1549PD - Treating diabetic patients with chemotherapy: single centre experience of toxicity and outcomes

Date 30 September 2012
Event ESMO Congress 2012
Session Supportive and palliative care: Controlling disease and treatment side-effects
Topics Complications of Treatment
Cancer in Special Situations
Presenter Jenny Seligmann
Authors J.F. Seligmann1, A. Young2, G. Heath2, D. Cairns3, A. Anthoney2, G. Hall2, M. Seymour2, D. Swinson2
  • 1Medical Oncology, St. James Institute of Oncology, Leeds Teaching Hospitals NHS Trust, LS9 7TF - Leeds/UK
  • 2Medical Oncology, The Leeds Teaching Hospital NHS Trust St. James University Hospital, LS9 7TF - Leeds/UK
  • 3Leeds Institute Of Molecular Medicine, University of Leeds, Leeds/UK

 

Abstract

Background

Diabetes is a common comorbidity in cancer patients, and is associated with poorer survival in colorectal cancer (CRC). However, there is little data to describe the experience of diabetic patients during chemotherapy. We have compared a diabetic population of cancer patients with matched controls receiving chemotherapy in a single centre.

Methods

We performed a retrospective case note analysis using an electronic patient record database (Patient Pathway Manager) and chemotherapy prescription software (ChemoCare) between 2001 and 2011. Diabetic patients starting first line chemotherapy for advanced CRC and advanced gynaecological cancers (GC) were identified. For each case a non-diabetic control was selected, matched for age (<65 vs ≥65), disease site (GC vs CRC) and chemotherapy type (single agent vs combination). Data for dose adjustments, acute admissions, stoppages, subsequent therapy and survival were compared, corrected for performance status (PS), comorbidity and primary site.

Results

146 diabetic patients and 146 matched controls were included. Median age was 67 years; 95% of diabetic patients had type 2 diabetes, 18.5% were receiving insulin. Performance status was similar (diabetic 66% PS0-1, 29% PS2-3; non-diabetic 64% PS0-1, 34% PS2-3); more diabetic patients had comorbidity (60% vs 45%). A non-significant difference was observed in dose reductions (upfront 31.5% vs 23.9% p = 0.15; on-treatment 23.3 vs 13.7% p = 0.35). Only 5% of diabetic patients had upfront steroid reduction. Diabetes was independently associated with an increased risk of acute admission (OR = 3.32, 95%CI 1.8-5.8, p < 0.0001), early stopping of chemotherapy (OR = 2.17, 95%CI 1.25-3.85, p = 0.006) and reduced use of 2nd line treatment (OR = 0.56, 95%CI 0.34-0.95, p = 0.03). The most common causes of admission in the diabetic group were infection (41%) and poor glycaemic control (17%). Poor PS was also an independent risk factor for the above factors in multivariable analysis. Primary site, PS and age, but not diabetes, were independently prognostic for survival.

Conclusions

Diabetic patients experienced more acute complications on chemotherapy possibly limiting further treatment options. A prospective study would clarify the contributing factors and inform planning and monitoring of diabetic patients with cancer.

Disclosure

All authors have declared no conflicts of interest.