Presence of Diabetes With CRC Increases Occurrence of Symptom Clusters, Symptoms

Researchers identified symptom clusters and their prevalence over time in patients with colorectal cancer (CRC) who have or do not have diabetes. Study results were reported in the journal Oncology Nursing Forum.

“The findings of this study suggest that having a concurrent diagnosis of CRC and diabetes may exacerbate symptoms and symptom clusters, compared to patients with CRC without diabetes,” the researchers wrote in their report.

The retrospective cohort study included patients with CRC who were being treated at a midwestern US cancer center during the years 2007 through 2017. Electronic health records were used to identify symptoms and symptom clusters in patients who were stratified for analyses by the presence or absence of comorbid diabetes. Symptom clusters were evaluated across 3 time periods, including 0 to 6 months (T1), 12 to 18 months (T2), and 24 to 30 months (T3) after initial chemotherapy.

There were 2293 patients included in the analysis, with diabetes present in 712 (31%) patients and absent in 1581 patients. Overall, most patients had stage III CRC. The mean age of patients with diabetes was 63.16 years (SD, 10.85), and the mean age in those without diabetes was 57.53 years (SD, 12.78).

Across each time period, the most frequently reported symptoms included gastrointestinal (GI) issues and fatigue in patients with CRC overall. Through the 3 time periods, symptom clusters were more abundant in patients with CRC and diabetes, compared with patients having CRC without diabetes. The researchers did not identify symptom clusters that were stable over time in either patient group, but they identified 7 total symptom clusters overall in patients with CRC and diabetes and 4 symptom clusters in patients with CRC and no diabetes.

During T1, patients with CRC and diabetes had 3 symptom clusters of 2 symptoms each in the following combinations: fatigue/GI issues, anxiety/depression, and peripheral neuropathy (PN)/physical function. Patients with CRC without diabetes had a single symptom cluster of 3 symptoms: GI issues/fatigue/anxiety.

In T2, both groups reported 2 symptom clusters of 2 or 3 symptoms in each. In patients with diabetes, symptom clusters were GI issues/fatigue/depression and anxiety/PN/depression, and in those without diabetes, symptom clusters were depression/anxiety/GI issues and PN/fatigue.

During T3, patients with CRC and diabetes reported 2 symptom clusters (1 with 3 symptoms and 1 with 2 symptoms) of anxiety/depression/fatigue and PN/GI issues. Patients with CRC and no diabetes had a single symptom cluster of 4 symptoms: PN/fatigue/depression/anxiety.

Because patients with CRC are tending to live longer and diabetes is expected to become more common over time, the researchers noted that clinicians in oncology are likely to encounter more patients with CRC having diabetes. “Ongoing assessment and monitoring of patients with CRC and diabetes for symptoms and symptom clusters is important because they may be at an increased risk for higher symptom burden,” the researchers wrote in their report.

Reference

Storey S, Luo X, Ren J, Huang K, Von Ah D. Symptom clusters in patients with colorectal cancer and diabetes over time. Oncol Nurs Forum. 2023;50(4):475-485. doi:10.1188/23.ONF.475-485