Faculty voice:

Denise Hershey: Multiple approach

June 1, 2016

Denise Soltow Hershey is assistant professor of nursing and family nurse practitioner whose research focuses on self-management of multi-morbidities in older adults, specifically patients with diabetes and cancer.

As a family nurse practitioner working in the primary care setting, I frequently encounter patients with more than one chronic condition, such as diabetes, hypertension, cancer or heart disease. The patient with multiple chronic conditions will frequently experience symptoms associated with their disease processes.

The combination of required self-management activities, symptoms that patients experience and the overall burden of treatment experienced by patients with multiple comorbidities can have a negative impact on their health related outcomes and overall quality of life. I became a nurse researcher to further understand the issues encountered by patients with multiple morbidities, such as diabetes and cancer, and to develop interventions targeted at improving the quality of life and health related outcomes for these patients.

Most cancer patients will have a pre-existing chronic condition at the time they receive their diagnosis. Individuals with both cancer and diabetes have a poorer prognosis, higher mortality rates, higher infection rates, and shorter remission periods when compared to individuals with cancer and no diabetes. During treatment, cancer patients with diabetes can encounter multiple challenges.

Patients with diabetes may prioritize their cancer treatment over managing their diabetes, experience symptoms related to their cancer treatment which impacts their ability to perform diabetes self-management activities, and experience problems with glycemic control which increases their risk for the development of complications. Cancer patients can experience multiple symptoms at one time, including fatigue, pain, nausea and vomiting, appetite changes and numbness and tingling. These symptoms also are common in patients with diabetes. Patients and health care providers are often unsure if the cause of the patient’s symptoms is due to the cancer and its treatment, their diabetes or both.

My research has focused on identifying issues that patients with cancer and diabetes experience, symptoms related to both of these conditions, the treatment they receive for these symptoms, and how chemotherapy impacts level of glycemic control and overall symptom experience. Currently I am developing an intervention targeted at improving symptom- and self-management of both cancer and diabetes simultaneously. This intervention is targeted at decreasing treatment burden, improving symptom severity and interference, and improving health related outcomes and quality of life for patients with diabetes and cancer

It is important for nurses to seek ways to assist patients with the management of their multiple comorbidities. To date, most interventions address a single condition. In order to decrease the burden of treatment experienced by those with multiple morbidities, we can no longer take a siloed or single disease approach. We must find ways to integrate the care we expect patients to perform to manage their multiple comorbidities.

Reprinted with permission from the College of Nursing