For patients battling both diabetes and cancer, even a small foot wound can carry devastating consequences. Chemotherapy, radiation, immunotherapy, and stem cell transplants all compromise immunity and circulation. Add diabetes to the mix, and the risk of diabetic foot ulcers (DFUs) and amputations rises dramatically. What’s more, even minor foot infections can force oncologists to pause or halt lifesaving cancer therapy.
At City of Hope National Cancer Institute–designated Comprehensive Cancer Center, Paul Han, MS, DPM has pioneered a Novel Limb Preservation Initiative that integrates symptom-focused patient education with strategically coordinated podiatric care.
A First-of-Its-Kind Model in Oncology
Unlike traditional DFU prevention programs, this initiative is rooted in the oncology setting. Patients undergoing active cancer treatment (for breast, prostate, colorectal, lung cancers, leukemia, and others) were enrolled in a program that combined:
- Symptom-targeted education from Dr. Han’s book What’s the Foot Got to Do with My Diabetes? — tailored by patient-reported warning signs.
- Language accessibility — resources provided in English, Spanish, Chinese, Korean, and Vietnamese.
- Risk-stratified podiatric monitoring — from annual exams for low-risk patients to every 4 weeks for those at highest risk.
This model ensured cancer patients received timely podiatric intervention before complications escalated.
Outcomes: Protecting Both Limbs and Cancer Therapy
- Diabetic Foot Ulcer incidence: 2.8%, far below the 6–10% national averages.
- Amputation rate: 0.43%, surpassing the Healthy People 2030 national target of 0.55%.
- Cancer treatment continuity: Crucially, 90% of patients who developed foot issues were able to continue their scheduled cancer therapies without interruption.
In other words, this program not only prevented limb loss — it helped patients stay on track with cancer treatment.
Why This Matters
Cancer centers are not usually thought of as hubs for limb preservation. Yet, as this study shows, they must be. For patients with diabetes and cancer, the stakes are uniquely high: a DFU isn’t just a foot problem — it can derail chemotherapy, compromise prognosis, and endanger life itself.
Dr. Han’s program demonstrates that embedding podiatric surveillance and education directly into oncology care pathways saves limbs and protects the continuity of cancer therapy.
Broader Impact
The initiative, designed and tested in the cancer care environment, could be scaled to other oncology centers nationwide. Its success also underscores the value of reclassifying podiatric care as essential preventive medicine — particularly in high-risk, underserved populations disproportionately affected by diabetes-related amputations.
Conclusion
By situating limb preservation at the heart of cancer care, City of Hope and Dr. Paul Han have reframed what it means to deliver comprehensive oncology care. The message is clear: preserving limbs isn’t separate from saving lives — it is part of it.
Citation:
Han P. A novel diabetic limb preservation initiative: Integrated symptom-focused patient education and strategically coordinated podiatric care to reduce diabetic foot ulcers and amputations. JAPMA. 2025;114(4):e1–e21. doi:10.7547/25-108 .
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