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Glucocorticoid-Induced Hyperglycemia in Oncologic Outpatients: A Narrative Review Using the Quadruple Aim Framework

  • Ihab Kandil
    Affiliations
    Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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  • Erin Keely
    Correspondence
    Address for correspondence: Erin Keely MD, Department of Medicine, University of Ottawa, Division of Endocrinology and Metabolism, The Ottawa Hospital, Riverside Campus, 1967 Riverside Drive, Ottawa, Ontario K1H 7W9, Canada.
    Affiliations
    Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
    Search for articles by this author
Published:March 08, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.02.011

      Abstract

      Glucocorticoids are a central part of cancer treatment protocols. Their use in patients receiving chemotherapy increases patient risk of hyperglycemia and associated adverse outcomes. Despite this, there have been few published protocols that guide the management of this patient group. In this narrative review, we use the quadruple aim as a framework to evaluate the current literature, including interventions, on glucocorticoid-induced hyperglycemia in patients receiving oncologic treatment, with a focus on the outpatient setting. Findings were drawn from published review articles, observational studies, qualitative reports and costing data. Results were synthesized using the framework’s 4 dimensions of care: population health, provider experience, patient experience and cost. Prospective studies proposing an intervention on oncologic patients receiving glucocorticoids were identified as intervention studies. Management of glucocorticoid-induced hyperglycemia in oncologic patients is a complex problem with no published interventions addressing all components of the quadruple aim. Most evidence on this population is based on retrospective studies. Six prospective intervention studies were identified and highlighted in this review, and only 2 were exclusively in the outpatient context. Challenges included lack of standardization in screening strategies and a paucity of interventions that have examined impact on patient and provider experience. There is limited evaluation of the impact of interventions targeting glycemic management on clinical outcomes and cost of care delivery, especially in the outpatient context. We propose a conceptual framework for evaluation of quality improvement programs. Management of glucocorticoid-induced hyperglycemia in the outpatient setting is complex and requires well-designed intervention studies evaluated across the quadruple aim.

      RÉSUMÉ

      Les glucocorticoïdes sont au cœur des protocoles de traitement du cancer. L’utilisation des glucocorticoïdes chez les patients qui reçoivent une chimiothérapie augmente leur risque d’hyperglycémie et est associée à des issues défavorables. Néanmoins, peu de protocoles sur l’orientation de la prise en charge de ce groupe de patients ont été publiés. Dans la présente revue narrative, nous utilisons le quadruple objectif pour évaluer la littérature actuelle, notamment les interventions, sur l’hyperglycémie induite par les glucocorticoïdes chez les patients qui reçoivent un traitement oncologique, et portons une attention particulière au contexte ambulatoire. Les résultats provenaient de publications d’articles de revue, d’études observationnelles, de rapports qualitatifs et de données sur les coûts. Les résultats ont fait l’objet d’une synthèse fondée sur les 4 dimensions de soins du cadre de référence : santé de la population, expérience des prestataires de soins, expérience des patients et les coûts. Il a été établi que les études prospectives sur des interventions auprès des patients en oncologie qui reçoivent des glucocorticoïdes sont des études d’intervention. La prise en charge de l’hyperglycémie induite par les glucocorticoïdes chez les patients en oncologie est un problème complexe pour lequel aucune intervention portant sur tous les volets du quadruple objectif n’a été publiée. La plupart des données probantes sur cette population sont fondées sur des études rétrospectives. Six études d’intervention ont été recensées et présentées dans cette revue, mais seules 2 études portaient exclusivement sur le contexte ambulatoire. Les enjeux étaient notamment le manque de standardisation des stratégies de dépistage, la rareté des interventions qui ont permis d’examiner l’incidence sur l’expérience des patients et des prestataires de soins. L’évaluation des résultats cliniques associés aux interventions sur la glycémie ainsi que sur les coûts est limitée, particulièrement dans le contexte ambulatoire. Nous proposons un cadre conceptuel en matière d’évaluation des programmes d’amélioration de la qualité. La prise en charge de l’hyperglycémie induite par les glucocorticoïdes dans le contexte ambulatoire est complexe et nécessite des études d’intervention bien conçues qui permettent d’évaluer tous les volets du quadruple objectif.

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