Intervention, Education on Diabetes Necessary Among Breast Cancer Survivors

Diabetes may be a risk factor for increased symptoms among breast cancer survivors, highlighting the need for interventions to control the disease, according to secondary analysis results presented at the ONS 44th Annual Congress.

“Women with diabetes have a 23% higher risk of developing breast cancer,” explained Susan Storey PhD, RN, AOCNS, Indiana University School of Nursing. “Pre-existing diabetes is associate with a 37% increased risk for mortality among women with breast cancer. Meanwhile, women with diabetes and women with breast cancer experience similar nonspecific symptoms and cancer treatment further worsens symptoms, reducing diabetes self-management activities.”

Since both diseases result in common symptoms, the researchers aimed to determine those—such as depression, anxiety, sexual function, peripheral neuropathy, physical function, attention function, sleep disturbance, and fatigue–from breast cancer survivors with and without comorbid diabetes. In addition, they examined if a diabetes diagnosis was associated with higher symptom profiles in women with breast cancer.

Using a large, cross-sectional study, data were collected from 97 sites across the United States to identify 1127 breast cancer survivors.

In total, 121 patients reported with diabetes and 1006 without. Of those with diabetes, the majority tended to be older (62 years vs. 57 years; P < .001), had higher body mass indexes (BMIs; 32 vs. 28; P < .001), income lower than $75,000 (72% vs. 56%; P < .001), and were less likely to be married (62% vs. 76%; P < .001) compared to those without the comorbidity.

Of the 8 symptoms analyzed, breast cancer survivors with diabetes reported higher symptom scores for physical function (2.30 vs. 2.60; P < .001), attention function (6.45 vs. 6.91; P = .01), sleep (7.20 vs. 6.33; P = .02), and fatigue (37.81 vs. 40.25; P = .01) compared to survivors without diabetes. There were no significant associations with sexual function, anxiety, depression, and peripheral neuropathy.

Of note, when controlled for demographic and medical variables, diabetes was associated with a higher symptom profile for the same 4 symptoms compared with breast cancer survivors without diabetes.

“This study provides evidence that diabetes is a risk factor for an increased symptom profile among women with breast cancer,” Storey said. “Prospective studies are needed to inform the development of interventions to mitigate the synergistic effects of breast cancer and diabetes on these symptoms. Interventions to improve diabetes control may mitigate late chemotherapy-associated symptoms.”

With this, Storey added these results have important implications for oncology nurses. “It is important that we monitor for our diabetic patients for post-treatment sequalae or even during treatment. We need to educate on how these symptoms may be exacerbated by diabetes, to assess the ability to self-manage diabetes. And lastly, we need to refer to members of the healthcare teams to assist in the management of diabetes.”

Reference:

Storey S, Cohee A, Champion V. The Role of Diabetes on the Symptom Severity of Breast Cancer Survivors. Presented at: ONS 44th Annual Congress; April 11-14, 2019; Anaheim, CA. Abstract 5320.