Download The Dual Diagnosis of Diabetes and Cancer

Kate McHenry BSN, RN
3W Oncology Unit
 Overview
of diabetes, cancer, and
interactions between the two
 Increased
risk of certain cancers with the
comorbid condition of diabetes
 Glucose
control in the management of
diabetes in patients with cancer
 Cancer
treatment and side effects in
patient with diabetes
 8%
of the U.S. population (or 25.8
million people) have diabetes
 One in three people born in the U.S. in
2000 are projected to develop
diabetes at some point in their lifetime
 One
in four deaths in the U.S. is caused
by cancer
• Most common and fatal cancers in men include:
prostate, lung, bronchus, colorectal
• Most common and fatal cancers in women
include: lung, breast, colorectal
 The
GOOD NEWS: the number of people
becoming long-term survivors is
increasing
 The BAD NEWS: a greater number of
patients will have to face the challenge of
living with both cancer and diabetes
 Age
 Race/ethnicity
 Sex
(men have a higher risk for both
cancer and diabetes)
 Obesity
 Physical activity
 Diet
 Alcohol
 Smoking
 Many
cells in the body have surface
receptors for insulin and insulin-like
growth factors that have been shown in
lab tests to stimulate the growth and
metastasis of cancer cells.
 About half of Type 2 diabetes and all
Type 1's take insulin daily, and their
blood-insulin levels spike higher than
normal.
 Diabetic patients also have episodes of
higher than normal blood sugar, which
may promote cell cancer growth.
 Diabetics
are twice as likely to get
cancer of the liver, pancreas and
uterine lining. Their risk of colon,
breast, and bladder cancer is 20 to 50
percent higher than non-diabetics'.
 There doesn't seem to be any higher
risk for other cancers, such as lung
cancer.
 The risk of prostate cancer is actually
lower among diabetics.
 Elevated
postprandial insulin have shown
to increase colorectal cancer risk
(Meyerhardt et al, 2003)
 Several studies show that patients with
diabetes and stage II and III colon cancer
had significantly higher rates of overall
mortality
 Patients with diabetes often have delayed
stool transit and gastrointestinal
abnormalities, which are associated with
colorectal cancer (Will et al, 1998)
 Women
with the highest fasting insulin
levels had two-fold increased risk of
distant cancer recurrence and threefold increased risk of death compared
to those with lower insulin levels
(Coughlin et al, 2004, Goodwin et al,
2002)
 In
a study (Weiser, et al 2004), the
complete remission duration, survival,
and treatment-related complications
were compared in patients with and
without hyperglycemia
• Patients with hyperglycemia had shorter complete
remission (24 versus 52 months)
• Shorter median survival (29 versus 88 months)
• More likely to develop a complicated infection
(39% versus 25%)
 Yes
and No
 Studies remain inconclusive on the
connection
 A link appears to be more prevalent
between diabetes and certain cancers,
i.e. breast and colon
 There appears to be enough of a
connection to warrant consideration
when treating a patient with this dual
diagnosis
 Macrovascular:
injury to the large
blood vessels of the heart and brain,
most commonly occur in coronary
arteries and large vessels of the legs;
CAD, atherosclerosis
 Microvascular: injury to capillaries
throughout the body, to organs such
as the eyes and kidneys, retinopathy,
nephropathy
 Neurologic: neuropathy
 Pre-existing
renal, cardiac, or
neuropathic complications
 Chemotherapy agents exacerbate these
complications:
• Cisplatin causes renal insufficiency
• Anthracyclines cause cardiotoxicity
• Cisplatin, pacitaxel, vincristine are neurotoxic
 Many
of these side effects are permanent
and irreversible, and diabetics have
underlying predisposition
 Chemotherapy
is the leading treatment
option available for cancer
 Chemotherapy can alter glucose
metabolism; Androgen suppression
therapy, used in patients with prostate
cancer, affects insulin resistance and
increase diabetes or hyperglycemia
 Supportive
medications, high-dose
steroids, elevated blood glucose
• Steroids induce a hypermetabolic state by
decreasing glucose uptake, increased hepatic
glucose production, and inhibiting insulin release
• So, glucocorticoids increase postprandial
hyperglycemia, and fasting hyperglycemia
 Induction
of chemotherapy treatment is
often preceded with steroid therapy, this
can cause a patient already predisposed
to diabetes to progress to type 2
Patients with pre-existing diabetes may be
kept on their oral hypoglycemic agents and
monitored carefully. However, these agents
are usually inadequate for managing
hyperglycemia
 These patients may require two to three times
their usual dose(s) of insulin.
 Insulin is the preferred drug for managing
steroid-induced or exacerbated
hyperglycemia in patients with known
diabetes. Many patients will require basal and
prandial bolus insulins to attain adequate
glycemic control

 Hyperglycemia
has been associated
with increased hospital mortality in
critically ill patients
 New hyperglycemia in any serious ill
patient results in poorer clinical
outcomes
 Nausea
and vomiting are common
adverse reactions to chemotherapy
 Patients with diabetes should be
assessed frequently for nausea and
vomiting, hydration status, ability to
eat and drink, and level of glycemic
control
 Both
diabetes and cancer are complex
diseases that require careful
management
 When a patient is diagnosed with both
diseases, there may be a connection, and
patient care becomes even more
complicated
 A well developed understanding of both
diseases, and the possible connections
between the two, can lead to better
patient care and better potentially patient
outcomes
 Center
for Disease Control and
Prevention [CDC], 2011
 December 2011, Volume 15, Number 6,
Clinical Journal of Oncology Nursing
 Clinical Journal of Oncology Nursing,
Volume 13, Number 2, Diabetes
Management and Self-Care Education
 Diabetes and Cancer: A Consensus
Report: 2010: American Diabetes
Association and the American Cancer
Society
 Diabetes Spectrum, Volume 19, Number
3, 2006: Clinical Challenges in Caring for
Patients with Diabetes and Cancer