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.
Keywords
Mots clés
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Article Info
Publication History
Published online: March 08, 2022
Accepted:
February 28,
2022
Received in revised form:
January 4,
2022
Received:
October 12,
2021
Identification
Copyright
© 2022 Canadian Diabetes Association.
