goals and approaches to glycemic management in this setting. Hyperglycemia related to oncology treatment can have unusual causes and challenges in management. Organizational guidelines can help standardize treatment and guide providers in managing hyperglycemia in oncology patients during hospitalization and upon discharge. Hospitalization is a critical period that provides an opportunity to reassess and modify management plans, coordinate follow-up care, and, crucially, educate and empower patients to successfully manage their blood glucose levels once they are discharged. Emerging technology such as patient portals can facilitate hyperglycemia management after discharge. This review discusses evidences and strategies to utilize the period of hospitalization to develop and implement an individualized plan of care for patients with concurrent hyperglycemia and cancer.
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Affiliation(s)
- Amy Hiestand
- Department of Endocrinology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - James Flory
- Department of Endocrinology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ritika Chitkara
- Department of Endocrinology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Sharma A, Sikora L, Bush SH. Management of Diabetes Mellitus in Adults at the End of Life: A Review of Recent Literature and Guidelines. J Palliat Med 2019; 22:1133-1138. [PMID: 30892135 DOI: 10.1089/jpm.2018.0614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: The prevalence of diabetes mellitus (DM) is rising with an increased risk of developing it as a person ages. Therefore, more persons will have comorbid DM throughout their health journey and are potentially prone to unpleasant symptoms associated with poor glycemic control at the end of life (EOL). We performed an in-depth literature review to examine evidence-based recommendations on DM management at the EOL. Design: A librarian-assisted systematic and gray literature search was performed in electronic clinical databases and Google™ for diabetes management articles (DMAs). National and international diabetes, palliative care, and general guideline websites were searched for clinical practice guidelines (CPGs). Inclusion criteria: adults ≥18 years with terminal illnesses, articles published between 2007 and 2017 with blood sugar target, monitoring frequency, and management recommendations for type 1 and type 2 DM. Exclusion criteria: conference poster abstracts and CPGs without published year or references. Two independent appraisers evaluated the CPGs using the "Rigour of Development" domain of the Appraisal of Guideline Research and Evaluation II (AGREE II) instrument. Results: Nine full-text DMAs were included for review from 2476 screened articles. Twenty-one CPG websites were searched. For the six included CPGs, the AGREE II "Rigour of Development" domain scores ranged from 6% to 34%. We found no high-quality evidence for DM management at the EOL. Treatment recommendations were based primarily on expert opinion (level IV evidence). Conclusions: Higher quality studies are required to inform a standardized approach to the management of DM at the EOL.
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Affiliation(s)
- Anish Sharma
- Postgraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Palliative Care, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Shirley Harvey Bush
- Department of Palliative Care, Bruyère Continuing Care, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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30
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Alqabandi N, Haywood A, Kindl K, Khan S, Good P, Hardy J. Managing diabetes at the end of life – a retrospective chart audit of two health providers in Queensland, Australia. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1611721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Naeema Alqabandi
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Alison Haywood
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University and Mater Research Institute – The University of Queensland, Brisbane, Australia
| | - Korana Kindl
- Palliative Care, St. Vincent’s Private Hospital, Brisbane and Mater Research Institute – The University of Queensland, Brisbane, Australia
| | - Sohil Khan
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University and Mater Research Institute – The University of Queensland, Brisbane, Australia
| | - Phillip Good
- Palliative Care, St. Vincent’s Private Hospital, Brisbane and Mater Research Institute – The University of Queensland, Brisbane, Australia
| | - Janet Hardy
- Department of Palliative and Supportive Care, Mater Health Services, Brisbane and Mater Research Institute – The University of Queensland, Brisbane, Australia
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Ferreira L, Moniz AC, Carneiro AS, Miranda AS, Fangueiro C, Fernandes D, Silva I, Palhinhas I, Lemos J, Antunes J, Leal M, Sampaio N, Faria S. The impact of glycemic variability on length of stay and mortality in diabetic patients admitted with community-acquired pneumonia or chronic obstructive pulmonary disease. Diabetes Metab Syndr 2019; 13:149-153. [PMID: 30641688 DOI: 10.1016/j.dsx.2018.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/27/2018] [Indexed: 01/07/2023]
Abstract
AIM To investigate the influence of glycemic variability (GV) on length of stay and in-hospital mortality in non-critical diabetic patients. METHODS A observation retrospective study was performed. Diabetic patients admitted between January and June 2016 with the diagnosis of community-acquire pneumonia (CAP) and/or acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled and glycemic control (persistent hyperglycemia, hypoglycemia, mean glucose level (MGL) and respective standard deviation (SD) and coefficient of variation (CV)) were evaluated. Primary outcomes were length of stay and in-hospital mortality. RESULTS Data from 242 patients were analyzed. Fifty-eight percent of the patients were male, with a median age of 77 years (min-max, 29-98). Patients had on average 2.1 glucose readings-day and the MGL was 193.3 mg/dl (min-max, 84.3-436.6). Hypoglycemia was documented in 13.4% of the patients and 55.4% had persistent hyperglycemia. The median length of hospital stay was 10 days (min-max, 1-66) and in-hospital mortality was 7.4%. We found a significant higher in-hospital mortality in older patients, with history of cancer and with nosocomial infections. We did not find any correlation between MGL, SD, CV, hypoglycemia or persist hyperglycemia and in-hospital mortality. A longer length of stay was observed in patients with heavy alcohol consumption and nosocomial infections. The length of stay was negatively correlated with the mean glucose level (r2-0.147; p < 0.05) and positively correlated with the coefficient of variation (p 0.162; p < 0.05). CONCLUSION This study confirmed the negative impact of the glycemic variability in the outcomes of diabetic patients admitted with CAP or acute exacerbation of COPD.
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Affiliation(s)
- L Ferreira
- Department of Endocrinology, Centro Hospitalar do Porto, Porto, Portugal.
| | - A C Moniz
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - A S Carneiro
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - A S Miranda
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - C Fangueiro
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - D Fernandes
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - I Silva
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - I Palhinhas
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - J Lemos
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - J Antunes
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - M Leal
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - N Sampaio
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - S Faria
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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