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ABSTRACT:
Background
Glucocorticoids are a central part of cancer treatment protocols. Their use in patients
receiving chemotherapy increases their 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.
Methods
Findings were drawn from published review articles, observational studies, qualitative
reports, as well as costing data. Results were synthesized using the framework’s four
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.
Results
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, only two were
exclusively in the outpatient context. Challenges included lack of standardization
in screening strategies, paucity of interventions that have examined impact on patient
and provider experience. Evaluation of clinical outcomes associated with glycemic
intervention as well cost is limited, especially in the outpatient context. We propose
a conceptual framework for evaluation of quality improvement programs.
Conclusion
Management of glucocorticoid induced hyperglycemia in the outpatient setting is complex
and requires well designed intervention studies evaluated across the Quadruple Aim.
Key-words
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Article Info
Publication History
Accepted:
February 28,
2022
Received in revised form:
January 4,
2022
Received:
October 12,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
Key Messages:
• Glucocorticoid-induced hyperglycemia in oncologic patients is a complex problem with no widely accepted treatment guidelines.
• Current challenges include standardizing screening practices, accessibility of specialized diabetes teams and patient education.
• Studies of glycemic interventions in the outpatient setting are needed and should be evaluated against the Quadruple Aim (population health, provider experiences, patient experience, and cost)
Author Disclosures
ab These authors have no conflicts of interest to declare.
Funding:
ab These authors have no special funding or financial support to declare.
Identification
Copyright
© 2022 Canadian Diabetes Association.
