Eliciting primary care and oncology provider perspectives on diabetes management during active cancer treatment

Purpose: We sought to elicit the perspectives of primary care providers (PCPs) and oncologists regarding their expectations on who should be responsible for diabetes management, as well as communication mode and frequency about diabetes care during cancer treatment.

Methods: In-depth interviews were conducted with PCPs (physicians and nurse practitioners) and oncologists who treat cancer patients with type 2 diabetes. Interviews were audio-recorded and professionally transcribed. A grounded theory approach was used to analyze the qualitative data and identify key themes.

Results: Ten PCPs and ten oncologists were interviewed between March and July 2019. Two broad themes emerged from our interviews with PCPs: (1) cancer patients pausing primary care during cancer treatments, and (2) patients with poorer prognoses and advanced cancer. The following theme emerged from our interviews with oncologists: (3) challenges in caring for cancer patients with uncontrolled diabetes. Three common themes emerged from our interviews with both PCPs and oncologists: (4) discomfort with providing care outside of respective specialty, (5) the need to individualize care plans, and (6) lack of communication across primary and oncology care.

Conclusions: Our findings suggest that substantial barriers to optimal diabetes management during cancer care exist at the provider level. Interventions prioritizing effective communication and educational resources among PCPs, oncologists, and additional members of the patients' care team should be prioritized to achieve optimal outcomes.