Abstract
Abstract
Background:
No method is available for evidence-based glycemic-control management in the context of advanced cancer.
Objective:
This study aimed to analyze, by investigating A1C levels, the necessity of glycemic control in terminal cancer patients with preexisting type 2 diabetes.
Design:
This was a retrospective study.
Subjects:
We analyzed 53 terminal cancer patients who had preexisting type 2 diabetes. All patients first visited Kondo Hospital between April 2002 and December 2006.
Measurements:
We assessed the necessity of glycemic control based on the length of hospitalization and the length of the end-of-life period by using the Kaplan-Meier method and Cox hazard model. Length of the end-of-life period was calculated from the completion of palliative chemotherapy until death. Length of hospitalization was calculated from last admission until death.
Results:
The median length of hospitalization was significantly longer in relatively well controlled patients—with A1C levels <7.5% (49 days; 95% confidence interval [CI] 34.9–63.1)—than in poorly controlled patients, with A1C levels ≥7.5% (23 days; 95% CI 14.6–31.4, P=0.05). The median length of end of life was significantly longer in the relatively well controlled patients (144 days; 95% CI 115.9–172.1) than in poorly controlled patients (45 days; 95% CI 13.8–76.2, P=0.02). Cox multivariate analysis indicated that performance status (PS) at the initial visit to the hospice (hazard ratio [HR] 2.79; 95% CI 1.46–5.32, P=0.002) and glycemic control (HR 2.10; 95% CI 1.18–3.75, P=0.01) were independent, positive prognostic factors.
Conclusion:
Good glycemic control, that is, maintenance of A1C levels at <7.5% during the terminal phase of cancer, conferred a significant survival benefit in cancer patients who had preexisting type 2 diabetes.
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