Denise Soltow Hershey

The 2014-2018 oncology nursing society research agenda

PURPOSE/OBJECTIVES To identify priority areas of research for the Oncology Nursing Society (ONS) Research Agenda for 2014-2018, consistent with ONSs mission to promote excellence in oncology nursing and quality cancer care
. DATA SOURCES Review of the literature, 2013 ONS Research Priorities Survey, National Institute of Nursing Research, and the National Cancer Institute research foci
. DATA SYNTHESIS Multimethod consensus-building approach by content leaders and content experts of the ONS Research Agenda Project Team
. CONCLUSIONS The 2014-2018 Research Agenda Project Team identified eight high-priority research areas: symptoms, late effects of cancer treatment and survivorship care, palliative and end-of-life care, self-management, aging, family and caregivers, improving healthcare systems, and risk reduction. In addition, four cross-cutting themes were identified: biomarkers, bioinformatics, comparative effectiveness research, and dissemination and implementation science. IMPLICATIONS FOR NURSING The Research Agenda is a synthesis of the state of the science in cancer and identifies gaps and directions for the conduct and dissemination of research. Oncology nurses can use the agenda to inform clinical practice, develop research proposals, inform policy makers, support interdisciplinary research efforts, and promote scientist and clinician collaborations in targeted patient-centered research
.

Perceived Impact of Cancer Treatment on Diabetes Self-Management:

Purpose The purpose of this study was to identify the impact that cancer and its treatment had on diabetes self-management and to identify common issues that individuals with diabetes encounter while undergoing chemotherapy. Methods This exploratory study utilized a baseline self-administered written survey and an 8-week telephone follow-up survey that included 2 open-ended questions. Forty-three adults aged 50 or older with diabetes and a solid tumor cancer receiving chemotherapy were recruited from 8 community outpatient cancer centers in Michigan and Ohio. Descriptives, t tests, and correlations were utilized to analyze the data. Content analysis was used to analyze the data from the open-ended questions. Results After a minimum of 8 weeks of chemotherapy, patients performed significantly fewer diabetes self-management behaviors. The majority of individuals experienced a moderate to high impact on their ability to perform diabetes self-management activities while receiving chemotherapy. Exercise, ability to eat and drink, and monitoring blood sugars were most affected. Three themes identifying patient issues were noted: self-management issues, health issues, and prioritization. Conclusions Cancer treatment and cancer-related symptoms can have a negative impact on diabetes self-management behaviors in adults with diabetes who are undergoing chemotherapy. Diabetes self-management education is targeted to improve health outcomes in patients with diabetes and cancer and addresses the “cause” not just the “source” of the problem needs to be developed. Further research needs to be done to address issues related to glycemic control and health-related outcomes in this population.

Hyperglycemic-inducing neoadjuvant agents used in treatment of solid tumors: A review of the literature

PURPOSE/OBJECTIVES To review the literature regarding the development of hyperglycemia associated with neoadjuvant agents used in the treatment of solid tumor cancers. DATA SOURCES Research articles were obtained from PubMed, CINAHL®, and Cochrane Reviews. The following search terms were used alone and in combination: diabetes, glycemic control, chemotherapy, androgen deprivation therapy, interferon-alpha, immunosuppressants, cancer, neoplasms, and hyperglycemia. DATA SYNTHESIS Twenty-two studies were identified reporting the development of hyperglycemic events in patients who received a variety of chemotherapeutic agents. CONCLUSIONS Findings suggest patients are at risk for the development of hyperglycemia from certain chemotherapeutic agents. Docetaxel, everolimus, and temsirolimus alone or in combination with other agents can promote hyperglycemia. Androgen-deprivation therapy commonly used in prostate cancer, increases the risk for the development of hyperglycemia and diabetes. IMPLICATIONS FOR NURSING Oncology nurses play an important role in the identification and treatment of hyperglycemia in patients receiving chemotherapy. Future research is needed that focuses on the association between glycemic control and adverse outcomes in patients with a solid tumor cancer who are at risk for treatment-induced hyperglycemia.

Predictors of diabetes self-management in older adults receiving chemotherapy.

Background: Cancer patients with diabetes have higher mortality rates and are more likely to develop infections, and be hospitalized during treatment. Hyperglycemia has been hypothesized as one of the factors associated with this increased risk. Diabetes self-management is one of the essential elements used by patients to maintain glucose levels. Objective: This exploratory study seeks to develop an understanding of the impact cancer treatment can have on overall diabetes self-management and how individual, clinical, and behavioral characteristics may influence or predict the level of diabetes self-management in adults who are undergoing chemotherapy for a solid tumor cancer. Methods: This study was conducted at 8 community-based cancer centers in Michigan and Ohio and used a written, self-administered survey at baseline and a phone survey 8 weeks later. Results: Diabetes self-management significantly decreased (P < .001), and the level of symptom severity significantly increased (P < .001) after patients were on chemotherapy for a minimum of 8 weeks. The level of symptom severity and diabetes self-efficacy were significantly predictive of the performance of diabetes self-management activities. Conclusions: Chemotherapy and associated symptoms can have a negative impact on the performance of diabetes self-management activities in adults with both diabetes and cancer, increasing the risk for hyperglycemia and development of complications. Implications for Practice: Oncology nurses need to be aware of the impact cancer treatment can have on the performance of diabetes self-management activities in adults. Future research needs to test interventions that may assist patients with diabetes and cancer in managing both diseases.

Hypoglycemia in patients with diabetes who are fasting for laboratory blood tests: the Cape Girardeau Hypoglycemia En Route Prevention Program.

Abstract Objective: Patients with diabetes are routinely asked to fast for laboratory tests. If not properly prepared, they may be at risk for hypoglycemia, which may result in traffic accidents while driving en route to and from laboratory facilities. We undertook this study to evaluate the magnitude of this overlooked problem, and to evaluate the effectiveness of a prevention program implemented in our clinic. Methods: A retrospective study consisting of chart reviews and telephone interviews of consecutive hypoglycemic events (blood glucose level < 70 mg/dL). The study cohorts, A and B, were extracted from our central laboratory database. Cohort A (from January 2008–September 2009) consisted of patients prior to–and cohort B (from October 2009–June 2011) subsequent to–the implementation of a prevention program involving blood glucose monitoring and adjustment of antidiabetic medications. Duration of each cohort was 21 months. For the purpose of this article, we use the acronym FEEHD (fasting–evoked en–route hypoglycemia in diabetes) to describe this overlooked form of hypoglycemia. Results: Of a total of 1801 blood glucose test results retrieved, cohort A included a total of 55 hypoglycemic events in 51 patients (4 patients with 2 events each). Cohort B included a total of 23 hypoglycemic events in 22 patients (with 1 patient sustaining 2 events) out of a total of 2561 blood glucose test results retrieved. In cohort A, of 35 patients on antidiabetic medications who recalled fasting or probably fasting, there were 39 hypoglycemic events (2.2% frequency), compared with 18 events (0.7% frequency) in 17 patients in cohort B. This indicates a 68% risk reduction. The frequency of critical hypoglycemia (< 50 mg/dL) was more significantly reduced, from 11 events (0.6%) to 2 events (0.07%), indicating a risk reduction of 88%. Conclusion: This study showed a 68% risk reduction of FEEHD with implementation of the prevention program, and an 88% reduction of severe FEEHD (blood glucose level < 50 mg/dL). Reporting on the first prevention program of its kind, this is the first study to evaluate an overlooked safety problem in diabetes management. Clinicians should consider if fasting laboratory tests are in fact necessary, and when ordered, clinicians should properly instruct their patients on adequate blood glucose monitoring and adjustment of antidiabetic medications. We present the guidelines that proved effective in our program to help patients with diabetes and their clinicians avert this potentially harmful complication.

Recruitment and retention of a challenging population: Lessons learned and design implications

PURPOSE The purpose of this article is share the lessons learned from recruiting and retaining adults with type 2 diabetes and solid tumor cancer into a longitudinal study exploring the relationship among chemotherapy, glycemic control, and symptoms. DESIGN/METHODS Twelve-week longitudinal study, recruited thirty-four adults 21years or older with pre-existing type 2 diabetes and a solid tumor cancer, from three community based cancer centers who were eligible to receive outpatient chemotherapy. METHODS Fishers Exact Test (categorical variables) and Logistic Regression (continuous variables) were used to evaluate factors associated with participant withdrawal. A dichotomous attrition variable was created to identify those who dropped out of the study before the final week and those who completed. RESULTS Thirteen of the 34 participants completed the study. Symptom severity, baseline HbA1c and metastases were all identified as being factors that potentially influenced attrition. Recruitment was improved once recruiters were hired at each of the cancer centers and adjustments made to the inclusion criteria. CONCLUSIONS/IMPLICATIONS FOR RESEARCH Several design elements need to be considered to address attrition in future including the use of recruiters, inclusion and exclusion criteria, consent timing, data collection schedules, participant characteristics, participant burden, and support person identification.

Controlling Malglycemia in Patients Undergoing Treatment for Cancer

Patients with or without preexisting diabetes undergoing treatment for cancer may be at risk for malglycemic events. Malglycemia, particularly hyperglycemia and diabetes in patients with cancer, may lead to adverse outcomes. Prevention, prompt recognition, and early intervention to regulate malglycemia can optimize the effects of cancer treatment, minimize the harmful consequences, and improve quality of life for patients with cancer. The development of evidence-based standards of care and protocols are needed to guide clinical practice when caring for patients with cancer.

Improving coordination of care among healthcare professionals and patients with diabetes and cancer

BACKGROUND Patients with diabetes and cancer have higher mortality and morbidity rates, and are more likely to be hospitalized during treatment. In addition, they often prioritize cancer treatment over self-management of diabetes. OBJECTIVES This research aims to identify the issues regarding the management of diabetes in patients with cancer by examining the perspectives of oncology providers, nurses, and patients. METHODS This study used six focus groups of oncology providers, nurses, and patients with preexisting diabetes who received chemotherapy for a solid tumor or lymphoma. Participants were recruited from two outpatient cancer centers in Michigan. All focus group discussions were audio recorded and transcribed, and thematic analysis was conducted to identify common themes. FINDINGS Three overarching themes were identified by patients, nurses, and oncologists.

Do we have a clue: The treatment burden for the patient with cancer?

M any who read Cancer Nursing have spent most of their professional career providing patients with cancer with strategies to deal with their cancer treatments and the symptoms and toxicities they generate. Those who conduct intervention research propose rigorous detailed intervention designs to help patients with cancer endure recommended therapies. Interventions are designed to assist patients to effectively manage symptoms and adverse effects or to assist them with coping with the emotional issues they may experience during treatment. Our current research uses symptom management strategies to foster adherence with targeted oral oncolytic medications for patients with advanced disease. As in previous research, the patients in this study have taught us that we do not have a clue! We had not considered the burden of taking oral oncolytics added to their lives. We had not come to appreciate how the addition of another intervention for patients with advanced cancer added more to their already complicated lives of living with cancer. Many of these patients are older, and most have additional comorbid conditions they are already managing. Most interventions for symptom management or adherence only assist patients with managing 1 chronic condition, but the more chronic conditions they have, the more work they need to perform, increasing their overall treatment burden. Here, we discuss treatment burden for the patient with preexisting chronic disease who now has a cancer diagnosis and propose recommendations for researchers to consider as they design interventions for clinicians to assist patients who are undergoing treatment with oral oncolytics. Patients with cancer today are living longer because of more effective cancer treatment. These same patients are surviving cancer while also living with and managing multiple other chronic conditions. Increasing multimorbidity has brought increased care demands for patients with cancer and added considerations for healthcare providers. Patients with multiple chronic conditions, such as diabetes, hypertension, and Parkinson_s disease, who were given a diagnosis of breast, colon, or lung cancer, now have a quantum increase in the complexity and time they need to devote to their own ongoing care requirements. Depending on how these conditions progress, more time will be required to manage and coordinate their care. Current changes in cancer care, with shortened hospital stays and treatment with oral oncolytics, rather than intravenous chemotherapy, shift responsibilities and pose increased demands on patients with cancer with other comorbidities. Not only patients need to manage symptoms and monitor to detect reportable adverse effects associated with all of their chronic conditions, but also those on oral oncolytics also need to obtain and administer their oral agents, implement dosing strategies (many of which have complex regimens, with variations in dosage within 1 day, within cycles and rest periods), observe for adverse effects, and separate cancer-related adverse effects from those that are associated with their other chronic conditions. Adverse effects associated with interactions between their cancer and other medications pose an additional problem for patients attempting to manage multiple chronic conditions. Thus, the daily work patients are expected to perform to manage their cancer is added to the work they are already doing for their comorbid conditions, which must be integrated into their social, work, and family roles. Frequently, these treatment burdens occur among older patients with advanced cancer who also have little endurance, poor physical function, and multiple diseaseand treatment-related symptoms. Consider the following case: A 68-year-old woman newly diagnosed with renal cell carcinoma in November 2014 now has progressed to stage IV with metastasis to the lungs and adrenal gland. She also has history of