Dual Diagnosis: Nurses Face Challenges in Caring for Patients With Both Cancer and Diabetes

Receiving a diagnosis of either cancer or diabetes can be life changing, but for patients with both diseases, it can prove especially challenging. Research shows that 8% to 18% of individuals living with cancer also have diabetes¹ and that treating both simultaneously makes the process more complicated for nurses and their patients. The American Diabetes Association states, “Cancer and diabetes are diagnosed within the same individual more frequently than would be expected by chance.”²

“As our population ages and people are living longer, we can expect to see the number of patients receiving diagnoses of both cancer and diabetes increase,” said Jill Olausson, PhD, RN, CDE, an assistant professor and assistant chair, Master’s of Nursing in Healthcare Administration, at Azusa Pacific University in California. Olausson is part of the Glycemic Control for Patients with Cancer Nursing Task Force, a group of nurses committed with improving health-related outcomes and the care of oncology patients with diabetes.

The Link Between Diabetes and Cancer

People with diabetes (primarily type 2) are at a higher risk of developing certain cancers than those without diabetes, as the diseases share risk factors such as aging, obesity, poor nutrition, and physical inactivity.³ Olausson notes that predni- sone and other steroids used to treat or prevent nausea, or as a component of cancer treatment, can also cause a spike in blood sugars and compound the management of diabetes. Patients who receive steroids should be closely monitored with premeal glucose testing and additional testing 2 hours after a meal.

Caring for Patients With Diabetes and Cancer

“Cancer patients with diabetes are at an increased risk for developing infections, being hospitalized, and requiring chemotherapy reductions or stoppages,” says Denise Hershey, PhD, RN, FNPBC, an associate professor at Michigan State University’s College of Nursing in East Lansing. Unfortunately, Hershey says there is not sufficient evidence on the best way to manage diabetes in patients with cancer. She believes in looking at each patient’s overall health rather than focusing solely on their cancer.

“It’s important for oncology nurses to work with diabetes educators, nutritionists, and others to form a comprehensive care plan for patients,” Hershey says. “Nurses can assess how well a patient’s diabetes is being controlled by looking at the patient’s A1C [glycated hemoglobin] at the time of their initial cancer diagnosis and seeing if they now appear to [have] hyperglycemia.”

Care plans can help patients balance their glucose levels with their cancer treatment after discharge. “It’s important to look at barriers patients may be facing, such as not being able to afford the high cost of diabetic test strips,” Hershey says. “Rather than just advising them to exercise, letting them know that regular exercise can help stabilize blood sugar levels while also lowering the chances of cancer adverse events [AEs] such as fatigue and neuropathy.”

Recent research shows that blood glucose above 180 increases the risk of complications in hospitalized patients.³ Hershey says oncology patients sometimes make the mistake of prioritizing their cancer diagnosis over their diabetes.

“We know glycemic control plays a role in the overall health quality of life for oncology patients, level of symptom severity, and can also affect overall survival,” Hershey says. “Educating patients about how to self-manage their glycemic control is just as important as treating their cancer, in order to achieve the best outcomes.”

Oncology nurses also need to be aware of changes in a patient’s condition; many
cancer symptoms are also signs of diabetes. Uncontrolled high blood sugar can lead to dehydration, but extreme thirst can also be an AE of chemotherapy. Both diabetes and cancer complications can cause or worsen neuropathy. “We need to look at cancer survivorship and ensure these patients receive optimal diabetes care and achieve their glycemic targets,” Hershey says.