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Perrey HM, Taylor E, Cropp BF, Bumpus MJ, Lessard S, Pretorius JA, Angus JH, Duperreault MF, Snow A, Wang D, Curtis M, Couture LA, Adolphson DR, Smith K, Moody JH, Bianchi MJ, Parker MG, Sanyal A, Remick SC. Seeking American Society of Clinical Oncology-Quality Oncology Practice Initiative (ASCO-QOPI) certification in a northern New England rural health system and cancer care network. Learn Health Syst 2024; 8:e10415. [PMID: 39036533 PMCID: PMC11257055 DOI: 10.1002/lrh2.10415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 07/23/2024] Open
Abstract
In 2006 following several years of preliminary study, the American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI). This cancer-focused quality initiative evolved considerably over the next decade-and-a-half and is expanding globally. QOPI is undoubtedly the leading standard-bearer for quality cancer care and contemporary medical oncology practice. The program garners attention and respect among federal programs, private insurers, and medical oncology practices across the nation. The MaineHealth Cancer Care Network (MHCCN) has undergone expansive growth since 2017. The network provides cancer care to more than 70% of the cases in Maine in a largely rural health system in Northern New England. In fall 2020, the MHCCN QOPI project leadership, following collaborative discussions with the ASCO-QOPI team, elected to proceed with a health system-cancer network-wide QOPI certification. Key themes emerged over the course of our two-year journey including: (1) Developing a highly interprofessional team committed to the project; (2) Capitalizing on a single electronic medical record for data transmission to CancerLinQ; (3) Prior experience, especially policy development, in other cancer-focused accreditation programs across the network; and (4) Building consensus through quarterly stakeholder meetings and awarding Continuing Medical Education (CME) and American Board of Medical Specialists (ABMS) Maintenance of Certification (MOC) credits to oncologists. All participants demonstrated a genuine spirit to work together to achieve certification. We report our successful journey seeking ASCO-QOPI certification across our network, which to our knowledge is the first-of-its-kind endeavor.
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Affiliation(s)
- Hilary M. Perrey
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Evelyn Taylor
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Brett F. Cropp
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Meaghan J. Bumpus
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Shannon Lessard
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Jeanette A. Pretorius
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Jonathan H. Angus
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Megan F. Duperreault
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Amanda Snow
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Dorothy Wang
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Meredith Curtis
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Lauren A. Couture
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - David R. Adolphson
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Kimberly Smith
- Harold Alfond Center for Cancer Care at Maine General Medical CenterAugustaMaineUSA
| | - Joy H. Moody
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Michael J. Bianchi
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Mark G. Parker
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
| | - Amit Sanyal
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
- ASCO MembersAlexandriaVirginiaUSA
| | - Scot C. Remick
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
- ASCO MembersAlexandriaVirginiaUSA
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Pham TD, Tsunoyama T. Exploring Extravasation in Cancer Patients. Cancers (Basel) 2024; 16:2308. [PMID: 39001371 PMCID: PMC11240416 DOI: 10.3390/cancers16132308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Extravasation, the unintended leakage of intravenously administered substances, poses significant challenges in cancer treatment, particularly during chemotherapy and radiotherapy. This comprehensive review explores the pathophysiology, incidence, risk factors, clinical presentation, diagnosis, prevention strategies, management approaches, complications, and long-term effects of extravasation in cancer patients. It also outlines future directions and research opportunities, including identifying gaps in the current knowledge and proposing areas for further investigation in extravasation prevention and management. Emerging technologies and therapies with the potential to improve extravasation prevention and management in both chemotherapy and radiotherapy are highlighted. Such innovations include advanced vein visualization technologies, smart catheters, targeted drug delivery systems, novel topical treatments, and artificial intelligence-based image analysis. By addressing these aspects, this review not only provides healthcare professionals with insights to enhance patient safety and optimize clinical practice but also underscores the importance of ongoing research and innovation in improving outcomes for cancer patients experiencing extravasation events.
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Affiliation(s)
- Tuan D. Pham
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
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Hu Y, Ma P, Chen L, Liu J, Shang Y, Jian W. Multi-parameter cardiac magnetic resonance imaging detects anthracycline-induced cardiotoxicity in rabbits model. Heliyon 2023; 9:e21845. [PMID: 38058655 PMCID: PMC10695840 DOI: 10.1016/j.heliyon.2023.e21845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 12/08/2023] Open
Abstract
Background Cardiac magnetic resonance (CMR) quantitative T1 and T2 mapping offers a non-invasive means to evaluate early cardiotoxicity changes. This study aimed to pinpoint the earliest CMR indicators of myocardial injury in Anthracycline-induced cardiotoxicity (AIC) and to elucidate the connections between these CMR indicators and associated pathological indicators. Methods A total of 34 rabbits were administered doxorubicin at a dosage of 1 mg/kg/weekly. The study incorporated six 3T CMR scan time points: baseline, and at intervals of four, six, eight, twelve, and sixteen weeks. Cine, T1 and T2 mapping sequences assessed the left ventricular ejection fraction (LVEF), native T1, extracellular volume fraction (ECV), and T2 values. Following each time point, three rabbits were sacrificed for histological analysis involving Hematoxylin and eosin (H&E), Masson, TUNEL, and microvascular density (MVD) stains. Spearman correlations and linear mixed model analysis served in the statistical analysis. Results Diverse degrees of alternation were recorded in LVEF, native T1, T2, and ECV over time. LVEF declined to 49.0 ± 2.6 % at 12 weeks from the baseline of 53.4 ± 3.2 %, p < 0.001. Native T1 values increase from the baseline (1396.5 ± 79.2 ms) until 8 weeks (1498.8 ± 95.4 ms, p < 0.001). T2 values increased from the baseline (36.6 ± 3.3 ms) within 4 weeks of initiation (37.5 ± 3.4, p = 0.02) and remained elevated through 16 weeks (42.8 ± 0.3, p < 0.01). ECV was elevated at 8 weeks (33.9 ± 3.8 %, p = 0.005) compared to the baseline (30.2 ± 2.5 %). By week 12, myocardial edema and increased CVF were apparent (p = 0.04 and = 0.001, respectively). The area under ROC curve for positive CMR presence and the gold standards were 0.87 (T2-ROC, 4 weeks) and 0.92 (LVEF&BNP-ROC, 12 weeks). Conclusion T1 and T2 mapping are effective tools for cardiotoxicity detection and monitoring. The prolongation of T2 value emerged as the most consistent and early-onset indicator.
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Affiliation(s)
- Yurou Hu
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- 7T Magnetic Resonance Imaging Translational Medical Center, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Peisong Ma
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- 7T Magnetic Resonance Imaging Translational Medical Center, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Juan Liu
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yongning Shang
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wang Jian
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- 7T Magnetic Resonance Imaging Translational Medical Center, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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4
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Management of Chemotherapy Infusion Extravasation in Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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5
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Comparison of Anticancer Drug Toxicities: Paradigm Shift in Adverse Effect Profile. Life (Basel) 2021; 12:life12010048. [PMID: 35054441 PMCID: PMC8777973 DOI: 10.3390/life12010048] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
The inception of cancer treatment with chemotherapeutics began in the 1940s with nitrogen mustards that were initially employed as weapons in World War II. Since then, treatment options for different malignancies have evolved over the period of last seventy years. Until the late 1990s, all the chemotherapeutic agents were small molecule chemicals with a highly nonspecific and severe toxicity spectrum. With the landmark approval of rituximab in 1997, a new horizon has opened up for numerous therapeutic antibodies in solid and hematological cancers. Although this transition to large molecules improved the survival and quality of life of cancer patients, this has also coincided with the change in adverse effect patterns. Typically, the anticancer agents are fraught with multifarious adverse effects that negatively impact different organs of cancer patients, which ultimately aggravate their sufferings. In contrast to the small molecules, anticancer antibodies are more targeted toward cancer signaling pathways and exhibit fewer side effects than traditional small molecule chemotherapy treatments. Nevertheless, the interference with the immune system triggers serious inflammation- and infection-related adverse effects. The differences in drug disposition and interaction with human basal pathways contribute to this paradigm shift in adverse effect profile. It is critical that healthcare team members gain a thorough insight of the adverse effect differences between the agents discovered during the last twenty-five years and before. In this review, we summarized the general mechanisms and adverse effects of small and large molecule anticancer drugs that would further our understanding on the toxicity patterns of chemotherapeutic regimens.
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Abstract
BACKGROUND Many drugs approved for other indications can control the growth of tumor cells and limit adverse events (AE). DATA SOURCES Literature searches with keywords 'repurposing and cancer' books, websites: https://clinicaltrials.gov/, for drug structures: https://pubchem.ncbi.nlm.nih.gov/. AREAS OF AGREEMENT Introducing approved drugs, such as those developed to treat diabetes (Metformin) or inflammation (Thalidomide), identified to have cytostatic activity, can enhance chemotherapy or even replace more cytotoxic drugs. Also, anti-inflammatory compounds, cytokines and inhibitors of proteolysis can be used to control the side effects of chemo- and immuno-therapies or as second-line treatments for tumors resistant to kinase inhibitors (KI). Drugs specifically developed for cancer therapy, such as interferons (IFN), the tyrosine KI abivertinib TKI (tyrosine kinase inhibitor) and interleukin-6 (IL-6) receptor inhibitors, may help control symptoms of Covid-19. AREAS OF CONTROVERSY Better knowledge of mechanisms of drug activities is essential for repurposing. Chemotherapies induce ER stress and enhance mutation rates and chromosome alterations, leading to resistance that cannot always be related to mutations in the target gene. Metformin, thalidomide and cytokines (IFN, tumor necrosis factor (TNF), interleukin-2 (IL-2) and others) have pleiomorphic activities, some of which can enhance tumorigenesis. The small and fragile patient pools available for clinical trials can cloud the data on the usefulness of cotreatments. GROWING POINTS Better understanding of drug metabolism and mechanisms should aid in repurposing drugs for primary, adjuvant and adjunct treatments. AREAS TIMELY FOR DEVELOPING RESEARCH Optimizing drug combinations, reducing cytotoxicity of chemotherapeutics and controlling associated inflammation.
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Affiliation(s)
- Catherine H Schein
- Department of Biochemistry and Molecular Biology Faculty, Institute for Human Infections and Immunity (IHII), University of Texas Medical Branch, Galveston 301 University Boulevard, Galveston, Texas 77555, USA
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8
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Cheong A, McGrath S, Cutts S. Anthracyclines. WIKIJOURNAL OF MEDICINE 2018. [DOI: 10.15347/wjm/2018.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Maly C, Fan KL, Rogers GF, Mitchell B, Amling J, Johnson K, Welch L, Oh AK, Chao JW. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1743. [PMID: 29876181 PMCID: PMC5977944 DOI: 10.1097/gox.0000000000001743] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/07/2018] [Indexed: 02/07/2023]
Abstract
Intravenous therapy is a common practice among many specialties. Intravenous therapy extravasation is a potential complication to such therapy. Hospitals without a dedicated wound care team trained in these interventions will often default to plastic surgical consultation, making an understanding of available interventions essential to the initial evaluation and management of these injuries. The goal of this article was to provide plastic surgeons and health care providers with a general overview of the acute management of intravenous infiltration and extravasation injuries. Though the decision for surgical versus nonsurgical management is often a clear one for plastic surgeons, local interventions, and therapies are often indicated and under-utilized in the immediate postinfiltration period. Thorough knowledge of these interventions should be a basic requirement in the armamentarium of plastic surgery consultants.
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Affiliation(s)
- Connor Maly
- Georgetown University School of Medicine, Washington, D.C
| | - Kenneth L Fan
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C
| | - Gary F Rogers
- Division of Plastic Surgery, Children's National Health System, Washington, D.C
| | | | - June Amling
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C.,Division of Nursing, Children's National Health System, Washington, D.C
| | - Kara Johnson
- Division of Nursing, Children's National Health System, Washington, D.C
| | - Laura Welch
- Division of Nursing, Children's National Health System, Washington, D.C
| | - Albert K Oh
- Division of Plastic Surgery, Children's National Health System, Washington, D.C
| | - Jerry W Chao
- Division of Plastic Surgery, Children's National Health System, Washington, D.C.,Division of Plastic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, D.C
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10
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Early Detection and Serial Monitoring of Anthracycline-Induced Cardiotoxicity Using T1-mapping Cardiac Magnetic Resonance Imaging: An Animal Study. Sci Rep 2017; 7:2663. [PMID: 28572614 PMCID: PMC5453985 DOI: 10.1038/s41598-017-02627-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/13/2017] [Indexed: 11/26/2022] Open
Abstract
A reliable, non-invasive diagnostic method is needed for early detection and serial monitoring of cardiotoxicity, a well-known side effect of chemotherapy. This study aimed to assess the feasibility of T1-mapping cardiac magnetic resonance imaging (CMR) for evaluating subclinical myocardial changes in a doxorubicin-induced cardiotoxicity rabbit model. Adult male New Zealand White rabbits were injected twice-weekly with doxorubicin and subjected to CMR on a clinical 3T MR system before and every 2–4 weeks post-drug administration. Native T1 and extracellular volume (ECV) values were measured at six mid-left ventricle (LV) and specific LV lesions. Histological assessments evaluated myocardial injury and fibrosis. Three pre-model and 11 post-model animals were included. Myocardial injury was observed from 3 weeks. Mean LV myocardium ECV values increased significantly from week 3 before LV ejection fraction decreases (week 6), and ECVs of the RV upper/lower insertion sites and papillary muscle exceeded those of the LV. The mean native T1 value in the mid-LV increased significantly increased from week 6, and LV myocardium ECV correlated strongly with the degree of fibrosis (r = 0.979, p < 0.001). Myocardial T1 mapping, particularly ECV values, reliably and non-invasively detected early cardiotoxicity, allowing serial monitoring of chemotherapy-induced cardiotoxicity.
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Negative-pressure wound therapy and early pedicle flap reconstruction of the chest wall after epirubicin extravasation. J Vasc Access 2017; 18:e27-e29. [PMID: 28165571 DOI: 10.5301/jva.5000654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Accidental extravasation is a serious iatrogenic injury among patients receiving anthracycline-containing chemotherapy. The aim of this work is to present a combination therapy for chest wall reconstruction following epirubicin extravasation. METHODS Herein, we report a 68-year-old woman with massive soft tissue necrosis of the anterolateral chest wall after epirubicin extravasation from a port implanted in the subclavicular area. RESULTS The necrotic tissue was resected, the port was removed, and negative-pressure wound therapy was applied. Three weeks later, a latissimus dorsi pedicle flap was successfully used to cover the defect. CONCLUSIONS To the best of the authors' knowledge, this is the first report of a strategy comprising the combination of negative-pressure wound therapy and a latissimus pedicle flap for reconstruction of the chest wall after soft tissue necrosis following epirubicin extravasation.
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Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. Pharmacological management of anticancer agent extravasation: A single institutional guideline. J Oncol Pharm Pract 2017; 24:129-138. [DOI: 10.1177/1078155217690924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the risk of extravasation of a chemotherapy (anticancer) medication is low, the complications associated with these events can have a significant impact on morbidity and health care costs. Institutions that administer anticancer agents should ideally have a current guideline on the proper management of the inadvertent administration of these toxic medications into tissues surrounding blood vessels. It is imperative that the health care team involved in administering drugs used to treat cancer be educated on the risk factors, preventative strategies and treatment of anticancer extravasations, as well as practice safe and proper administration techniques. Anticancer agents are generally divided into classes based on their ability to cause tissue damage. The review of current published guidelines and available literature reveals a lack of consensus on how these medications should be classified. In addition, many recently approved drugs for the treatment of cancer may lack data to support their classification and management of extravasation events. The treatment of the majority of extravasations of anticancer agents involves nonpharmacological measures, potentially in the ambulatory care setting. Antidotes are available for the extravasation of a minority of vesicant agents in order to mitigate tissue damage. Due to the limited data and lack of consensus in published guidelines, a working group was established to put forth an institutional guideline on the management of anticancer extravasations.
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Affiliation(s)
- Jaime Kimmel
- Department of Pharmacy, University of Texas MD Anderson Cancer Center, USA
| | - Patrick Fleming
- Department of Pharmacy, University of Illinois Hospital & Health Sciences System, USA
| | - Sandra Cuellar
- Department of Pharmacy, University of Illinois Hospital & Health Sciences System, USA
| | | | - Christina Mactal Haaf
- Department of Pharmacy, University of Illinois Hospital & Health Sciences System, USA
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Hale O, Deutsch PG, Lahiri A. Epirubicin extravasation: consequences of delayed management. BMJ Case Rep 2017; 2017:bcr-2016-218012. [PMID: 28062432 DOI: 10.1136/bcr-2016-218012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Epirubicin is an anthracycline chemotherapy agent used for treatment of several cancers including oesophageal, breast and gastric. Extravasation is a well-recognised and serious complication of any intravenous therapies but especially chemotherapeutic agents. Signs of the injury can be subtle and without prompt recognition and treatment there can be extensive tissue damage and depending on location of injury this can result in significant functional loss. In this article, a case of delayed management of epirubicin extravasation from a cannula situated at the dorsum of the hand is discussed. Successful surgical reconstruction of the resulting substantial tissue damage using a radial forearm flap 21 days following injury is described.
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Affiliation(s)
- Olivia Hale
- Department of Plastic Reconstructive and Hand Surgery, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Peter George Deutsch
- Department of Plastic Reconstructive and Hand Surgery, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Anindya Lahiri
- Department of Plastic Reconstructive and Hand Surgery, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
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Kreidieh FY, Moukadem HA, El Saghir NS. Overview, prevention and management of chemotherapy extravasation. World J Clin Oncol 2016; 7:87-97. [PMID: 26862492 PMCID: PMC4734939 DOI: 10.5306/wjco.v7.i1.87] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/04/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
Chemotherapy extravasation remains an accidental complication of chemotherapy administration and may result in serious damage to patients. We review in this article the clinical aspects of chemotherapy extravasation and latest advances in definitions, classification, prevention, management and guidelines. We review the grading of extravasation and tissue damage according to various chemotherapeutic drugs and present an update on treatment and new antidotes including dexrazoxane for anthracyclines extravasation. We highlight the importance of education and training of the oncology team for prevention and prompt pharmacological and non-pharmacological management and stress the availability of new antidotes like dexrazoxane wherever anthracyclines are being infused.
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Ghanem AM, Mansour A, Exton R, Powell J, Mashhadi S, Bulstrode N, Smith G. Childhood extravasation injuries: Improved outcome following the introduction of hospital-wide guidelines. J Plast Reconstr Aesthet Surg 2015; 68:505-18. [DOI: 10.1016/j.bjps.2014.12.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/13/2014] [Indexed: 11/26/2022]
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16
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Aigner B, Bauernhofer T, Petru E, Niederkorn A, Arzberger EJ, Richtig E. Complete recovery of a wide local reaction by the use of dexrazoxane 72 hours after epirubicin extravasation: case report and review of the literature. Dermatology 2014; 229:288-92. [PMID: 25472626 DOI: 10.1159/000365391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/30/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Accidental extravasation of anthracyclines might result in devastating side effects and complications, including necrosis of tissue, with impairment of neighboring structures - most of them requiring surgery. Following recent approach guidelines, intravenous administration of dexrazoxane within 6 h after the event is recommended. CASE REPORT We report on a 63-year-old female patient with breast cancer treated with epirubicin combination therapy. She experienced extravasation on the distal right arm at the end of the very first cycle, being initially treated with dimethylsulfoxide 99% topically. Clinical symptoms became worse. Despite the interval between the event and referral, dexrazoxane was given once daily for 3 days. She recovered completely without any sequelae. CONCLUSION To our knowledge, this is the first case report of a successful treatment and complete recovery by the use of dexrazoxane even 3 days after extensive epirubicin extravasation. Additionally, a review of the literature is given.
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Affiliation(s)
- Birgit Aigner
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
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Abstract
For more than half a century, the different properties of dexrazoxane have captured the attention of scientists and clinicians. Presently, dexrazoxane is licensed in many parts of the world for two different indications: prevention of cardiotoxicity from anthracycline-based chemotherapy, and prevention of tissue injuries after extravasation of anthracyclines. This article reviews the historical, preclinical, and clinical background for the use of dexrazoxane for these indications.
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Affiliation(s)
- Seppo W Langer
- Thoracic and Neuroendocrine Section, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
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Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract 2013; 67:244-9. [PMID: 23409691 DOI: 10.1111/ijcp.12103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/04/2012] [Indexed: 11/30/2022] Open
Abstract
Extravasation is recognised as a major complication of administering intravenous chemotherapy treatment. Of the agents involved in extravasation, anthracyclines are associated with the greatest risk to patients because they are vesicant agents, having the potential to cause blistering and ulceration. If not identified and left untreated, anthracycline extravasation can lead to more serious complications such as tissue necrosis and functional impairment. Dexrazoxane (Savene(®) ) is the only licensed antidote for the treatment of anthracycline extravasation and clinical evidence has shown Savene(®) to be highly effective for preventing the need for surgery following anthracycline extravasation, allowing full recovery in the majority of patients. To date, there have been eight published studies reporting a total of 102 cases of Savene(®) use. Here, we review the published data on the efficacy of Savene(®) and present an analysis of 12 UK case studies. All UK oncology centres where Savene(®) has been used to manage anthracycline extravasation were contacted by SpePharm UK, who requested case studies for this publication. All of the cases received, including two from our own experience of using Savene(®) have been included in the analysis.
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de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, Mayer-Steinacker R, Bokemeyer C, Jordan K. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. ACTA ACUST UNITED AC 2013; 36:127-35. [PMID: 23486002 DOI: 10.1159/000348524] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel. MATERIAL AND METHODS A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined. RESULTS Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended. CONCLUSION We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects.
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Affiliation(s)
- Maike de Wit
- Klinik für Innere Medizin - Hämatologie und Onkologie, Vivantes Klinikum Neukölln, Berlin, Germany.
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Affiliation(s)
- Helen Roe
- North Cumbria University Hospitals NHS Trust
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Conde-Estévez D, Mateu-de Antonio J. [Update in the management of extravasations of cytocytostatic agent]. FARMACIA HOSPITALARIA 2011; 36:34-42. [PMID: 21798785 DOI: 10.1016/j.farma.2011.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 01/24/2011] [Accepted: 01/27/2011] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To present current developments in the specific management of extravasations of antineoplastic agents after the extravasation. METHOD We conducted a search in PubMed, Medline and IDIS-Iowa to identify papers written in English or Spanish that described new specific measures for the management of extravasations. We also reviewed the references given in these papers and recent tertiary sources related to oncology or cytostatic agents. The search covered the period between 1997 and 2010. RESULTS There are only specific measures for the treatment of extravasations of 22 cytostatic agents. These measures are presented for each cytostatic agent, according their drug group. CONCLUSIONS Although currently there is no general consensus on the specific management of antineoplastic agents after extravasation, this review outlines the information collected and published so far, so that it may be of use to any national health centre where cytostatic drugs are prescribed, handled or administered.
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Affiliation(s)
- D Conde-Estévez
- Servicio de Farmacia, Hospital del Mar (Parc de Salut Mar), Barcelona, España.
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