Older adults with diabetes and cancer: Impact on diabetes self-management

Background. Self-management is an important component of diabetes and cancer care. Eight to 18% of individuals with cancer will have preexisting diabetes. Individuals with diabetes who develop cancer have higher mortality and morbidity rates when compared to those without diabetes. Framework. This study was guided by the framework for heart failure self-management and family variables by Dunbar et al (2008). Aims. The primary aim of this study was to examine the relationship between individual, clinical and behavioral characteristics in adults 50 and older who have preexisting diabetes and are receiving chemotherapy for a solid tumor cancer at baseline and after a minimum of 8 weeks of chemotherapy. A secondary aim for this study was to identify challenges or issues related to diabetes self-management in adults who are undergoing chemotherapy. Methods. This pilot study utilized a baseline self-administered survey and a follow up phone survey 8 weeks later. The Diabetes Complications Index, Katz Comorbidity scale, Confidence in Diabetes Scale, outcome expectancies subscale of the Multi-Diabetes Questionnaire and the Hospital Anxiety and Depression Scale were utilized at baseline, in addition to other descriptive questions. The Symptoms of Illness Checklist and Self-care Inventory were utilized at both baseline and 8 weeks to assess symptom severity and diabetes self-management behaviors. The 8 week survey included two open-ended questions that asked patients about challenges or issues with their diabetes self-management, which were tape recorded and then transcribed for analysis. Correlations and a linear regression model were performed for both the baseline and 8 week time intervals to determine factors which influenced diabetes self-management. A paired t-test was utilized to compare diabetes self-management at baseline and 8weeks to determine if there was a difference in the level of performance. Sample. The sample consisted of 34 adults 50 and older with pre-existing diabetes who were receiving chemotherapy for a solid tumor cancer or lymphoma. Individuals were recruited from 8 different community cancer centers in Michigan and Ohio. Results. Age, years with diabetes and level of diabetes self-efficacy where all positively correlated with performance of diabetes self-management behaviors at baseline. Age and level of diabetes self-efficacy are significant (p<.05) predictors for baseline self-management. At 8 weeks, years with diabetes, level of diabetes severity and diabetes self-efficacy were found to be positively correlated with diabetes self-management behaviors. Diabetes severity, number of comorbidities, ethnicity and baseline self management were noted to be significant (p<.05) predictors. A paired t- test indicated significant difference between baseline and 8 week self-management, with individuals having lower scores, indicating they performed less self-management after a minimum of 8 weeks of chemotherapy, with significant (p<.05) differences for the specific behaviors of diet and exercise. Themes Identified were: prioritization, health issues and self-management issues. Implications. Implications for practice include increasing awareness among nurses and health care providers who care for this population regarding the challenges and issues of managing 2 competing chronic conditions, and the need for increased patient education regarding the management of diabetes while undergoing chemotherapy. Further research needs to look at the relationship between glycemic control, diabetes self-management and health related outcomes in this population. Development of guidelines and quality indicators for patients with diabetes and cancer need to be developed, which improve health related outcomes, survivorship and overall health related quality of life for this population.