Impact of stress on diabetes self-management in cancer survivors.

Abstract

11 Background: Few studies have evaluated the impact of stress on diabetes self- management among cancer survivors. We undertook this study to assess factors associated medication adherence and diabetes self-management in a cohort of diabetic patients with recently-diagnosed early-stage cancer. Methods: We recruited diabetes patients recently diagnosed with early-stage breast, prostate, lung or colorectal cancer on at least one oral hypoglycemic agent and used the Impact of Event Scale (IES) to assess the subjective distress caused by cancer. The 15-item IES consists of 2 subscales assessing avoidant and intrusive feelings about cancer. We measured medication adherence using the 8-item Morisky Medication Adherence Scale, and diabetes self-management behaviors were evaluated using the Summary of Diabetes Self-Care Activities. Participants were surveyed at baseline and after 3 months. Descriptive and univariate analyses were used to assess baseline factors associated with diabetes self-management at 3 months. Results: Of the 36 participants recruited to date, 20 (56%) were male. At baseline, 70% reported adherence to their diabetes medications which dropped to 63% at 3 months. There were no gender differences between IES scores at baseline; however, at 3 months women were more stressed (p = 0.02) and had more intrusive thoughts (p = 0.005) about cancer. Higher baseline total IES scores were associated with lack of a general healthy diet (p = 0.01). Patients who had trouble falling asleep from thoughts about cancer felt more hassled sticking to their diabetes medication treatment at 3 months (p = 0.02). Those who had dreams about cancer (p = 0.007) and those who tried to stay away from reminders about cancer (p = 0.04) were more likely to forget their diabetes medications when travelling. Lastly, patients who felt that the cancer wasn’t real were more likely to have difficulty remembering to take medications (p = 0.03). Conclusions: Cancer survivors with comorbid diabetes who have higher stress are less likely to follow a healthy diet and more likely to report trouble with taking their diabetes medications. Providers should be aware of the impact of stress caused by cancer to better support diabetes self-management among early cancer survivors.