Article

Impact of Malglycemia on Clinical Outcomes in Hospitalized Patients With Cancer: A Review of the Literature

Susan Storey

Diane Von Ah

quality of life
ONF 2012, 39(5), 458-465. DOI: 10.1188/12.ONF.458-465

Purpose/Objectives: To examine empirical research regarding the role of malglycemia (hyperglycemia, hypoglycemia, or glycemic variability) on clinical outcomes among hospitalized patients with cancer.

Data Sources: Research articles were obtained from the Ovid, PubMed, and CINAHL® databases. Key words used in the search included hyperglycemia or malglycemia and neoplasm combined with venous thromboembolism, infection, or mortality.

Data Synthesis: Eleven research articles were examined reporting the impact of malglycemia on various outcomes, including infection, mortality or survival, length of hospital stay, and toxicity.

Conclusions: Findings suggest that malglycemia may have a negative impact on outcomes for hospitalized patients with cancer. Increased rates of infection, mortality, length of stay, and toxicities, as well as decreased survival, were reported.

Implications for Nursing: Oncology nurses play an important role in the identification of patients with malglycemia. Early assessment and intervention for those patients can improve outcomes and quality of life.

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    References

    Ali, N. A., O'Brien, J. M., Blum, W., Byrd, J. C., Klisovic, R. B., Marcucci, G., … Grever, M. R. (2007). Hyperglycemia in patients with acute myeloid leukemia is associated with increased hospital mortality. Cancer, 110, 96-102. doi:10.1002/cncr.22777
    Ali, N. A., O'Brien, J. M., Dungan, K., Phillips, G., Marsh, C. B., Lemeshow, S., … Preiser, J. (2008). Glucose variability and mortality in patients with sepsis. Critical Care Medicine, 36, 2316-2321. doi:10.1097/CCM.0b013e3181810378
    Barone, B. B., Yeh, H. C., Snyder, C. F., Peairs, K. S., Stein, K. B., Derr, R. L., … Brancati, F. L. (2008). Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: A systematic review and meta-analysis. JAMA, 300, 2754-2764. doi:10.1001/jama.2008.824
    Benfield, T., Jensen, J. S., & Nordestgaard, B. G. (2007). Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome. Diabetologia, 50, 549-554. doi:10.1007/s00125-006-0570-3
    Brunello, A., Kapoor, R., & Extermann, M. (2010). Hyperglycemia during chemotherapy for hematologic and solid tumors is correlated with increased toxicity. American Journal of Clinical Oncology, 34, 293-296. doi:10.1097/COC.0b013e3181e1d0c0
    Carr, M. (2001). Diabetes mellitus: A hypercoaguable state. Journal of Diabetes and Its Complications, 15, 44-54. doi:10.1016/S1056-8727(00)00132-X
    Derr, R. L., Hsiao, V. C., & Saudek, C. D. (2008). Antecedent hyperglycemia is associated with an increased risk of neutropenic infections during bone marrow transplantation. Diabetes Care, 31, 1972-1977. doi:10.2337/dc08-0574
    Derr, R. L., Ye, X., Islas, M. U., Desideri, S., Saudek, C. D., & Grossman, S. A. (2009). Association between hyperglycemia and survival in patients with newly diagnosed glioblastoma. Journal of Clinical Oncology, 27, 1082-1086. doi:10.1200/JCO.2008.19.1098
    Dossett, L. A., Cao, H., Mowery, N. T., Dortch, M. J., Morris, J. M., & May, A. K. (2008). Blood glucose variability is associated with mortality in the surgical intensive care unit. American Surgeon, 74, 679-685.
    Egi, M., Bellomo, R., Stachowski, E., French, C. J., & Hart, G. (2006). Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology, 105, 244-252. doi:10.1097/00000542-200608000-00006
    Fugi, S., Kim, S., Mori, S., Kamiya, S., Yoshimura, K., Yokoyama, H., … Fukuda, T. (2009). Intensive glucose control after allogeneic hematopoietic stem cell transplantation: A retrospective matched-cohort study. Bone Marrow Transplantation, 44, 105-111. doi:10.1038/bmt.2008.431
    Fugi, S., Kim, S. W., Mori, S., Fukuda, T., Kamiya, S., Yamasaki, S., … Takaue, Y. (2007). Hyperglycemia during the neutropenia period is associated with a poor outcome in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation. Transplantation, 84, 814-820. doi:10.1097/01.tp.0000296482.50994.1c
    Garg, R., Bhutani, H., Alyea, E., & Pendergrass, M. (2007). Hyperglycemia and length of stay in patients hospitalized for bone marrow transplantation. Diabetes Care, 30, 993-994. doi:10.2337/dc06-2563
    Hammer, M. J., Casper, C., Gooley, T. A., O'Donnell, P. V., Boeckh, M., & Hirsch, I. B. (2009). The contribution of malglycemia to mortality among allogeneic hematopoietic cell transplant recipients. Biology of Blood and Marrow Transplantation, 15, 344-351. doi:10.1016/j.bbmt.2008.12.488
    Hardy, S. J., Nowacki, A. S., Bertin, M., & Weil, R. J. (2010). Absence of an association between glucose levels and surgical site infections in patients undergoing craniotomies for brain tumors. Journal of Neurosurgery, 113, 161-166. doi:10.3171/2010.2.JNS09950
    Hermanides, J., Vriesendorp, T. M., Bosman, R. J., Zandstra, D. F., Hoekstra, J. B., & DeVries, J. H. (2010). Glucose variability is associated with intensive care unit mortality. Critical Care Medicine, 38, 838-842. doi:10.1097/CCM.0b013e3181cc4be9
    Kent, T., Soukup, V., & Fabian, R. (2001). Heterogeneity affecting outcome from acute stroke therapy: Making reperfusion worse. Stroke, 32, 2318-2327. doi:10.1161/hs1001.096588
    Kreutziger, J., Schlaepfer, J., Wenzel, V., & Constantinescu, M. A. (2009). The role of admission blood glucose in outcome prediction of surviving patients with multiple injuries. Journal of Trauma, 67, 704-708. doi:10.1097/TA.0b013e3181b22e37
    Krinsley, J. S. (2004). Effect of intense glucose management protocol on the mortality of critically ill adult patients. Mayo Clinic Proceedings, 79, 992-1000. doi:10.4065/79.8.992
    Marchant, M. H., Viens, N. A., Cook, S., Vail, T. P., & Bolognesi, M. P. (2009). The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. Journal of Bone and Joint Surgery, 91, 1621-1629. doi:10.1097/CCM.0b013e3181810378
    Melynk, B. M. (2004). Integrating levels of evidence into clinical decision making. Pediatric Nursing, 30, 323-324.
    Mraovic, B., Hipzer, B. R., Epstein, R. H., Pequignot, E. C., Parvizi, J., & Joseph, J. I. (2010). Preadmission hyperglycemia is an independent risk factor for in-hospital symptomatic pulmonary embolism after major orthopedic surgery. Journal of Arthroplasty, 25, 64-70. doi:10.1016/j.arth.2008.10.002
    National Cancer Institute. (2006). Common Toxicity Criteria for Adverse Events [v3.0]. Retrieved from http://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcaev3.pdf
    Sheean, P. M., Freels, S. A., Helton, W. S., & Braunshweig, C. A. (2006). Adverse clinical consequences of hyperglycemia from total parenteral nutrition exposure during hematopoietic stem cell transplantation. Biology of Blood and Marrow Transplantation, 12, 656-664. doi:10.1016/j.bbmt.2006.01.010
    Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitababchi, A. E. (2002). Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. Journal of Clinical Endocrinology and Metabolism, 87, 978-982.
    Van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninickx, F., Schetz, M., … Bouillon, R. (2001). Intensive insulin therapy in critically ill patients. New England Journal of Medicine, 345, 1359-1367. doi:10.1210/jc.2009-0663
    Von Ah, D., Kang, D. H., & Carpenter, J. (2008). Predictors of cancer-related fatigue in women with breast cancer prior to, during, and after adjuvant therapy. Cancer Nursing, 31, 134-144. doi:10.1097/01.NCC.0000305704.84164.54
    Weiser, M. A., Cabanillas, M. E., Konopleva, M., Thomas, D. A., Pierce, S. A., Escalante, C. P., … O'Brien, S. M. (2004). Relation between the duration of remission and hyperglycemia during induction chemotherapy for acute lymphocytic leukemia with a hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone/methotrexate cytarabine regimen. Cancer, 100, 1179-1185. doi:10.1002/cncr.20071
    Zeng, L., Biernacka, K. M., Holly, J. M., Jarrett, C., Morrison, A. A., Morgan, A., … Perks, C. M. (2010). Hyperglycaemia confers resistance to chemotherapy on breast cancer cells: The role of fatty acid synthase. Endocrine-Related Cancer, 17, 539. doi:10.1677/ERC-09-0221