Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck Cancer
Patients with cancer and diabetes face unique challenges. Limited data are available on diabetes management in patients undergoing concurrent chemoradiotherapy (CCRT), a curative intent anticancer therapy commonly associated with glucocorticoid administration, weight fluctuations and enteral feeds....
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/31/2/61 |
| _version_ | 1797298512526835712 |
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| author | Rhiannon Mellor Christian M. Girgis Anthony Rodrigues Charley Chen Sonia Cuan Parvind Gambhir Lakmalie Perera Michael Veness Purnima Sundaresan Bo Gao |
| author_facet | Rhiannon Mellor Christian M. Girgis Anthony Rodrigues Charley Chen Sonia Cuan Parvind Gambhir Lakmalie Perera Michael Veness Purnima Sundaresan Bo Gao |
| author_sort | Rhiannon Mellor |
| collection | DOAJ |
| description | Patients with cancer and diabetes face unique challenges. Limited data are available on diabetes management in patients undergoing concurrent chemoradiotherapy (CCRT), a curative intent anticancer therapy commonly associated with glucocorticoid administration, weight fluctuations and enteral feeds. This retrospective case–control study examined the real-world incidence of acute diabetes-related complications in patients with head and neck cancer receiving CCRT, along with the impact of diabetes on CCRT tolerance and outcomes. Methods: Consecutive patients with head and neck squamous cell or nasopharyngeal cancer who underwent definitive or adjuvant CCRT between 2010 and 2019 at two large cancer centers in Australia were included. Clinicopathological characteristics, treatment complications and outcomes were collected from medical records. Results: Of 282 patients who received CCRT, 29 (10.3%) had pre-existing type 2 diabetes. None had type 1 diabetes. The majority (74.5%) required enteral feeding. A higher proportion of patients with diabetes required admission to a high-dependency or intensive care unit (17.2 versus 4.0%, <i>p</i> = 0.003). This difference was driven by the group who required insulin at baseline (<i>n</i> = 5), of which four (80.0%) were admitted to a high-dependency unit with diabetes-related complications, and three (60.0%) required omission of at least one cycle of chemotherapy. Conclusions: Patients with diabetes requiring insulin have a high risk of acute life-threatening diabetes-related complications while receiving CCRT. We recommend multidisciplinary management involving a diabetes specialist, educator, dietitian, and pharmacist, in collaboration with the cancer care team, to better avoid these complications. |
| first_indexed | 2024-03-07T22:36:54Z |
| format | Article |
| id | doaj.art-c9bd0a0ec68544358253f0c0856925f5 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-07T22:36:54Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-c9bd0a0ec68544358253f0c0856925f52024-02-23T15:13:24ZengMDPI AGCurrent Oncology1198-00521718-77292024-02-0131282883810.3390/curroncol31020061Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck CancerRhiannon Mellor0Christian M. Girgis1Anthony Rodrigues2Charley Chen3Sonia Cuan4Parvind Gambhir5Lakmalie Perera6Michael Veness7Purnima Sundaresan8Bo Gao9Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW 2145, AustraliaDepartment of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW 2145, AustraliaThe Kinghorn Cancer Centre, St Vincent’s Hospital, Darlinghurst, NSW 2010, AustraliaBlacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, NSW 2148, AustraliaCrown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW 2145, AustraliaBlacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, NSW 2148, AustraliaNepean Cancer Care Centre, Nepean Hospital, Kingswood, NSW 2747, AustraliaCrown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW 2145, AustraliaCrown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW 2145, AustraliaCrown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW 2145, AustraliaPatients with cancer and diabetes face unique challenges. Limited data are available on diabetes management in patients undergoing concurrent chemoradiotherapy (CCRT), a curative intent anticancer therapy commonly associated with glucocorticoid administration, weight fluctuations and enteral feeds. This retrospective case–control study examined the real-world incidence of acute diabetes-related complications in patients with head and neck cancer receiving CCRT, along with the impact of diabetes on CCRT tolerance and outcomes. Methods: Consecutive patients with head and neck squamous cell or nasopharyngeal cancer who underwent definitive or adjuvant CCRT between 2010 and 2019 at two large cancer centers in Australia were included. Clinicopathological characteristics, treatment complications and outcomes were collected from medical records. Results: Of 282 patients who received CCRT, 29 (10.3%) had pre-existing type 2 diabetes. None had type 1 diabetes. The majority (74.5%) required enteral feeding. A higher proportion of patients with diabetes required admission to a high-dependency or intensive care unit (17.2 versus 4.0%, <i>p</i> = 0.003). This difference was driven by the group who required insulin at baseline (<i>n</i> = 5), of which four (80.0%) were admitted to a high-dependency unit with diabetes-related complications, and three (60.0%) required omission of at least one cycle of chemotherapy. Conclusions: Patients with diabetes requiring insulin have a high risk of acute life-threatening diabetes-related complications while receiving CCRT. We recommend multidisciplinary management involving a diabetes specialist, educator, dietitian, and pharmacist, in collaboration with the cancer care team, to better avoid these complications.https://www.mdpi.com/1718-7729/31/2/61head and neck cancerchemoradiotherapymanagementdiabetesdiabetes complications |
| spellingShingle | Rhiannon Mellor Christian M. Girgis Anthony Rodrigues Charley Chen Sonia Cuan Parvind Gambhir Lakmalie Perera Michael Veness Purnima Sundaresan Bo Gao Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck Cancer Current Oncology head and neck cancer chemoradiotherapy management diabetes diabetes complications |
| title | Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck Cancer |
| title_full | Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck Cancer |
| title_fullStr | Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck Cancer |
| title_full_unstemmed | Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck Cancer |
| title_short | Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck Cancer |
| title_sort | acute diabetes related complications in patients receiving chemoradiotherapy for head and neck cancer |
| topic | head and neck cancer chemoradiotherapy management diabetes diabetes complications |
| url | https://www.mdpi.com/1718-7729/31/2/61 |
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