P-0140 Hospital Based Audit of Patients Admitted with Sided Effects of 5FU Based Chemotherapy

Abstract

ABSTRACT Introduction 5FU based chemotherapy is the backbone of gastrointestinal chemotherapy. Over time dose modifications has improved efficacy and reduced toxicity. Despite advances a significant proportion of patients continue to be admitted to hospital with complications of treatment. This study was an audit of patients receiving 5FU based chemotherapy (IV 5FU or oral capecitabine) who required hospital admission for chemotherapy induced toxicity particularly diarrhoea. Methods All chemotherapy prescribed uses the ChemoCare electronic prescribing software. The records of all patients receiving 5FU based chemotherapy over a 12 month period were reviewed. Any admissions were noted and details collected. Results 465 patients received 5FU based chemotherapy (192 with upper GI cancer and 273 with lower GI cancer). Mean age 67 (range 31 to 88). 40 patients (8.6%) were admitted with chemotherapy related complications (50% because of diarrhoea, 22% febrile neutropenia, 13% cardiac and 11% nausea and vomiting). 3/17(17.6%), 8/64(12.5%), 8/77(10.4%), 8/87(9.2%) and 10/152(6.6%) patients were admitted to hospital receiving FOLFOX, XELOX, ECX, EOX and single agent capecitabine chemotherapy regimens respectively. In total 374 bed days were used. 4 patients ( 70 years ) had a longer hospital stay than younger patients( median 14 days vs. 7 days for colorectal cancer and median 13.2 vs. 9 days for upper GI cancer). The average cost per patient was £3000. Conclusion 5FU chemotherapy continues to result in a significant number of hospital admissions to the hospital at a cost in our UK institute on average of £3000 per patient. 5FU blood level monitoring demonstrates that there is a significant variation in levels with some patients receiving 5FU at a sub-therapeutic level and others having levels in the toxic range. We are introducing 5FU blood level monitoring and will dose adjust patients receiving infusional 5FU according to the protocol highlighted by Gamelin. A reaudit of hospital admissions will then be made to assess potential benefits including reduced toxicity.