1
|
Vazquez L, Coussirou J, Grenier J, Billemont B, Mege A, de Rauglaudre G, Stancu A, David C, Durand A, Decrozals F, Arnaud A. [Needs assessment for the establishment of an Oral Therapy Unit]. Bull Cancer 2023; 110:184-192. [PMID: 36411129 DOI: 10.1016/j.bulcan.2022.10.005] [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: 04/07/2022] [Revised: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Oncological at home-treatment improves patient quality of life and autonomy but requires close watchfulness of adverse events and compliance to treatment. For nearly ten years, pharmaceutical consultations for home-based anticancer oral therapies patients are proposed on medical request in Avignon-Provence Cancer Institute (ICAP). Organizational changes led us to modify this management by integrating dedicated nurses to create an Oral Therapy Unit (OTU). MATERIALS ET METHODS Needs and expectations assessment questionnaires were proposed to healthcare professionals and patients treated by oral therapies. The analysis of these questionnaires allows to set up an OTU, integrating a dedicated nurse, adapted to the expectations of patients and healthcare professionals. About 8 months later, a new evaluation was carried out to assess the impact of this new support for patient care and health professionals' organization. RESULTS The results of the studies carried out before OTU implementation highlight the importance of multi-professional support for patients from the start of treatment and during the follow-up. With the new OTU pathway, professionals expect a patient course improvement (94%), a better compliance (88%), a therapeutic accidents reduction (81%) and an improvement in the patient-caregiver relationship (69%). Regarding the organization, 56% of them are expecting to save medical and pharmaceutical time. CONCLUSION The OTU creation in our institution and these new multi-professionals' teams' management of patients has obtained a favourable opinion from healthcare professionals and patient satisfaction.
Collapse
Affiliation(s)
- Léa Vazquez
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France.
| | - Julie Coussirou
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Julien Grenier
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Bertrand Billemont
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Alice Mege
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Gaetan de Rauglaudre
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Alma Stancu
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Celeste David
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Anais Durand
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Françoise Decrozals
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Antoine Arnaud
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| |
Collapse
|
2
|
Dhellemmes A, Melan C, Sordes F. [Quality of life in home-based cancer patients: A comparative study of chemotherapy administration route]. Bull Cancer 2019; 106:1124-1131. [PMID: 31759513 DOI: 10.1016/j.bulcan.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Home healthcare can be totally different depending on the route of treatment: intravenous anticancer drugs involve regular contact with the health caregiver while the oral route leaves the patient completely autonomous. This cross-sectional research has a comparative purpose between the representations of disease and treatments, the self-efficacy and the quality of life of patients treated with oral anticancer drugs and those treated by intravenous route. METHODS The sample include 130 patients with cancer. Seventy-two are treated with intravenous chemotherapy and 48 by oral route. The protocol includes a questionnaire of disease representations (IPQ-r), treatment representations (BMQ), self-efficacy (GSES 10) and quality of life (QLQ-C30). RESULTS The administration route of anticancer treatment impacts the illness representations with the normalization of cancer. The intravenous route, by its invasive and time-consuming nature, increases difficulties in fulfilling family and professional roles. Moreover, side effects are correlated with the perceived dangerousness of the treatment and self-efficacy. Age and the length of time since the diagnosis affect respectively the understanding of the disease and the cognitive dimension of quality of life. DISCUSSION More than a difference in form of treatment, the whole pathway of healthcare has to be taken into account since it involves different psychological consequences, in particular about therapeutic choices or in terms of patient support.
Collapse
Affiliation(s)
- Alice Dhellemmes
- Université de Toulouse, laboratoire CERPPS, Pôle 3: psychologie de la santé, EA7411, 5, allée Antonio-Machado, 31058 Toulouse cedex 9, France.
| | - Claudine Melan
- Université de Toulouse, laboratoire CLLE; UMR 5263, 5, allée Antonio-Machado, 31058 Toulouse cedex 9, France
| | - Florence Sordes
- Université de Toulouse, laboratoire CERPPS, Pôle 3: psychologie de la santé, EA7411, 5, allée Antonio-Machado, 31058 Toulouse cedex 9, France
| |
Collapse
|
3
|
Yang Y, Chang J, Huang C, Zhang Y, Wang J, Shu Y, Burillon JP, Riggi M, Petain A, Ferre P, Liang Y, Zhang L. A randomised, multicentre open-label phase II study to evaluate the efficacy, tolerability and pharmacokinetics of oral vinorelbine plus cisplatin versus intravenous vinorelbine plus cisplatin in Chinese patients with chemotherapy-naive unresectable or metastatic non-small cell lung cancer. J Thorac Dis 2019; 11:3347-3359. [PMID: 31559038 DOI: 10.21037/jtd.2019.08.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A phase II study to evaluate the efficacy, tolerability and pharmacokinetics of oral or intravenous vinorelbine (VRL) plus cisplatin (CDDP) in Chinese patients with non-small cell lung cancer (NSCLC). Methods One hundred and thirty-one patients were randomised to oral VRL 60 mg/m2 (arm A) or intravenous VRL 25 mg/m2 (arm B) on days 1 and 8, plus CDDP 80 mg/m2 on day 1 (both arms). VRL was increased to 80 mg/m2 (arm A) or 30 mg/m2 (arm B) in cycles 2-4 in the absence of toxicity. Primary efficacy endpoint was objective response rate (ORR). VRL pharmacokinetics was evaluated for possible drug-drug interactions with CDDP. Results ORR was 25.8% in arm A and 23.1% in arm B. Disease control rate was 72.7% in arm A, 72.3% in arm B. Median overall survival was 16.1 months in arm A and 19.0 months in arm B. Median progression-free survival was 4.6 months in arm A and 4.9 months in arm B. Forty-three point nine percent and 86.2% of patients had grade 3/4 neutropenia in arms A and B, respectively; incidence of febrile neutropenia was low (6.1% and 9.2%, respectively). Frequency of grade 3/4 non-haematological adverse events was also low. VRL pharmacokinetics was not affected by co-administration of CDDP. Conclusions Oral and intravenous VRL in combination with CDDP is effective and well-tolerated in Chinese patients with advanced NSCLC. VRL pharmacokinetics is unaffected by CDDP co-administration. Oral VRL could be an effective alternative to intravenous VRL as a first-line treatment for NSCLC, as it optimises treatment convenience while maintaining high efficacy.
Collapse
Affiliation(s)
- Yunpeng Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jianhua Chang
- Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Cheng Huang
- Fujian Provincial Tumor Hospital, Fuzhou 350014, China
| | - Yiping Zhang
- Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jie Wang
- Beijing Cancer Hospital, Beijing 100035, China
| | - Yongqian Shu
- Jiangsu Provincial People's Hospital, Nanjing 210029, China
| | | | | | | | - Pierre Ferre
- Institut de Recherche Pierre Fabre, Toulouse, France
| | - Ying Liang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| |
Collapse
|
4
|
Effectiveness of a standardized patient education program on therapy-related side effects and unplanned therapy interruptions in oral cancer therapy: a cluster-randomized controlled trial. Support Care Cancer 2017; 25:3475-3483. [DOI: 10.1007/s00520-017-3770-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/30/2017] [Indexed: 01/12/2023]
|
5
|
O'Gorman C, Barry A, Denieffe S, Sasiadek W, Gooney M. Nursing implications: symptom presentation and quality of life in rectal cancer patients. J Clin Nurs 2016; 25:1395-404. [PMID: 26991024 DOI: 10.1111/jocn.13234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To determine the changes in symptoms experienced by rectal cancer patients during preoperative chemoradiotherapy, with a specific focus on fatigue and to explore how symptoms impact the quality of life. BACKGROUND Rectal cancer continues to be a healthcare issue internationally, despite advances in management strategies, which includes the administration of preoperative chemoradiotherapy to improve locoregional control. It is known that this treatment may cause adverse effects; however, there is a paucity of literature that specifically examines fatigue, symptoms and quality of life in this patient cohort. DESIGN A prospective, quantitative correlational design using purposive sampling was adopted. METHODS Symptoms and quality of life were measured with validated questionnaires in 35 patients at four time points. RESULTS Symptoms that changed significantly over time as examined using rm-anova include fatigue, bowel function issues, nutritional issues, pain, dermatological issues and urinary function issues. Findings indicate that fatigue leads to poorer quality of life, with constipation, bloating, stool frequency, appetite loss, weight worry, nausea and vomiting, dry mouth and pain also identified as influencing factors on quality of life. CONCLUSION Findings have highlighted the importance of thorough symptom assessment and management of patients receiving preoperative chemoradiotherapy, particularly midway through treatment, in order to optimise quality of life and minimise interruptions to treatment. RELEVANCE TO CLINICAL PRACTICE Close monitoring of symptoms during preoperative chemoradiotherapy, particularly at week 4, will enable the implementation of timely interventions so that interruptions to treatment are prevented and the quality of life is optimised, which may hasten postoperative recovery times.
Collapse
Affiliation(s)
| | - Amanda Barry
- UPMC Whitfield Cancer Centre, Co. Waterford, Ireland
| | | | | | - Martina Gooney
- Waterford Institute of Technology, Co. Waterford, Ireland
| |
Collapse
|
6
|
Şahin ZA, Ergüney S. Effect on Symptom Management Education Receiving Patients of Chemotherapy. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:101-107. [PMID: 25812800 DOI: 10.1007/s13187-015-0801-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The study of a planned education in patients receiving chemotherapy can alleviate the side effects of chemotherapy and, thus, can increase the quality of the patients' lives. In accordance with this view, this study was conducted with the purpose of examining the effect of planned education given to patients receiving chemotherapy on their symptom control. The study was quasi-experimental. A sample of 140 patients participated, of which 70 were in the experimental group and 70 were in the control group. A patient data form and the chemotherapy symptom assessment scale (C-SAS) were used in order to collect the data. Median, Mann-Whitney U test, and Wilcoxon signed rank test were used to analyze the data. There were statistically significant decreases in the frequencies of the following symptoms: nausea, vomiting, feeling distressed/anxious, feeling pessimistic and unhappy, unusual fatigue, and difficulty sleeping. Also, there were statistically significant decreases in the severity of the 11 symptoms and on the discomfort levels of these symptoms. In the study, the planned education provided by the health-care providers had a positive effect on the symptom control of patients receiving chemotherapy.
Collapse
Affiliation(s)
| | - Seher Ergüney
- Faculty of Health Sciences, Atatürk University, Erzurum, Turkey.
| |
Collapse
|
7
|
Riu G, Gaba L, Victoria I, Molas G, do Pazo F, Gómez B, Creus N, Vidal L. Implementation of a pharmaceutical care programme for patients receiving new molecular-targeted agents in a clinical trial unit. Eur J Cancer Care (Engl) 2016; 27. [PMID: 26786594 DOI: 10.1111/ecc.12447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 01/20/2023]
Abstract
A pharmaceutical care programme was implemented at our hospital in early 2013. The main objectives were to analyse and describe the pharmaceutical interventions made, to calculate adherence, interventions and to evaluate patient satisfaction with the care programme. We performed a single-centre descriptive and prospective intervention in cancer patients who received oral chemotherapy as part of a clinical trial in 2013. Eighty-three patients were included. Median age was 58 years (range, 31-80) and 42 patients (50.6%) were men. We recorded 23 interventions, 13 of which were associated with drug interactions. The mean percentage of adherence was 98.9%. The interview with the pharmacist was considered to be very important by 84.6% of the respondents. A total of 92.3% said that they would like to speak to the pharmacist at subsequent visits. The doubts detected during the visits enable us to conclude that the information patients receive with respect to their study medication is usually incomplete. An integrated pharmaceutical care programme for cancer patients participating in clinical trials with oral cytostatic drugs was successful in terms of adherence and patient satisfaction and makes it possible to guarantee the safety and effectiveness of treatment on an individual basis.
Collapse
Affiliation(s)
- G Riu
- Department of Pharmacy, Hospital Clinic Barcelona, Barcelona, Spain
| | - L Gaba
- Department of Medical Oncology, Hospital Clinic Barcelona, Barcelona, Spain
| | - I Victoria
- Department of Medical Oncology, Hospital Clinic Barcelona, Barcelona, Spain
| | - G Molas
- Department of Pharmacy, Hospital Clinic Barcelona, Barcelona, Spain
| | - F do Pazo
- Department of Pharmacy, Hospital Clinic Barcelona, Barcelona, Spain
| | - B Gómez
- Department of Pharmacy, Hospital Clinic Barcelona, Barcelona, Spain
| | - N Creus
- Department of Pharmacy, Hospital Clinic Barcelona, Barcelona, Spain
| | - L Vidal
- Department of Medical Oncology, Hospital Clinic Barcelona, Barcelona, Spain
| |
Collapse
|
8
|
Arber A, Odelius A, Williams P, Lemanska A, Faithfull S. Do patients on oral chemotherapy have sufficient knowledge for optimal adherence? A mixed methods study. Eur J Cancer Care (Engl) 2015; 26. [DOI: 10.1111/ecc.12413] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2015] [Indexed: 12/19/2022]
Affiliation(s)
- A. Arber
- Faculty of Health and Medical Sciences; University of Surrey; Guildford UK
| | - A. Odelius
- Faculty of Health and Medical Sciences; University of Surrey; Guildford UK
| | - P. Williams
- Faculty of Engineering and Physical Sciences; University of Surrey; Guildford UK
| | - A. Lemanska
- Faculty of Health and Medical Sciences; University of Surrey; Guildford UK
| | - S. Faithfull
- Faculty of Health and Medical Sciences; University of Surrey; Guildford UK
| |
Collapse
|
9
|
Bourmaud A, Henin E, Tinquaut F, Regnier V, Hamant C, Colomban O, You B, Ranchon F, Guitton J, Girard P, Freyer G, Tod M, Rioufol C, Trillet-Lenoir V, Chauvin F. Adherence to oral anticancer chemotherapy: What influences patients' over or non-adherence? Analysis of the OCTO study through quantitative-qualitative methods. BMC Res Notes 2015; 8:291. [PMID: 26142140 PMCID: PMC4490730 DOI: 10.1186/s13104-015-1231-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/15/2015] [Indexed: 12/20/2022] Open
Abstract
Background Numerous oral anticancer chemotherapies are available. Non-adherence or over-adherence to these chemotherapies can lead to lowered efficacy and increased risk of adverse events. The objective of this study was to identify patients’ adherence profiles using a qualitative–quantitative method. Methods A capecitabine treatment was initiated for 38 patients with advanced breast or colorectal cancer. At inclusion, information on patients’ beliefs was reported using a questionnaire. Later, Information on patients’ relation to treatment was obtained from a sub-group during an interview with a sociologist. Questionnaires were analyzed using Multiple Classification Analysis to cluster patients. Treatment adherence was evaluated by an electronic medication event monitoring systems (MEMS caps) and then correlated with patient clusters. Interviews were analyzed to complete and explain results. Results 38 patients were enrolled between 2008 and 2011 and completed the questionnaire. Twenty had adherence measured with MEMS caps all along treatment. Between 4 and 6 months after inclusion, 16 patients were interviewed. Patient profile B (retired, with a regular life, surrounded by a relative’s attention to drug adherence, with a low educational level) was statistically associated with adequate adherence (p = 0.049). A tendency for lower adherence was observed among more highly educated patients with an irregular, active life (NS). All patients taking capecitabine demonstrated a risk of over-adherence, potentiating side effects. Conclusions These encouraging primary results suggest that further studies should be undertaken and that educational programs tailored to patient profiles should be evaluated to enhance adherence for those who need it and to empower all patients to manage treatment side effects. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1231-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Aurélie Bourmaud
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institut, Inserm, CIC1408, 108 bis avenue A. Raimond, 42 270, Saint Priest en Jarez, France.
| | - Emilie Henin
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France.
| | - Fabien Tinquaut
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institut, Inserm, CIC1408, 108 bis avenue A. Raimond, 42 270, Saint Priest en Jarez, France.
| | - Véronique Regnier
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institut, Inserm, CIC1408, 108 bis avenue A. Raimond, 42 270, Saint Priest en Jarez, France.
| | - Chloé Hamant
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institut, Inserm, CIC1408, 108 bis avenue A. Raimond, 42 270, Saint Priest en Jarez, France.
| | - Olivier Colomban
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France.
| | - Benoit You
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Medical Oncology Department, Teaching Hospital, Lyon-Sud University, Lyon, France.
| | - Florence Ranchon
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Oncologic Pharmaceutical Department, Lyon-Sud University Teaching Hospital, Lyon, France.
| | - Jérôme Guitton
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Pharmacology-Toxicology Laboratory, Hospices Civils de Lyon, South Biology Center, Lyon, France.
| | - Pascal Girard
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France.
| | - Gilles Freyer
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Medical Oncology Department, Teaching Hospital, Lyon-Sud University, Lyon, France.
| | - Michel Tod
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France.
| | - Catherine Rioufol
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Oncologic Pharmaceutical Department, Lyon-Sud University Teaching Hospital, Lyon, France.
| | - Véronique Trillet-Lenoir
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Medical Oncology Department, Teaching Hospital, Lyon-Sud University, Lyon, France.
| | - Franck Chauvin
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institut, Inserm, CIC1408, 108 bis avenue A. Raimond, 42 270, Saint Priest en Jarez, France. .,Jean Monnet University, Saint-Etienne, France.
| |
Collapse
|
10
|
Steffens CC, Tschechne B, Schardt C, Jacobs G, Valdix AR, Schmidt P, Hansen R, Kröning H, Wohlfarth T, Guggenberger D. Observational study of adjuvant therapy with capecitabine in colon cancer. Curr Med Res Opin 2015; 31:731-41. [PMID: 25651480 DOI: 10.1185/03007995.2015.1014030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This observational study was conducted to document the safety of capecitabine-based adjuvant therapy in patients with resected colon cancer under routine clinical conditions. RESEARCH AND DESIGN METHODS ML20431 was a prospective, multicenter, non-interventional, observational study. It was designed to answer five research questions relating to safety, dosage and administration, and discontinuation from capecitabine-based adjuvant therapy. Patients were required to have R0 resected stage III colon cancer and have started treatment with capecitabine-based adjuvant therapy based on a decision by the investigator. Patients were followed over an observation period of ≤6 months after initiation of therapy. Investigators were required to complete the study case report form at study entry, each treatment cycle, and at the final examination. MAIN OUTCOME MEASURES A total of 1485 patients were included in the study, and 1481 patients were treated with capecitabine and formed the analysis population. Most patients had colon cancer (78.3%), followed by rectal cancer (16.4%). Most patients had stage III disease (69.3%); the remaining patients had stage II disease (30.7%). The most common all-grade adverse reactions were hand-foot syndrome (46.9%), diarrhea (34.4%), and hemoglobin decreases (31.5%). Grade 3/4 adverse reactions were infrequent (<4%). Serious adverse events were reported in 96 patients (6.5%). Six or more cycles of treatment were completed by 77.9% of patients. Approximately two-thirds of patients (67.3%) received capecitabine monotherapy and the remainder (32.7%) received capecitabine in combination with ≥1 drugs, most commonly oxaliplatin (460 cases). Discontinuation of capecitabine was documented in 344 patients (23.2%). STUDY LIMITATIONS no efficacy data were collected; the questionnaires for patients' expectations and satisfaction were not formally validated; and a few patients (<1.5%) had some retrospective data. CONCLUSIONS The safety profile of capecitabine-based adjuvant therapy in a broad patient population with colon cancer is similar to that previously documented in phase III clinical trials.
Collapse
|
11
|
Mollaoğlu M, Erdoğan G. Effect on symptom control of structured information given to patients receiving chemotherapy. Eur J Oncol Nurs 2013; 18:78-84. [PMID: 24095215 DOI: 10.1016/j.ejon.2013.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE The performance of a planned education model in patients receiving chemotherapy can alleviate the side effects of chemotherapy and thus can increase the quality of the patients' lives. In accordance with this view, this study was conducted with the purpose of examining the effect of planned education given to patients receiving chemotherapy on their symptom control. METHODS The study was quasi-experimental. A sample of 120 patients participated, of which 60 were in the experimental group (EG) and 60 were in the control group (CG). A patient data form and the chemotherapy symptom assessment scale (C-SAS) were used in order to collect the data. Median, Mann-Whitney U test and Wilcoxon signed rank test were used to analyze the data. RESULTS There were statistically significant decreases in the frequencies of the following symptoms: nausea, vomiting, constipation, pain, infectious signs, problems of mouth and throat, problems of skin and nails, appetite changes, weight loss or weight gain, feeling distressed/anxious, feeling pessimistic and unhappy, unusual fatigue, difficulty sleeping. Also, there were statistically significant decreases in the severity of eleven symptoms and on the discomfort levels of nine symptoms. CONCLUSION In the study, the planned education provided by the health-care providers had a positive effect on the symptom control of patients receiving chemotherapy.
Collapse
Affiliation(s)
| | - Gülyeter Erdoğan
- Erciyes University, Mehmet Kemal Dedeman Oncology Hospital, Hematology-Oncology Unit, Erciyes, Turkey
| |
Collapse
|
12
|
Tawfik H, Rostom Y, Elghazaly H. All-oral combination of vinorelbine and capecitabine as first-line treatment in HER2/Neu-negative metastatic breast cancer. Cancer Chemother Pharmacol 2013; 71:913-9. [PMID: 23344713 DOI: 10.1007/s00280-013-2082-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/08/2013] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of an all-oral vinorelbine and capecitabine combination therapy in anthracycline- ± taxane-pretreated HER2/Neu-negative metastatic breast cancer (MBC). METHODS A phase 2 trial including women >18 years with HER2/Neu-negative MBC previously exposed to anthracycline- ± taxane-based chemotherapy in the adjuvant or neoadjuvant setting. Enrolled patients received oral vinorelbine 60 mg/m(2) on days 1 and 8 and oral capecitabine 1,000 mg/m(2) twice daily on days 1-14 on a 3 weekly schedule. Patients with progressive disease after 3 cycles discontinued the study, while the remaining patients continued treatment for a maximum of 6 cycles. RESULTS From January 2007 to March 2011, 30 patients were enrolled in this study (median age 47 years). In the 28 evaluable patients, the overall response rate was 57.1 % (95 % CI 30-67 %), including 3 complete (10.7 %) and 13 partial (46.4 %) responses. Six (21.4 %) patients suffered from disease progression. With a median follow-up time of 13 months, the median time to disease progression was 8.6 months (95 % CI 6.2-10.6 months) and the median survival time was 27.2 months. Treatment-related adverse events were manageable, and no World Health Organization grade 4 toxicities were noted. Neutropenia observed in 6 (21.4 %) patients was the main grade 3 toxicity. Grade 3 nausea and vomiting were reported in 2 (7.1 %) and 3 (10.7 %) patients, respectively. Two (7.1 %) patients developed grade 3 hand and foot syndrome. CONCLUSION These results show that the combination of oral vinorelbine and capecitabine is an effective and well-tolerated first-line regimen for HER2/Neu-negative MBC patients pretreated with anthracyclines ± taxanes.
Collapse
Affiliation(s)
- Hesham Tawfik
- Clinical Oncology Department, Tanta University, Tanta, Egypt.
| | | | | |
Collapse
|
13
|
Schott S, Schneeweiss A, Reinhardt J, Bruckner T, Domschke C, Sohn C, Eichbaum MH. Acceptance of oral chemotherapy in breast cancer patients - a survey study. BMC Cancer 2011; 11:129. [PMID: 21486437 PMCID: PMC3080835 DOI: 10.1186/1471-2407-11-129] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 04/12/2011] [Indexed: 12/02/2022] Open
Abstract
Background Oral (p.o.) chemotherapy treatments gained increasing importance in the palliative treatment of metastatic breast cancer (MBC). Aim of this survey was to evaluate the acceptance of p.o. treatment and patients' individual attitudes towards it. Methods A specific 14 item-questionnaire was designed. Patients suffering from breast cancer receiving a newly launched p.o. or i.v. chemotherapy treatment were prospectively evaluated during 4 months of time. 224 questionnaires using descriptive statistics, chi-square test, Spearman correlation were evaluated. Results Patients' median age was 54 years, 164 received i.v., 60 p.o therapy. 89% with p.o. and 67% with i.v. regimens would choose p.o. over i.v. therapy, if equal efficacy is guaranteed. Significant differences were especially found in terms of personal benefit (55% i.v., 92% p.o.), reduced feeling of being ill due to p.o. treatment (26% i.v., 65% p.o.), better coping with disease due to p.o. therapy (36% i.v., 68% p.o.). Side effects were significantly less often reported under p.o. treatment (19% p.o. vs. 53% i.v.) Conclusion P.o. chemotherapy shows a high acceptance in MBC patients under palliative therapy. Compliance can be achieved in particular through a differentiated indication, patient education and competent support along a p.o. treatment.
Collapse
Affiliation(s)
- Sarah Schott
- University Hospital Heidelberg, Department of Gynecology and Obstetrics, The National Center for Tumor Diseases, Voßstraße 9, D-69115 Heidelberg, Germany.
| | | | | | | | | | | | | |
Collapse
|
14
|
REGNIER DENOIS V, POIRSON J, NOURISSAT A, JACQUIN JP, GUASTALLA JP, CHAUVIN F. Adherence with oral chemotherapy: results from a qualitative study of the behaviour and representations of patients and oncologists. Eur J Cancer Care (Engl) 2010; 20:520-7. [DOI: 10.1111/j.1365-2354.2010.01212.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
15
|
OAKLEY C, JOHNSON J, REAM E. Developing an intervention for cancer patients prescribed oral chemotherapy: a generic patient diary. Eur J Cancer Care (Engl) 2010. [DOI: 10.1111/j.1365-2354.2010.01198.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
HARROLD K. Effective management of adverse effects while on oral chemotherapy: implications for nursing practice. Eur J Cancer Care (Engl) 2010. [DOI: 10.1111/j.1365-2354.2010.01197.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
17
|
Enhancing adherence to capecitabine chemotherapy by means of multidisciplinary pharmaceutical care. Support Care Cancer 2010; 19:1009-18. [PMID: 20552377 PMCID: PMC3109264 DOI: 10.1007/s00520-010-0927-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 05/31/2010] [Indexed: 12/21/2022]
Abstract
Purpose In this prospective multi-centre observational cohort study, we investigated the effect of an intensified multidisciplinary pharmaceutical care programme on the adherence of cancer patients treated with capecitabine, a prodrug of fluorouracil. Patients and methods Twenty-four colorectal and 24 breast cancer patients participated in this study. Patients of the control group (n = 24) received standard care, patients of the intervention group (n = 24) received intensified pharmaceutical care consisting of written and spoken information. Adherence to capecitabine chemotherapy was measured using an electronic medication event monitoring system (MEMS™). Results Patients in the intervention group exhibited an enhanced but not significantly different mean overall adherence compared to the control group (97.9% vs 90.5%, p = 0.069). Mean daily adherence was significantly higher in the intervention group (96.8% vs 87.2%, p = 0.029). Variability of both adherence parameters was considerably reduced when pharmaceutical care was provided. At the end of the observation period of 126 days, the probability of still being treated with capecitabine was found to be 48% in the control group and 83% in the intervention group (p = 0.019, log-rank test). The relative risk for a deviating drug intake interval, i.e. <10 or >14 instead of 12 h, in the intervention group was found to be 0.51 (95% CI, 0.46–0.56) compared with the control group (p < 0.05, Chi-square test). Conclusions The provision of intensified pharmaceutical care can enhance adherence to and prolong treatment with capecitabine. The results underline the importance of multidisciplinary care to assure the effectiveness of oral chemotherapy.
Collapse
|
18
|
Anticancer oral therapy: emerging related issues. Cancer Treat Rev 2010; 36:595-605. [PMID: 20570443 DOI: 10.1016/j.ctrv.2010.04.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 04/10/2010] [Accepted: 04/25/2010] [Indexed: 11/23/2022]
Abstract
The use of oral anticancer drugs has shown a steady increase. Most patients prefer anticancer oral therapy to intravenous treatment primarily for the convenience of a home-based therapy, although they require that the efficacy of oral therapy must be equivalent and toxicity not superior than those expected with the intravenous treatment. A better patient compliance, drug tolerability, convenience and possible better efficacy for oral therapy as compared to intravenous emerge as the major reasons to use oral anticancer agents among oncologists. Inter- and intra-individual pharmacokinetic variations in the bioavailability of oral anticancer drugs may be more relevant than for intravenous agents. Compliance is particularly important for oral therapy because it determines the dose-intensity of the treatment and ultimately treatment efficacy and toxicity. Patient stands as the most important determinant of compliance. Possible measures for an active and safe administration of oral therapy include a careful preliminary medical evaluation and selection of patients based on possible barriers to an adequate compliance, pharmacologic issues, patient-focused education, an improvement of the accessibility to healthcare service, as well as the development of home-care nursing symptom-focused interventions. Current evidences show similar quality of life profile between oral and intravenous treatments, although anticancer oral therapy seems to be more convenient in terms of administration and reduced time lost for work or other activities. Regarding cost-effectiveness, current evidences are in favor of oral therapy, mainly due to reduced need of visits and/or day in hospital for the administration of the drug and/or the management of adverse events.
Collapse
|
19
|
Dosing Considerations for Capecitabine-Irinotecan Regimens in the Treatment of Metastatic and/or Locally Advanced Colorectal Cancer. Am J Clin Oncol 2010; 33:307-13. [DOI: 10.1097/coc.0b013e3181d27361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
20
|
|
21
|
Camacho FT, Wu J, Wei W, Kimmick G, Anderson RT, Balkrishnan R. Cost impact of oral capecitabine compared to intravenous taxane-based chemotherapy in first-line metastatic breast cancer. J Med Econ 2009; 12:238-45. [PMID: 19732030 DOI: 10.3111/13696990903269673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Few studies have examined the costs associated with differing first-line chemotherapy regimens in patients with metastatic breast cancer (MBC). This study compares the relative cost impact of women starting first-line chemotherapy with capecitabine versus taxanes. METHODS Women receiving first-line chemotherapy for MBC from 1998 to 2002 were identified from a hybrid North Carolina Medicaid-claims-tumour registry linked database and Medicare records, and were followed through to 2005 with claims data. Statistical t- and chi-square tests were used to compare baseline characteristics between patients who received first-line chemotherapy with capecitabine versus taxanes. Projected mean costs for 12 months continuous eligibility were estimated using an ordinary least squares linear regression. Overall cost impact of capecitabine after start of therapy was then examined using a multivariate log-linear regression model. RESULTS While patients starting taxanes had significantly lower total costs in the pre-index year than patients starting capecitabine (mean: $20,042 vs. $35,538, p<0.001), in the post-index year, the patients on taxanes experienced significantly higher healthcare utilisation and associated costs compared to patients on capecitabine (mean: $43,353 vs. $35,842, p=0.0089). The differences were primarily attributable to lower expenses in chemotherapy related claims and fewer visit days to outpatient settings for patients on capecitabine. After adjustment with propensity scores and other confounders, the capecitabine group was associated with 32% lower healthcare costs compared to the taxane group (p=0.0001). CONCLUSIONS In this population-based study, women who received capecitabine as first-line treatment for MBC had significantly lower costs compared to women starting taxane therapy.
Collapse
Affiliation(s)
- Fabian T Camacho
- Department of Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | | | | | | | | | | |
Collapse
|
22
|
Hénin E, Tod M, Trillet-Lenoir V, Rioufol C, Tranchand B, Girard P. Pharmacokinetically Based Estimation of Patient Compliance with Oral Anticancer Chemotherapies. Clin Pharmacokinet 2009; 48:359-69. [DOI: 10.2165/00003088-200948060-00002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
23
|
Tan EH, Rolski J, Grodzki T, Schneider CP, Gatzemeier U, Zatloukal P, Aitini E, Carteni G, Riska H, Tsai YH, Abratt R. Global Lung Oncology Branch trial 3 (GLOB3): final results of a randomised multinational phase III study alternating oral and i.v. vinorelbine plus cisplatin versus docetaxel plus cisplatin as first-line treatment of advanced non-small-cell lung cancer. Ann Oncol 2009; 20:1249-56. [PMID: 19276396 DOI: 10.1093/annonc/mdn774] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The study compared the efficacy of a first-line treatment with day 1 i.v. vinorelbine (NVBiv) and day 8 oral vinorelbine (NVBo) versus docetaxel (DCT) in a cisplatin-based combination in advanced non-small-cell lung cancer, in terms of time to treatment failure (TTF), overall response, progression-free survival (PFS), overall survival (OS), tolerance and quality of life (QoL). METHODS Patients were randomly assigned to receive cisplatin 80 mg/m2 with NVBiv 30 mg/m2 on day 1 and NVBo 80 mg/m2 on day 8 every 3 weeks, after a first cycle of NVBiv 25 mg/m2 on day 1 and NVBo 60 mg/m2 on day 8 (arm A) or cisplatin 75 mg/m2 and DCT 75 mg/m2 on day 1 every 3 weeks (arm B), for a maximum of six cycles in both arms. RESULTS From 2 February 2004 to 1 January 2006, 390 patients were entered in a randomised study and 381 were treated. The patient characteristics are as follows (arms A/B): metastatic (%) 80.5/84.8; patients with three or more organs involved (%) 45.3/40.8; median age 59.4/62.1 years; male 139/146; squamous (%) 34.2/33.5; adenocarcinoma (%) 41.6/39.3; median TTF (arms A/B in months) [95% confidence interval (CI)]: 3.2 (3.0-4.2), 4.1 (3.4-4.5) (P = 0.19); overall response (arms A/B) (95% CI): 27.4% (21.2% to 34.2%), 27.2% (21.0% to 34.2%); median PFS (arms A/B in months) (95% CI): 4.9 (4.4-5.9), 5.1 (4.3-6.1) (P = 0.99) and median OS (arms A/B in months) (95% CI): 9.9 (8.4-11.6), 9.8 (8.8-11.5) (P = 0.58). The median survival for squamous histology was 8.87/9.82 months and for adenocarcinoma 11.73/11.60 months for arms A and B, respectively. Main haematological toxicity was grade 3-4 neutropenia: 24.4% (arm A) and 28.8% (arm B). QoL as measured by the Lung Cancer Symptom Scale was similar in both arms. CONCLUSIONS Both arms provided similar efficacy in terms of response, time-related parameters and QoL, with an acceptable tolerance profile. In the current Global Lung Oncology Branch trial 3, NVBo was shown to be effective as a substitute for the i.v. formulation. This can relieve the burden of the i.v. injection on day 8 and can optimise the hospital's resources and improve patient convenience.
Collapse
Affiliation(s)
- E H Tan
- Department of Medical Oncology, Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Baker J, Ajani JA. Proactive nurse management guidelines for managing intensive chemotherapy regimens in patients with advanced gastric cancer. Eur J Oncol Nurs 2008; 12:227-32. [PMID: 18329956 DOI: 10.1016/j.ejon.2007.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 11/22/2007] [Accepted: 11/26/2007] [Indexed: 01/01/2023]
Abstract
Patients with advanced gastric cancer have a poor prognosis. Intensive chemotherapy regimens may be effective for the treatment of this disease but may be associated with a significant number of severe adverse events. Optimal management of these adverse events can improve outcome for the patient. Currently, there is little information in the literature about the nursing management of this particular group of patients. This American study involved the nursing management of all patients with gastric or gastroesophageal cancer enrolled in clinical trials at a single center. Patients had close contact with research nurses and received education about adverse events and how to deal with them. Patients completed a detailed treatment diary for each cycle of treatment. Protocols were established for the management of emergent adverse events. The guidelines developed during this study could help to underpin the role of the specialist oncology nurse and improve the management of patients undergoing intensive chemotherapy for gastric and gastroesophageal cancer, with the potential of improving outcome, or at least quality of life, for the patients. The nurses' role should be pivotal in the management of intensive chemotherapy for gastric and gastroesophageal cancer.
Collapse
Affiliation(s)
- J Baker
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA.
| | | |
Collapse
|
25
|
Morishita M, Leonard RC. Capecitabine and docetaxel combination for the treatment of breast cancer. WOMEN'S HEALTH (LONDON, ENGLAND) 2008; 4:11-22. [PMID: 19072447 DOI: 10.2217/17455057.4.1.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The management of breast cancer depends on the tumor and patient's characteristics. Anthracycline-based regimens have been proven to decrease the risk of relapse and prolong survival time in breast cancer. Taxanes have been incorporated not only into metastatic breast cancer but also into adjuvant regimens. Capecitabine, an oral fluoropyrimidine carbamate, has good single-agent activity and, together with docetaxel, demonstrated preclinical synergy and a survival benefit in metastatic breast cancer. Recent analyses show that capecitabine/docetaxel dosing flexibility for managing side effects does not compromise efficacy, and define this combination regimen as an important treatment option for its efficacy, tolerability and cost-effectiveness.
Collapse
Affiliation(s)
- Mariko Morishita
- Imperial College Healthcare NHS Trust, Fulham Palace Road, London W68RF, UK.
| | | |
Collapse
|
26
|
Findlay M, von Minckwitz G, Wardley A. Effective oral chemotherapy for breast cancer: pillars of strength. Ann Oncol 2007; 19:212-22. [PMID: 18006898 DOI: 10.1093/annonc/mdm285] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Traditionally, anticancer therapy has been dominated by intravenous drug therapy. However, oral agents provide an attractive approach to chemotherapy and use of oral treatments is increasing. We discuss the benefits and challenges of oral chemotherapy from the perspectives of patients, healthcare providers and healthcare funders. Important issues include patient preference, efficacy, compliance, bioavailability, reimbursement, use in special patient populations, financial and staff time savings and flexibility of dosing. We review data for traditional oral agents (e.g. cyclophosphamide, methotrexate), newer oral chemotherapies (e.g. capecitabine), oral formulations of traditionally intravenous agents (e.g. vinorelbine, idarubicin) and new biologic agents under evaluation in breast cancer (e.g. tyrosine kinase inhibitors). Lastly, we review studies of all-oral combination regimens. The wealth of data available and the increasing use of oral agents in breast cancer suggest that many of the concerns and perceptions about oral therapy, including efficacy and bioavailability, have been overcome, and that oral therapy will play a major role in breast cancer management in the future in both the metastatic and adjuvant settings.
Collapse
Affiliation(s)
- M Findlay
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
| | | | | |
Collapse
|
27
|
MacLeod A, Branch A, Cassidy J, McDonald A, Mohammed N, MacDonald L. A nurse-/pharmacy-led capecitabine clinic for colorectal cancer: Results of a prospective audit and retrospective survey of patient experiences. Eur J Oncol Nurs 2007; 11:247-54. [PMID: 17188937 DOI: 10.1016/j.ejon.2006.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 09/21/2006] [Accepted: 10/03/2006] [Indexed: 12/27/2022]
Abstract
Oral chemotherapy agents provide patients with choice and home-based therapy but demand greater emphasis on patient support and education to minimise toxicities. To meet this demand, a nurse-/pharmacy-led clinic was established at the Beatson Oncology Centre in 2003 for the provision of oral capecitabine to metastatic colorectal cancer patients to provide a controlled and supportive environment. We conducted a prospective audit of 52 patients attending the clinic from March 2003 to June 2004 and a retrospective survey of patient experiences to assess clinic effectiveness. Of 52 patients, 79% completed at least 3 cycles of treatment (mean 3.5). Capecitabine was well tolerated. The dose was reduced on at least one occasion in 15 (29%) patients and 17 (30%) patients experienced at least one delay. Patient satisfaction, indicated by questionnaire responses (n=27), was high. Most patients (> or =85%) thought that the service provision was useful and well organised. The results indicate that a nurse-/pharmacy-led clinic for the provision of home-based oral capecitabine is safe, effective and acceptable to most patients. The success of this clinic can provide a model for use in other centres and in other types of cancer, such as breast cancer, where oral chemotherapy is a treatment option.
Collapse
Affiliation(s)
- A MacLeod
- Beatson Oncology Center, Dumbarton Road, Glasgow, G11 6NT, UK.
| | | | | | | | | | | |
Collapse
|
28
|
Moore S. Facilitating oral chemotherapy treatment and compliance through patient/family-focused education. Cancer Nurs 2007; 30:112-22; quiz 123-4. [PMID: 17413776 DOI: 10.1097/01.ncc.0000265009.33053.2d] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Oral chemotherapy is assuming an increasingly important role in cancer therapy. Pharmaceutical firms continue to invest heavily in oral drug development with approximately 25% of more than 400 antineoplastic drugs currently in the development pipeline planned as oral agents. New treatments, patient preference, and the economic realities of cancer care delivery present physicians, nurses, pharmacists, and cancer center administrators with a challenge to restructure and reorganize to provide cost-effective and high-quality care to cancer patients. Oncology nurses are uniquely positioned to step into new roles emphasizing patient and family education and support. A discussion of the Health Belief Model provides an increased understanding of patient motivation and helps healthcare providers increase compliance among patients using oral therapies. This article provides an overview of the current status of oral cancer therapy in the United States and takes into consideration a historical perspective; illustrates pharmacology, indications, administration, and side effect profile through an exemplar agent; discusses potential advantages of and challenges to integration of oral therapies; and discusses alternative methods of patient and family education to improve compliance and outcome.
Collapse
Affiliation(s)
- Susan Moore
- Division of Hematology, Oncology and Stem Cell Transplant, Rush University Medical Center, Chicago, Ill, USA.
| |
Collapse
|
29
|
Hénin E, You B, Tranchand B, Freyer G, Girard P. Les enjeux de l’observance pour les nouvelles chimiothérapies par voie orale : intérêt du modèle pharmacocinétique-pharmacodynamique. Therapie 2007; 62:77-85. [PMID: 17582305 DOI: 10.2515/therapie:2007027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nowadays, more and more oral anticancer chemotherapies are developed either for cytotoxic or new targeted drugs. But this relatively new route of administration in oncology drives to new problems in treatment management and particularly to non-compliance, i.e. the deviance of the actual way patients take their treatment with the prescription. Population PK-PD models and Monte-Carlo simulations allow to study the impact of non-compliance on toxicities. After a brief review on recent developments about oral chemotherapies, this work presents a simulation where non-compliance, modelled with a two state Markov chain defining four compliance profiles from excellent to poor, is linked to two dose-toxicity (continuous or categorical) population models. Simulated patients with the lowest compliance level were less exposed to treatment and therefore experienced less toxicity with shorter events. Nevertheless treatment efficacy is also lower, and this loss of efficacy may compromise patient's outcome. These results foresee the necessity of global simulations, combining compliance, toxicity and efficacy modelling.
Collapse
Affiliation(s)
- Emilie Hénin
- Université de Lyon, Lyon, France - Université Lyon 1, EA3738, CTO, Faculté de Médecine Lyon-Sud, 69921 Oullins Cedex, France.
| | | | | | | | | |
Collapse
|
30
|
Abstract
Many people with cancer have oral medication as part or all of their regime. This medication is primarily self administered in the community. This mini-review aimed to determine the level of compliance of adult cancer patients with oral chemotherapy and to assess the quality of the available evidence. Searches were undertaken using three electronic databases (Medline, Embase, CINAHL) for studies which evaluated the compliance of adult cancer patients with oral anti-neoplastic agents through self-report, pill counts, drug/metabolite levels or microelectronic monitoring system (MEMS). Articles were selected if the follow-up was higher than 80% of patients. Six papers were identified for the review. The methodological quality of the studies was poor. The sample size of the majority of them was small and the method used to measure adherence was not entirely reliable. The results of these papers were varied and contradictory. A firm conclusion cannot be drawn because the studies present significant methodological flaws. The comparison of results between studies is difficult due to the lack of a gold-standard measure of adherence and a standardised definition of non-compliance. Further research in this area is needed. However it does appear that compliance is a problem in this patient group.
Collapse
Affiliation(s)
- Paula Escalada
- School of Nursing, University of Navarra, Pamplona, Spain
| | | |
Collapse
|
31
|
Kav S, Bostanci H. Role of the nurse in patient education and follow-up of people receiving oral chemotherapy treatment in Turkey. Support Care Cancer 2006; 14:1252-7. [PMID: 16758174 DOI: 10.1007/s00520-006-0084-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Accepted: 04/10/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The goal of this study was to identify the nursing role in providing education and follow-ups of patients who were taking oral chemotherapy (CT) treatment in oncology clinics in Turkey. This study arises from the fact that an increasing number of oral CT agents are being developed and used in clinical practice. METHODS One hundred and two nurses from various centers completed a 16-item questionnaire. RESULTS Nearly half of the nurses work in outpatient/ambulatory clinics (46.1%); the most commonly used oral CT agents were etoposide, capecitabine, methotrexate, hydroxyurea, melphalan, and uracil plus tegafur; 86.3% of the nurses had not received any education on the oral drugs; 72.6% of the nurses stated there was no guideline/protocol for oral CT administration in their unit; and 91.2% of the subjects reported the lack of educational materials specifically for oral CT agents. Half of the subjects reported providing some patient education, mostly giving information about "timing," among them 42.3% reported not giving any information on drug safety, side effects, or symptom management. The reasons for the nurses not being involved in oral CT education and follow-ups were because the physicians plan oral CT and follow-ups of the patients and because of a lack of knowledge. CONCLUSIONS Nurses and physicians describe the role of the nurse as "giving intravenous CT." Given that the number of oral CT agents is on the rise, nurses must begin to take an active role in patient education and follow-up.
Collapse
Affiliation(s)
- Sultan Kav
- Faculty of Health Sciences, Department of Nursing, Baskent University, Baglica Kampusu, Eskisehir Yolu 20. Km, 06810, Baglica, Ankara, Turkey.
| | | |
Collapse
|
32
|
Gerbrecht BM, Kangas T. Implications of capecitabine (Xeloda®) for cancer nursing practice. Eur J Oncol Nurs 2004; 8 Suppl 1:S63-71. [PMID: 15341883 DOI: 10.1016/j.ejon.2004.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Home-based therapy with oral capecitabine (Xeloda) has a number of advantages over i.v. hospital-based chemotherapy regimens, including improvement in patients' quality of life, and medical resource/cost savings compared with 5-FU/LV in metastatic colorectal cancer. In addition, the ability of capecitabine to extend survival beyond docetaxel in patients with previously treated metastatic breast cancer means that capecitabine plus docetaxel is a very cost-effective combination. Oncology nurses should prepare for the increased use of oral capecitabine as a single agent or in combination regimens in the outpatient setting. The use of this drug requires enhanced patient education skills, communication (e.g. telephone contact) and patient management on the part of the nurse. Oncology nurses will also need to accept a more significant and pivotal role in the clinical oncology team, not only as a point of contact between the patient and clinician, but also in documenting the benefits of capecitabine to ensure the effective management of patients receiving the drug.
Collapse
|
33
|
Faithfull S, Deery P. Implementation of capecitabine (Xeloda®) into a cancer centre: UK experience. Eur J Oncol Nurs 2004; 8 Suppl 1:S54-62. [PMID: 15341882 DOI: 10.1016/j.ejon.2004.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Switching patients from intravenous 5-FU/LV to oral capecitabine (Xeloda) for the treatment of metastatic colorectal cancer is associated with a reduction in the need for hospitalisations to manage 5-FU-associated delivery and complications, with resulting healthcare savings. However, implementing oral therapy with capecitabine within a cancer centre in the UK has required a considerable change in attitude within healthcare services. The resulting need for patients to take an active role in their treatment, and the co-ordination and monitoring of such a service at home has raised issues for chemotherapy services. To enhance patient involvement and compliance with medication a patient guide was developed to educate, and support individuals and enable them to understand the rationale for treatment and when to seek help. In addition, patients are encouraged to monitor and record symptoms in a diary. This change in service focus has required an investment in time educating and informing patients, community health workers and hospital practitioners. This change has been co-ordinated through the chemotherapy outpatient clinic. Effective communication between hospital and home has been important in implementing oral chemotherapy. While the initial challenge of monitoring and educating patients receiving capecitabine has been met, the Primary Care team and cancer centre need to continue to assess side effects and patient compliance in order to improve knowledge of capecitabine among healthcare professionals and ensure safe practice.
Collapse
Affiliation(s)
- Sara Faithfull
- European Institute of Health and Medical Sciences, Surrey University, Guildford, Surrey GU2 7TE, UK.
| | | |
Collapse
|
34
|
Molassiotis A. Challenges and opportunities when using oral chemotherapy in the home setting: the example of capecitabine (Xeloda®). Eur J Oncol Nurs 2004. [DOI: 10.1016/j.ejon.2004.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|