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From Your NavigatorSurvivorship

Improving the Care of Patients with Cancer and Diabetes: The Role of the Navigator

“Navigators can play an important role in assisting patients and caregivers in managing diabetes and cancer treatment,” says oncology nurse navigator Cheryl Bellomo.
June 2017 Vol 3 No 3
Cheryl Bellomo, MSN, RN, OCN, ONN-CG
Oncology Nurse Navigator, Intermountain Southwest Cancer, Center, Cedar City, UT

Diabetes and cancer are 2 of the most common chronic conditions in the United States. The American Cancer Society estimates that more than 1 million (1,688,780) people will be newly diagnosed with cancer in 2017, and 8% to 18% of these patients will also have preexisting diabetes.

Diabetes has been linked to higher risks for certain types of cancer and death, and patients with cancer and diabetes have higher mortality and morbidity rates than patients with cancer without diabetes. As the US population ages and the number of cancer survivors increases, we can expect an increase in the number of individuals who will have to deal with both of these diseases.

Challenges in Dealing with Cancer and Diabetes

Dealing with diabetes and cancer treatment together can be difficult for patients and their caregivers and can result in hospitalizations. Cancer treatment, especially chemotherapy and its associated side effects, can negatively affect diabetes self-management and increase the patient risk for poor health outcomes.

For example, medications, such as glucocorticoids (steroids), often used for cancer treatment to manage the side effects of chemotherapy, including nausea and allergic reactions, may cause high blood sugar levels (hyperglycemia).

In addition, nausea and vomiting related to cancer treatment can interfere with appropriate nutrition. Sticking to a diabetic diet for blood sugar (glycemic) control can also prove difficult for patients receiving chemotherapy, because their bodies require additional protein and calories to prevent or treat fatigue and nausea and help the body’s healing process.

Fatigue related to cancer treatment can interfere with a regular exercise schedule and sleep cycles, making it difficult for patients to maintain their regular sleep and exercise patterns. Overall, diet, exercise, and blood sugar levels can become a challenge to manage for patients with cancer.

Patients often feel too overwhelmed to manage self-care for cancer and diabetes simultaneously. Patients with cancer and diabetes typically view cancer as being the more serious condition, and because of a lack of energy, may find themselves able to focus on only 1 disease at a time, often prioritizing cancer treatment over diabetes self-management.

Care Coordination

A gap in care coordination for patients with chronic conditions, such as diabetes and cancer, can be the result of poor or ineffective communication between healthcare providers. Uncertainty about who should be managing different aspects of care for the patient can exist between multiple healthcare providers.

For example, oncologists and primary care providers may not have a clear understanding as to who will manage blood sugar levels during cancer treatment in patients with cancer who also have preexisting diabetes.

Talk to Your Navigator About Self-Management of Cancer and Diabetes

As members of the oncology team, navigators can play an important role in assisting patients and caregivers in managing diabetes and cancer treatment. Through open communication and trusting relationships, navigators can assess and address barriers and challenges that affect patients’ prioritization of disease management. Ask your navigator for information about managing diabetes while treating your cancer.

As educators, navigators can provide patients and caregivers with patient-centered education about blood sugar control, diet, and exercise, as well as symptoms that could affect diabetes management.

Navigators can also help to empower patients to develop interventions that aim to improve their self-management of their diabetes during cancer treatment. In addition, as members of the oncology multidisciplinary team, navigators can refer patients to registered dietitians and diabetes educators to provide patients and their caregivers additional support.

Working with the patient’s healthcare providers—oncologist, primary care physician, and multidisciplinary team—navigators can help improve the patient’s care coordination, by establishing roles and responsibilities for all members of the healthcare team regarding the management of diabetes at the start of cancer treatment.

As our population ages, more patients with cancer and cancer survivors will have a greater number of chronic conditions, such as diabetes, that will need to be treated. All members of the healthcare team, including navigators, must be properly prepared to manage all aspects of patient care for their patients with cancer through improved communication and coordination of care.

By providing interventions targeted at improving patient self-management and care coordination, navigators can help improve the care and health outcomes of patients with cancer, diabetes, and other chronic conditions.

Key Points

  • Of the 1,688,780 people who are estimated to be diagnosed with cancer in 2017, 8% to 18% will also have diabetes
  • Patients with cancer and diabetes have higher mortality and morbidity than patients with cancer without diabetes
  • Diabetes has been linked to increased risk for certain types of cancer and death
  • Cancer treatment, especially chemotherapy and its associated side effects, can negatively affect diabetes self-management, increasing the risk for side effects
  • It is important to find a balance in treating both diseases so as not to neglect one disease or the other
  • Patients should talk with their nurse navigators to ensure proper treatment
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Last modified: October 5, 2017