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(255) Oncologists’ responsibility, comfort, and knowledge managing hyperglycemia in patients with cancer undergoing chemotherapy

    Primary Author(s)

  • TS

    Teresa M. Salgado, MPharm, PhD

    Assistant Professor
    Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.
    Richmond, Virginia, United States

    • Co-Author(s)

  • RR

    Rotana M. Radwan, PharmD, MS

    PhD Candidate
    Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA., Virginia, United States

  • EM

    Emily Mackler, PharmD

    Director of POEM (Pharmacists Optimizing Oncology Care Excellence in Michigan)
    Michigan Oncology Quality Consortium (MOQC) and Michigan Institute for Care Management and Transformation (MICMT), Ann Arbor, MI, USA., United States

  • TB

    Tonya Buffington, PharmD

    Pharmacist
    Bon Secours Mercy Health, Richmond, VA, USA., United States

  • JP

    Jennifer M. Perkins, MD, MBA

    Professor
    Division of Endocrinology, University of California San Francisco Medical Center, San Francisco, CA, USA., United States

  • DD

    Dave Dixon, PharmD

    Professor
    Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.
    Richmond, United States

  • VS

    Vanessa B. Sheppard, PhD

    Professor
    Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, VA, USA., United States

  • RJ

    Resa M. Jones, MPH, PhD

    Associate Professor
    Department of Epidemiology & Biostatistics, Temple University, Philadelphia, Pennsylvania, USA., United States

Objective : To assess oncologists’ responsibility, comfort, and knowledge managing hyperglycemia in patients undergoing chemotherapy.

Methods: In this cross-sectional study, a questionnaire collected oncologists’ perceptions about professionals responsible for managing hyperglycemia during chemotherapy; comfort (score range 12-120); and knowledge (score range 0-16). Descriptive statistics were calculated including Student t-tests and one-way ANOVA for mean score differences. Multivariable linear regression identified predictors of comfort and knowledge scores.

Results: Respondents (N=229) were 67.7% men, 91.3% White and mean age 52.1 years. Oncologists perceived endocrinologists/diabetologists and primary care physicians as those responsible for managing hyperglycemia during chemotherapy, and most frequently referred to these clinicians. Reasons for referral included lack of time to manage hyperglycemia (62.4%), belief that patients would benefit from referral to an alternative provider clinician (54.1%), and not perceiving hyperglycemia management in their scope of practice (52.4%). The top-3 barriers to patient referral were long wait times for primary care (69.9%) and endocrinology (68.1%) visits, and patient’s provider being outside of the oncologist’s institution (52.8%). The top-3 barriers to treating hyperglycemia were lack of knowledge about insulin: when to start (mean=8.5/10), how to start (mean=7.2/10), how to adjust (mean=8.5/10), and what type works best (mean=8.3, SE=0.08). Women (ß=1.67, 95% CI: 0.16, 3.18) and oncologists in suburban areas (ß=6.98, 95% CI: 2.53, 11.44) had higher comfort scores than their counterparts; oncologists working in practices with >10 oncologists had lower comfort scores (ß=-2.75, 95% CI: -4.96, -0.53) than those in practices with < 10. Predictors for knowledge were non-significant.

Conclusions: Oncologists expected endocrinology or primary care to manage hyperglycemia during chemotherapy. Long wait times were among the top barriers cited when referring patients. New models that provide prompt and coordinated care are needed.