December 3, 2012
NYU Bluestone Center for Clinical Research investigator Dr. Marilyn Hammer has been awarded the Muriel and Virginia Pless Center for Nursing’s pilot award to study the association between hyperglycemia and symptom severity in patients with cancer.
Dr. Brian Schmidt, Director of the NYU Bluestone Center for Clinical Research, and Dr. Fran Cartwright, Senior Director of Nursing, Oncology Services and Medicine at the NYU Langone Medical Center and Cancer Institute, are co-investigators for the study. This project is a sub-study within the "Symptom Clusters in Oncology Patients Receiving Chemotherapy" Study, based out of the University of California, San Francisco with principal investigators, Dr. Christine Miaskowski and Dr. Bradley Aouizerat. This inter-institutional collaboration will aid in expediting the translation of findings to clinical practice to improve patient outcomes.
Patients with cancer face a number of challenges in addition to their principal focus on survival. Cancer-related symptoms present a particularly devastating challenge and can occur before the diagnosis and continue through many years post treatment. While these symptoms can occur in isolation, more often they are identified in clusters. These symptom clusters typically include pain, fatigue, depression, and sleep disturbances with variations in both severity and in combination. These symptoms contribute to the physiological and psychological trauma these patients face and can be as devastating as the cancer diagnosis itself.
Many of the known contributors to these symptoms, including the malignancy itself, are non-modifiable. However, one possible contributor to increased symptom expression and severity that is modifiable is hyperglycemia. While having pre-existing diabetes is a risk for hyperglycemic events during cancer treatments, hyperglycemia can occur in patients with cancer independent of diabetic history. Hyperglycemia during cancer treatment is usually due to older age, high body mass index, nutritional imbalances, low physical activity levels, high stress levels, glucocorticoids, chemotherapeutic regimens, and infections.
Inflammation has been identified as a central link between hyperglycemia and pain, fatigue, depression, and sleep disturbances. It is further hypothesized that sleep disturbances can trigger inflammatory pathways, which in turn, can contribute to depression. Investigating these pathways, and in particular, the modifiable contributors to these pathways, is essential to optimizing quality of life. The role of hyperglycemia is understudied in this capacity and, as a modifiable factor, the importance of understanding hyperglycemic events in patients with cancer is paramount.
The study will evaluate correlations between glycosylated hemoglobin A1c levels, an established measure of glucose, and self-reported severity levels of pain, fatigue, sleep disturbances, and depression in patients undergoing chemotherapy. Adult patients being treated with primary or adjuvant chemotherapy at the outpatient NYU Clinical Cancer Center for cancers of the breast, lung, gastrointestinal, or gynecologic tissue will be enrolled with a target of 600 total patients.
Dr. Hammer believes that the study will contribute greatly to our understanding about the influence of glycemic status in relation to cancer. Dr. Hammer says, “We are excited to expand our glycemic research in patients with cancer to assess symptom severity. Based on findings, we anticipate incorporating tailored interventions to the care of patients with cancer to mitigate glycemic excursions for the improvement of functional status, quality of life, infection control, and overall survival.”