SRF020: Diabetes management of head and neck cancer survivors accessing primary care at academic, county, and community care clinics

Ashna Ghazal, MD; Samah El-Khaled, DO; Jordan Salley; Andrew Day, MD, MPH; Rebecca Eary, DO


Context: Primary care clinicians (PCC) are uniquely positioned to optimize treatment of comorbid conditions of cancer patients, such as diabetes. Head and neck cancer (HNC) survivors with poorly controlled diabetes have increased treatment-related complications and all-cause mortality. The purpose of this project is to understand the relationship between HNC survivors with established primary care and compliance with American Diabetes Association (ADA) practice guidelines. Objective:  Determine if HNC survivors who receive primary care are ADA guideline complaint and identify covariate associations with diabetes control, a known predictor for improved health outcomes. Human Subjects Review:  This project was approved by the UTSW IRB (STU 122016-038). Design:  Retrospective cohort review will be conducted on HNC survivors from a National Cancer Institute (NCI)-designated center registry from 2013-2018. Three groups of 20 patients separated by type of primary care practice accessed will be randomly selected from the registry. Chart review will include: hgbA1c, lipid management, blood pressure control, eye exam, foot exam, microalbumin/creatinine ratio, dental care or referral, vaccinations and preventive health including other cancer screenings. Covariates will include: sociodemographic data, other comorbidities, number and types of medications and number of PCC visits. Measures will be evaluated at three time points: pre-treatment, during treatment, post-treatment.
Setting:  Primary care setting will include: a tertiary academic medical center, county hospital clinics or community practices. Oncologic care was administered at a tertiary academic medical center and a county hospital. Intervention/Instrument (as pertinent):  n/a No specific interventions were used. Main and Secondary Outcome Measures: The main outcome of this study will be PCC adherence to ADA guidelines for the initiation of care and patient adherence evaluated through a developed scoring system. Secondary outcomes will include level of control of diabetes (hbA1c <7). Anticipated Results: HNC Survivors with diabetes seen more frequently by a PCC are more likely to have controlled diabetes and follow ADA guidelines. Conclusions:  Diabetes control in HNC survivors is poorly described, understanding the relationship between diabetes control and access with primary care during cancer care may help improve outcomes in the future.
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Jack 11/21/2020

terrific. thanks for sharing this with NAPCRG

Anne Gaglioti 11/22/2020

I have a diabetic patient who is a head neck cancer survivor, and didn't know about this increased risk. Her DM is thankfully under good control, but thank you for teaching me about her diabetes status as a potential risk factor! 

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