Diabetology and oncology meet in a network model: union is strength.
Marco GalloLuigi GentileEmanuela ArvatOscar BertettoGennaro ClementePublished in: Acta diabetologica (2016)
Diabetes and cancer are increasingly common conditions, and the management of cancer patients with diabetes is often challenging. Diabetes in cancer patients poses several complex clinical issues, including which treatment is suitable to control hyperglycemia, how to better counteract glucocorticoid-induced hyperglycemia, and how to manage nutritional problems of cachectic patients and glucose variability linked to artificial nutrition. A key aspect to consider is the patients' position on the trajectory of the oncologic disease, both to establish which level of glycemic control should be pursued and to decide the most suitable antidiabetic treatment to recommend. Endocrinologists are rarely involved in the management of patients with advanced cancer. Furthermore, lack of guidelines results in a "trial-and-error" approach, often with suboptimal disease management. Lastly, cancer survivors represent a frequently underestimated category of patients at higher cardiometabolic risk. A practical solution for these challenges lies in the implementation of care networks based on a close partnership and ongoing communication between oncologists, endocrinologists, and nutritionists, placing the patient at the center of the care process. At the same time, universities and scientific societies should play a key role in promoting research into areas of intersection of oncology and endocrinology, in raising awareness of common possibilities of primary and secondary prevention of metabolic and oncologic diseases, as well as specific challenges of managing diabetes and cancer, and proper training of health workers, while also supporting the shared implementation of effective management strategies.
Keyphrases
- glycemic control
- palliative care
- type diabetes
- healthcare
- advanced cancer
- end stage renal disease
- papillary thyroid
- cardiovascular disease
- chronic kidney disease
- ejection fraction
- newly diagnosed
- mental health
- quality improvement
- prognostic factors
- blood glucose
- primary care
- squamous cell
- public health
- randomized controlled trial
- study protocol
- clinical trial
- childhood cancer
- physical activity
- clinical practice
- squamous cell carcinoma
- weight loss
- risk assessment
- robot assisted
- blood pressure
- case report
- social media
- open label
- rectal cancer
- phase iii