How chronic disease can affect cancer treatment
By Roberta Cannon, RN
A cancer diagnosis can be devastating and turn your life upside down even without other health issues. For those with chronic diseases, it can add to an already long list of medications, testing, treatment regimens, and specialist visits that come into play with a chronic disease.
“When patients are newly diagnosed with cancer and present to our clinic for an initial consult, we complete an ECOG (Eastern Cooperative Oncology Group) performance test. This is a status scale used to evaluate a patient’s functional status which helps us to determine a patient’s ability to tolerate cancer treatments,” said Hannah Moselsky, BSN MSN FNP-C, an oncology nurse practitioner at the Davenport-Mugar Cancer Center at Cape Cod Hospital. “Chronic diseases can have a huge impact on a patient’s performance status before we even begin to treat their cancer and can limit our treatment options.”
Chronic diseases can affect the type of chemotherapy that can be used, depending on the patient’s organ functions.
“Prior to starting chemotherapy we have to assess the patient’s kidney and liver function, as these are the organs responsible for breaking down and clearing the medications we need to use to treat their cancer,” said Moselsky. “If patients present with decreased kidney or liver function secondary to uncontrolled chronic diseases then they will often be unable to receive the standard dose of chemotherapy required to treat their cancer or may not be able to safely receive certain treatment options at all. Giving less treatment or having less options to choose from to treat their cancer will affect their outcome negatively.”
How Chronic Disease Affects Chemotherapy
The following are chronic diseases that can play a role in deciding the type and dose of treatment and can influence the outcomes of treatment, according to Moselsky:
Importance of Primary Care
With her background in internal medicine, Moselsky said she now sees how important it is to have primary care providers as an integral part of the team. They provide tight management of these chronic diseases while patients are going through chemotherapy treatment.
“Our patients tend to do best when their primary care physician and their specialists remain involved in their care throughout their cancer treatment. Having this support allows us as their oncology team to focus primarily on treating their cancer,” she said. “If patients present with uncontrolled chronic disease that will impact our ability to treat them then we will often communicate directly with their PCPs through our EMR. If needed we will arrange referrals or e-consults from specialists within our network, often hearing back same day with their recommendations. We are also a member of the Dana-Farber Cancer Institute Collaborative and can consult with these providers at any time for support. It is a collaborative effort which is what our community members deserve during such a vulnerable time in their life.”
Moselsky offers the following advice for patients with chronic diseases:
“When faced with a cancer diagnosis, the volume of appointments required for lab draws, follow up visits and infusions can be overwhelming and time consuming. It is easy to understand why patients often cancel their other follow up appointments to prioritize ours. I encourage patients to keep their follow-up appointments with their PCP and specialists in order to keep their chronic diseases well managed throughout our treatment process while also encouraging the patient to remain an active participant in their care as well. This can be achieved through healthy lifestyle modifications, staying active as tolerated or by monitoring their chronic conditions at home. This will help to reduce their risk of hospitalization, complications and treatment delays and will give us the chance to successfully treat their cancer.”
Originally published on Cape Cod Health News, July 16, 2024
“When patients are newly diagnosed with cancer and present to our clinic for an initial consult, we complete an ECOG (Eastern Cooperative Oncology Group) performance test. This is a status scale used to evaluate a patient’s functional status which helps us to determine a patient’s ability to tolerate cancer treatments,” said Hannah Moselsky, BSN MSN FNP-C, an oncology nurse practitioner at the Davenport-Mugar Cancer Center at Cape Cod Hospital. “Chronic diseases can have a huge impact on a patient’s performance status before we even begin to treat their cancer and can limit our treatment options.”
Chronic diseases can affect the type of chemotherapy that can be used, depending on the patient’s organ functions.
“Prior to starting chemotherapy we have to assess the patient’s kidney and liver function, as these are the organs responsible for breaking down and clearing the medications we need to use to treat their cancer,” said Moselsky. “If patients present with decreased kidney or liver function secondary to uncontrolled chronic diseases then they will often be unable to receive the standard dose of chemotherapy required to treat their cancer or may not be able to safely receive certain treatment options at all. Giving less treatment or having less options to choose from to treat their cancer will affect their outcome negatively.”
How Chronic Disease Affects Chemotherapy
The following are chronic diseases that can play a role in deciding the type and dose of treatment and can influence the outcomes of treatment, according to Moselsky:
- Diabetes: When the body is not making an effective amount of insulin, blood sugar levels will rise. This causes glucose to remain trapped in the bloodstream, unable to move out of the bloodstream and into the cells that need glucose. Some chemotherapy regimens include pre-medication with steroids that can cause blood sugar levels to increase further and exacerbate symptoms of hyperglycemia (high blood sugar). In addition to this, symptoms such as headaches, electrolyte imbalances and kidney dysfunction can also occur as side effects of chemotherapy. When a patient, who already has uncontrolled blood sugar levels starts chemotherapy, it can be difficult to differentiate if these symptoms are a result of chemotherapy or uncontrolled diabetes. Patients who have neuropathy, which is damage to the peripheral nervous system from their diabetes, may not be good candidates for receiving certain types of chemotherapy that can cause further nerve damage. Diabetic patients that do qualify for these treatments are more likely to experience neuropathy earlier than others, leading to decrease in dosing or elimination of these drugs from their treatment regimen which in turn can affect our ability to manage or cure their cancer.
- Heart disease: Heart failure occurs when the heart can’t pump enough blood throughout the body to meet its needs. Some of our treatment options require an echocardiogram prior to starting and cannot be given if the patient does not have healthy heart function. Management of heart failure requires a careful fluid and electrolyte balance. Chemotherapy can cause major changes in that balance when patients have the side effects of nausea, vomiting, and diarrhea that can cause a large fluid loss. When replacing their losses with IV fluid, we have to make sure their heart can tolerate the amount of fluid we need to give them. It makes it much more difficult to treat them and can end with hospitalizations which delays their treatment.
- Chronic kidney disease: Most of our treatments are cleared through the kidneys and can strain the kidneys further if patients are presenting with pre-existing kidney disease. The health and function of your kidneys can limit the type of chemotherapy you can receive. Kidney function can be compromised prior to starting treatment due to chronic diseases such as uncontrolled diabetes, hypertension, tobacco use, vascular and autoimmune diseases.
- Liver disease: The liver is responsible for clearing toxins from the body and plays an important role in metabolizing the drugs we use to treat cancer. It is more easily strained when patients have pre-existing liver disease which can occur secondary to uncontrolled cholesterol levels, obesity and chronic alcohol use. Asking the liver to work harder to break down chemotherapy when it is already compromised by chronic disease can make it difficult to be able to safely administer treatment and can lead to delays or discontinuation of treatment.
Importance of Primary Care
With her background in internal medicine, Moselsky said she now sees how important it is to have primary care providers as an integral part of the team. They provide tight management of these chronic diseases while patients are going through chemotherapy treatment.
“Our patients tend to do best when their primary care physician and their specialists remain involved in their care throughout their cancer treatment. Having this support allows us as their oncology team to focus primarily on treating their cancer,” she said. “If patients present with uncontrolled chronic disease that will impact our ability to treat them then we will often communicate directly with their PCPs through our EMR. If needed we will arrange referrals or e-consults from specialists within our network, often hearing back same day with their recommendations. We are also a member of the Dana-Farber Cancer Institute Collaborative and can consult with these providers at any time for support. It is a collaborative effort which is what our community members deserve during such a vulnerable time in their life.”
Moselsky offers the following advice for patients with chronic diseases:
“When faced with a cancer diagnosis, the volume of appointments required for lab draws, follow up visits and infusions can be overwhelming and time consuming. It is easy to understand why patients often cancel their other follow up appointments to prioritize ours. I encourage patients to keep their follow-up appointments with their PCP and specialists in order to keep their chronic diseases well managed throughout our treatment process while also encouraging the patient to remain an active participant in their care as well. This can be achieved through healthy lifestyle modifications, staying active as tolerated or by monitoring their chronic conditions at home. This will help to reduce their risk of hospitalization, complications and treatment delays and will give us the chance to successfully treat their cancer.”
Originally published on Cape Cod Health News, July 16, 2024