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Hyperglycemia, symptoms, and symptom clusters in colorectal cancer survivors with type 2 diabetes

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Abstract

Purpose

The purpose of the study was to compare the individual and total number of symptoms and explore symptom clusters by hyperglycemia status in colorectal cancer survivors (CRCS) with diabetes (type 2).

Methods

A retrospective cohort study was conducted, whereby symptom data were extracted from clinical notes in electronic health records. CRCS (stage II or III) diagnosed between 2007 and 2017 who had diabetes and at least one HbA1c within 8 months of initial chemotherapy were included. Zero-inflated negative binomial regression analysis was used to examine total symptoms by hyperglycemia status (hyperglycemia versus no hyperglycemia). Exploratory factor analysis was conducted to identify symptom clusters.

Results

Two hundred forty-three CRCS met inclusion criteria. CRCS with hyperglycemia (HbA1c ≥ 6.5%) had greater individual symptoms (fatigue and depression) and total number of symptoms than those with no hyperglycemia. Two distinct symptom clusters, with five (nausea, vomiting, constipation, fatigue, and peripheral neuropathy) and two symptoms (anxiety and depression), were identified among CRCS with hyperglycemia.

Conclusion

These findings indicate that CRCS with diabetes and hyperglycemia had more symptoms and two distinct symptom clusters compared to those with no hyperglycemia. Prospective research studies are needed to examine the role of hyperglycemia in symptoms among CRCS with diabetes. Understanding hyperglycemia’s influence is important as it is a modifiable risk factor towards which prevention and intervention can be directed, potentially mitigating symptoms and symptom clusters and improving outcomes for CRCS with diabetes.

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Funding

This study was supported by an Oncology Nursing Foundation RE01 grant and an Indiana University Simon Cancer Center, Cancer Prevention and Control Pilot grant (PI Storey).

Author information

Authors and Affiliations

  1. Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46260, USA

    Susan Storey

  2. School of Engineering and Technology, Indiana University-Purdue University Indianapolis, 799 W Michigan Street, Indianapolis, IN, 46202, USA

    **ao Luo

  3. Department of Biostatistics and Health Data Science, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, 410 W 10Th Street, Suite 3000, Indianapolis, IN, 46202, USA

    Susan Ofner & Susan M. Perkins

  4. Cancer Research, Center for Healthy Aging, Self-Management and Complex Care, The Ohio State University, 384 Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210, USA

    Diane Von Ah

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  1. Susan Storey
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  2. **ao Luo
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  4. Susan M. Perkins
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  5. Diane Von Ah
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Contributions

All authors contributed to this manuscript: study conception and design (Storey, Von Ah, Luo, and Perkins); acquisition of data (Luo); data analysis (Ofner and Perkins); data interpretation (Storey, Von Ah, Ofner, and Perkins); and writing and revising (Storey, Von Ah, Luo, Ofner, and Perkins). All authors read and approved the final manuscript.

Corresponding author

Correspondence to Susan Storey.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Indiana University (Date February 19, 2021, No. 10526).

Competing interests

The authors declare no competing interests.

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Key message

This innovative study examined the role of hyperglycemia in symptoms and symptom clusters among colorectal cancer survivors (CRCS) with diabetes. We found that CRCS with diabetes and hyperglycemia had more symptoms and two distinct symptom clusters. Prospective research is needed to confirm these findings.

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Storey, S., Luo, X., Ofner, S. et al. Hyperglycemia, symptoms, and symptom clusters in colorectal cancer survivors with type 2 diabetes. Support Care Cancer 30, 10149–10157 (2022). https://doi.org/10.1007/s00520-022-07442-3

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