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Shih YW, Wang MH, Monsen KA, Chang CW, Rias YA, Tsai HT. Effectiveness of Acupuncture for Relieving Chemotherapy-Induced Bone Marrow Suppression: A Systematic Review with a Meta-analysis and Trial Sequential Analysis. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:621-636. [PMID: 37163212 DOI: 10.1089/jicm.2022.0735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Objective: Bone marrow suppression is the most common side effect of chemotherapy that may lead to discontinuation for treatment pertaining to patients during the therapy course. Acupuncture may relieve bone marrow suppression with regulation hematopoietic function during chemotherapy. The purpose of this study is to evaluate the effectiveness of acupuncture in relieving chemotherapy-induced bone marrow suppression and determine the effects of acupuncture on bone marrow function. Design: PubMed, Embase, Cochrane Library, Medline OVID, CINAHL Plus, Web of Science, and Chinese articles in the Airiti Library and China National Knowledge Infrastructure databases were searched up to February 2023. Publications in both English and Chinese were eligible for inclusion without any limitations on the publication date. Only randomized controlled trials investigating the impact of acupuncture on chemotherapy-induced bone marrow suppression were considered. In addition, a trial sequential analysis was performed to assess the adequacy of the current sample size. Results: A total of 25 studies met the inclusion criteria. Acupuncture was found to increase the levels of hematopoietic cytokine granulocyte colony-stimulating factor (G-CSF) (Hedges' g = 0.79, p < 0.001), as well as stimulate the production of white blood cells (Hedges' g = 0.69, p < 0.001), red blood cells (Hedges' g = 0.37, p = 0.01), neutrophils (Hedges' g = 0.66, p < 0.001), absolute neutrophil count (Hedges' g = 0.89, p = 0.01), hemoglobin (Hb) (Hedges' g = 0.37, p = 0.02), platelets (Hedges' g = 0.50, p < 0.001), and natural killer (NK) cells (Hedges' g = 1.30, p = 0.02). Further, the levels of platelets and NK cells were observed to increase cumulatively over time. Conclusions: Acupuncture may improve chemotherapy-induced bone marrow suppression due to increasing levels of the hematopoietic cytokine, G-CSF and further relieving chemotherapy-induced bone marrow suppression. PROSPERO Registration: This review was registered with PROSPERO (International Prospective Register of Systematic Reviews: CRD42020185813).
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Affiliation(s)
- Ya Wen Shih
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Post-BaccalaureateProgram in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Mei Hua Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Karen A Monsen
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Ching Wen Chang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yohanes Andy Rias
- Faculty of Health and Medicine, College of Nursing, InstitutIlmu Kesehatan Bhakti Wiyata, Kediri, Indonesia
| | - Hsiu Ting Tsai
- Post-BaccalaureateProgram in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Mazzaro RT, Vaz MV, Badin RC, Bernardina ED, Manaças LRA. Management of chemotherapy-induced febrile neutropenia and use of granulocyte colony-stimulating factor in patients with soft tissue or bone sarcoma. J Oncol Pharm Pract 2023; 29:1428-1436. [PMID: 36226408 DOI: 10.1177/10781552221131901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Febrile neutropenia, an oncological complication related to myelosuppressive chemotherapy, can lead to unplanned hospitalization, morbidity, mortality, and changes in the oncological therapeutic plan. The present study aimed (1) to determine the prevalence of chemotherapy-induced febrile neutropenia requiring hospitalization and the use of granulocyte colony-stimulating factor and (2) to evaluate its consequences for the oncological treatment of patients with soft tissue or bone sarcomas. METHODS This is a cross-sectional and retrospective study (January 2018 to December 2019) carried out in a reference oncology hospital in the Brazilian public health system. Inpatients diagnosed with chemotherapy-induced febrile neutropenia, older than the age of 18 years, and treated with granulocyte colony-stimulating factor were included in the study. RESULTS Twenty-nine chemotherapy-induced febrile neutropenia events were identified, involving 25 patients. Among the febrile neutropenia events, 90% were grade 4, and 59% occurred during palliative chemotherapy. Among patients with febrile neutropenia, 31% had arterial hypertension or/and diabetes mellitus comorbidities, 34% had infectious skin sites, such as compression ulcers and tumor wounds, and 31% had infections with defined etiologic agents. Treatment of hospitalized patients was performed with cefepime in combinations or alone (97%) and filgrastim. The outcomes related to chemotherapy-induced febrile neutropenia were chemotherapy dose reduction (31%), chemotherapy cycle delays (21%), chemotherapy treatment suspension (17%), deaths (7%), and other associated complications (10%). Granulocyte colony-stimulating factor prophylaxis was prescribed in 72.41% of febrile neutropenia events. The frequency of febrile neutropenia concerning total chemotherapy cycles was 2.15%. CONCLUSION Even with granulocyte colony-stimulating factor prophylaxis, an overall prevalence of 2.15% of febrile neutropenia associated with hospitalization was observed, causing negative outcomes in chemotherapy treatment of patients.
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Affiliation(s)
- Raphaele Teixeira Mazzaro
- Department of Clinical Pharmacy, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA) - Cancer Hospital II, Rio de Janeiro, Brazil
| | - Mahanna Vanzeler Vaz
- Department of Clinical Pharmacy, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA) - Cancer Hospital II, Rio de Janeiro, Brazil
| | - Rebeka Caribé Badin
- Department of Clinical Pharmacy, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA) - Cancer Hospital II, Rio de Janeiro, Brazil
| | - Eliza Dalla Bernardina
- Department of Clinical Pharmacy, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA) - Cancer Hospital II, Rio de Janeiro, Brazil
| | - Liliane Rosa Alves Manaças
- Department of Clinical Pharmacy, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA) - Cancer Hospital II, Rio de Janeiro, Brazil
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Larrarte-González MA, Pineda-Posada M, Gaitán ÁA, Amaya-Amaya J, Ojeda K. Health professionals' preferences with the use of pegfilgrastim on-body injector at oncology centers in 8 cities in Colombia. BMC Health Serv Res 2023; 23:529. [PMID: 37221537 DOI: 10.1186/s12913-023-09454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Febrile neutropenia associated with some chemotherapy regimens can lead to potentially fatal complications and high health care costs. Administration of pegfilgrastim using an On-Body Injector (OBI) may be more convenient for cancer patients and physicians in countries with limited access to high-complexity healthcare. This study aims to describe physician and nurse preferences regarding different options for administration of pegfilgrastim at cancer centers, the chemotherapy schemes for which pegfilgrastim is most frequently prescribed and how healthcare providers prioritize certain administration schemes according to patients' access to healthcare services. METHODS Observational, descriptive, cross-sectional study and survey, conducted between 2019 and 2020, to describe physician and nurse preferences regarding options for administration of pegfilgrastim at cancer centers, the demographics of the study population and characteristics of participating cancer centers. It included 60 healthcare professionals practicing at oncology centers from 8 cities in Colombia who were contacted and surveyed via telephone. Quantitative continuous variables were summarized using central tendency and dispersion measures. RESULTS It was found that 35% of participants are haemato-oncologists, oncologists or hematologists, 30% are general practitioners, and 35% are other healthcare professionals (i.e., nurse, oncology nurse and head nurse). Our study shows that 48% of physicians prefer the use of OBI, particularly in the scheme of 24 h after myelosuppressive chemotherapy administrations. Regardless of patient frailty and travel time to the clinic, over 90% of healthcare providers (HCPs) prefer to prioritize preventing the patient from having to return to the clinic for pegfilgrastim administration as well as to increase healthcare staff availability through the use of OBI. CONCLUSIONS The present study is the first one in Colombia that sought the reasons behind HCPs' choice to use OBI pegfilgrastim. Our results indicate that most professionals prefer to avoid the patient having to re-enter the care center for pegfilgrastim administration to facilitate access to healthcare for patients; patient characteristics and ease of transport are determining factors for respondents when choosing an option for drug administration. We found OBI is the preferred alternative by most HCPs and a good resource optimization strategy in the context of cancer patients' health care in Colombia.
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Affiliation(s)
| | | | | | | | - Kelman Ojeda
- Centro Javeriano de Oncología of the Hospital Universitario San Ignacio, Carrera 7# 40-62, Bogotá, Colombia
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Supportive therapies in the prevention of chemotherapy-induced febrile neutropenia and appropriate use of granulocyte colony-stimulating factors: a Delphi consensus statement. Support Care Cancer 2022; 30:9877-9888. [PMID: 36334157 PMCID: PMC9715510 DOI: 10.1007/s00520-022-07430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE Data indicate that the use of prophylactic granulocyte colony-stimulating factors (G-CSFs) for chemotherapy-induced febrile neutropenia (FN) in routine practice is not consistent with guideline recommendations. The initiative "supportive care for febrile neutropenia prevention and appropriateness of G-CFS use" was undertaken to address the issue of inappropriate prescription of G-CSFs and to improve guideline adherence in the treatment of FN. METHODS In a two-round Delphi procedure, 36 medical oncologists reviewed clinically relevant recommendations on risk assessment, the appropriate use of G-CSFs, and the prevention of FN based on available literature and individual clinical expertise. RESULTS The consensus was reached on 16 out of 38 recommendations, which are backed by evidence from randomised clinical trials and routine clinical practice. The medical oncologists agreed that the severity of neutropenia depends on patients' characteristics and chemotherapy intensity, and therefore, the risk of severe neutropenia or FN should be assessed at each chemotherapy cycle so as to initiate prophylaxis with G-CSFs if required. The use of biosimilar G-CSFs, with similar efficacy and safety profiles to the originator biologic, has improved the availability and sustainability of cancer care. The timing of supportive therapy is crucial; for example, long-acting G-CSF should be administered 24-72 h after chemotherapy administration. Each biological agent has a recommended administration dose and duration, and it is important to follow these recommendations to avoid complications associated with under-prophylaxis. CONCLUSION It is hoped that these statements will help to increase adherence to guideline recommendations for appropriate G-CSF use and improve patient care.
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Shih YW, Su JY, Kung YS, Lin YH, To Anh DT, Ridwan ES, Tsai HT. Effectiveness of Acupuncture in Relieving Chemotherapy-induced Leukopenia in Patients With Breast Cancer: A Systematic Review With A Meta-Analysis and Trial Sequential Analysis. Integr Cancer Ther 2021; 20:15347354211063884. [PMID: 34930039 PMCID: PMC8728772 DOI: 10.1177/15347354211063884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Breast cancer is one of the most common cancers and a major cause of death in
women worldwide. Chemotherapy is mainly used to treat and control the
progression of breast cancer. Leukopenia is the most common side effect of
chemotherapy which may decrease immune function and further lead to serious
fatal infections. The purpose of this study was to evaluate the effect of
acupuncture on regulating hematopoietic function in chemotherapy-induced
leukopenia among patients with breast cancer. Methods: PubMed, Embase, Cochrane Library, CINAHL Plus, Web of Science, and Chinese
articles in the Airiti Library and China National Knowledge Infrastructure
(CNKI) databases were searched to August 2021 for papers to include in a
systematic review and meta-analysis. A random-effects model was applied. The
effect size was calculated by Hedges’ g. Heterogeneity was determined using
Cochran’s Q test. Moderator analyses were performed to examine potential
sources of heterogeneity. A trial sequential analysis (TSA) was conducted to
determine whether the current sample size was sufficient. Results: Ten randomized controlled trials involving 650 participants were eligible for
inclusion. Analysis by the random-effects model showed a significant effect
by acupuncture of ameliorating leukopenia during chemotherapy. Levels of
white blood cells (WBCs) were increased (Hedges’ g = 0.70,
P < .001, I2 = 34%),
neutrophil counts (Hedges’ g = 0.80, P < .001,
I2 = 0%) were significantly enhanced.
Moreover, regardless of the manner through which acupuncture was applied,
overall values of WBCs increased. Conclusions: The current meta-analysis supports acupuncture possibly ameliorating
chemotherapy-induced leukopenia, as WBC and neutrophil values significantly
increased after acupuncture in patients undergoing chemotherapy.
Additionally, regardless of the type of acupuncture, values of WBCs
increased. These findings are actionable and support both the clinical use
of acupuncture to relieve chemotherapy-induced leukopenia and further
research regarding the use of acupuncture in patients experiencing
immunosuppression when undergoing chemotherapy. Trial Registration: PROSPERO-CRD42020215759.
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Affiliation(s)
- Ya Wen Shih
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jui Yuan Su
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu Shan Kung
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu Huei Lin
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Duong Thi To Anh
- Personnel Department, Thai Nguyen Medical College, Thai Nguyen, Viet Nam
| | - Edi Sampurno Ridwan
- Department of Nursing, Faculty of Health Sciences, Universitas Alma Ata, Yogyakarta, Indonesia
| | - Hsiu Ting Tsai
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,School of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Scotte F, Simon H, Laplaige P, Antoine EC, Spasojevic C, Texier N, Gouhier K, Chouaid C. Febrile neutropenia prophylaxis, G-CSF physician preferences: discrete-choice experiment. BMJ Support Palliat Care 2021:bmjspcare-2021-003082. [PMID: 34706865 DOI: 10.1136/bmjspcare-2021-003082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Febrile neutropenia (FN) commonly occurs during cancer chemotherapy. Prophylaxis with granulocyte colony-stimulating factors (G-CSFs) is known to reduce the severity and incidence of FN and infections in patients with cancer. Despite the proven efficacy, G-CSFs are not always prescribed as recommended. We performed a discrete-choice experiment (DCE) to determine what factors drive the physician preference for FN prophylaxis in patients with cancer undergoing chemotherapy. METHODS Attributes for the DCE were selected based on literature search and on expert focus group discussions and comprised pain at the injection site, presence of bone pain, associated fever/influenza syndrome, efficacy of prophylaxis, biosimilar availability, number of injections per chemotherapy cycle and cost. Oncologists, in a national database, were solicited to participate in an online DCE. The study collected the responses to the choice scenarios, the oncologist characteristics and their usual prescriptions of G-CSFs in the context of breast, lungs and gastrointestinal cancers. RESULTS Overall, the responses from 205 physicians were analysed. The physicians were mainly male (61%), with ≤20 years of experience (76%) and working only in public hospitals (73%). The physicians prescribe G-CSF primary prophylaxis for 32% of patients: filgrastim in 46% and pegfilgrastim in 54%. The choice of G-CSF for primary and secondary prophylaxis was driven by cost and number of injections. Biosimilars were well accepted. CONCLUSION Cost and convenience of G-CSF drive the physician decision to prescribe or not G-CSF for primary and secondary FN prophylaxes. It is important that these results be incorporated in the optimisation of G-CSF prescription in the clinical setting.
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Affiliation(s)
- Florian Scotte
- Interdisciplinary patient pathway department, Gustave Roussy Institute, Villejuif, France
| | | | | | | | | | | | | | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France
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Kara E, Kelleci Çakır B, Sancar M, Demirkan K. Impact of Clinical Pharmacist-led Interventions in Turkey. Turk J Pharm Sci 2021; 18:517-526. [PMID: 34496559 DOI: 10.4274/tjps.galenos.2020.66735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Detecting drug-related problems (DRPs) is important in pharmaceutical care in for better therapeutic outcomes. Clinical pharmacists-led comprehensive medication management plays a crucial role in the rational use of drugs by preventing, identifying, and resolving DRPs. In this review, we aimed to determine the effect of interventions on patient outcomes performed by clinical pharmacists in Turkey. A systematic literature search was performed on PubMed, Google Scholar, EMBASE, Cochrane Library, and Turkish databases (ULAKBIM, Dergipark). The main categories were "clinical pharmacist", "intervention", and "Turkey". Two reviewers reviewed each article independently. Two independent reviewers screened all records and extracted data; disagreements were resolved through a consensus. Randomized controlled studies, pre- to post-intervention comparison studies, and cross-sectional studies including pharmacist-led interventions were included in the review. This review included 15 articles evaluating clinical pharmacist interventions. Ten studies (66.7%) focused on DRPs and pharmacist interventions to these problems, while the remaining 5 (33.3%) studies focused on patient education and adherence issues. Studies were conducted in oncology (33.3%), geriatrics (20.0%), chest diseases (13.3%), psychiatry (6.7%), cardiology (6.7%), and infectious diseases (6.7%) clinics. When results of studies are reviewed, most of the interventions were made at the prescriber level followed by the drug level and patient level. Problems were solved in 54.2-93.2% of DRPs, and adherence, patient knowledge, or skills were improved in most of the studies. Most of the studies were carried out within the scope of a postgraduate or doctorate thesis and yet various positive outcomes such as the prevention of side effects, increased quality of life, and decreased duration of hospital stay were observed with high positive rates of interventions, which indicate that other healthcare workers are ready to collaborate with the clinical pharmacists in Turkey.
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Affiliation(s)
- Emre Kara
- Hacettepe University Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkey
| | - Burcu Kelleci Çakır
- Hacettepe University Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkey
| | - Mesut Sancar
- Marmara University Faculty of Pharmacy, Department of Clinical Pharmacy, İstanbul, Turkey
| | - Kutay Demirkan
- Hacettepe University Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkey
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Rizzo A. Use of granulocyte colony-stimulating factor for adult cancer patients: current issues and future directions. Future Oncol 2021; 17:3411-3413. [PMID: 34263652 DOI: 10.2217/fon-2021-0678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alessandro Rizzo
- Department of Experimental, Diagnostic & Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
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