Administration Of Intravenous Chemotherapy Research Articles

Degree of technological implementation in intravenous chemotherapy management in hospitals of the Autonomous Community of Madrid

ObjectiveTo understand the degree of technological implementation in the processes of preparation and administration of cytostatics drugs that is available in those hospitals of the Autonomous Community of Madrid where intravenous chemotherapy is prepared. MethodA descriptive observational study through the completion of a survey targeted to the staff responsible for the preparation of this type of treatments. ResultsThe degree of implementation of assisted electronic prescription is high, there is a medium degree in the case of bar code reading technology, and low in terms of vial re-labelling and gravimetric and voice control for preparation. ConclusionsThere is a large room for improvement regarding traceability in the process of preparation and administration of intravenous chemotherapy.

Hair safe study: Effects of scalp cooling on hair preservation and hair regrowth in breast cancer patients receiving chemotherapy - A prospective interventional study

Hair safe study: Effects of scalp cooling on hair preservation and hair regrowth in breast cancer patients receiving chemotherapy - A prospective interventional study

End-of-life intravenous chemotherapy administration patterns in the treatment of Queensland lung and pancreas cancer patients: a 10-year retrospective analysis.

End-of-life (EOL) chemotherapy administration rates for solid tumours are 12-20% and are associated with a reduced quality of life, increased hospitalisation and incidence of death within an acute care facility. We sought to determine the rate of EOL chemotherapy in government and private hospitals and determine the impact on hospitalisations and location of death in lung and pancreatic cancer patients. Data were obtained from the Queensland Oncology Repository between 2005 and 2014. Lung (n = 16 501) and pancreatic cancer (n = 4144) deaths were analysed. EOL chemotherapy was determined to be within 30 days of death. Demographics, location of treatment and death are reported. Chemotherapy was administered to 6518 (40%) lung cancer and 1694 (41%) pancreatic cancer patients. A total of 1474 (9%) and 477 (12%) patients, respectively, received EOL chemotherapy. EOL chemotherapy was more common in males and those with distant metastatic disease, while less likely in the elderly and those with a lower socioeconomic status. EOL chemotherapy was more prevalent in large hospitals and was more common in private compared with government hospitals for pancreatic cancer (30 vs 26%; P < 0.001), while it was similar for lung cancer (24 vs 22%; P = 0.115). Death after EOL chemotherapy compared with all cancer deaths was more common in an acute care facility (lung cancer: 60 vs 37%; P < 0.001; pancreatic cancer: 53 vs 36%; P < 0.001). EOL chemotherapy rates were similar to Australian yet marginally lower than international rates, with variation dependent on the size and type of facility and increased the rate of deaths within an acute care facility.

Oncology Nurses' Knowledge and Practices regarding Safe Administration of Intravenous Chemotherapy

Oncology Nurses' Knowledge and Practices regarding Safe Administration of Intravenous Chemotherapy

Possible cardiotoxicity associated with low‐dose doxorubicin during chemotherapy in a ring‐tailed lemur (Lemur catta) with multicentric lymphoma

AbstractThis case report describes an 18‐year‐old, male, ring‐tailed lemur (Lemur catta) diagnosed with multicentric lymphoma and leukaemia treated with a modified 16‐week cyclophosphamide, doxorubicin, vincristine, and prednisolone protocol, using anaesthesia for the intravenous chemotherapy administration of vincristine and doxorubicin, in addition to daily oral prednisolone and monthly oral cyclophosphamide. This regimen was repeated four times and modified to a 3‐week protocol with removal of doxorubicin for one additional cycle. There was initial decrease in peripheral node diameter without change of leukaemia. The lemur tolerated treatments well, remaining socially active within the troop, with normal appetite and demeanour. The lemur gradually developed azotaemia and then declined rapidly in the fifth month after diagnosis, ultimately becoming hyporexic, losing weight, and was humanely euthanased. At postmortem examination, multicentric lymphoma was as noted clinically with severe myocardial degeneration and fibrosis that included histological features similar to doxorubicin cardiotoxicity, as described in humans and other species.

VERU-111, an oral cytoskeleton disruptor, to treat men with metastatic castration-resistant prostate cancer (mCRPC) who failed an androgen receptor targeting agent.

5056 Background: VERU-111 is an oral cytoskeletal disruptor that disrupts microtubules supporting the cytoskeleton and has no affinity for multidrug resistance proteins. A phase 1b/2 clinical study has been conducted to establish the maximum tolerated dose (MTD) and evaluate the preliminary efficacy in men with mCRPC also resistant to androgen receptor targeting agents. Methods: In the phase 1b component of the study, a 3+3 design with escalating oral dosing of 4.5 mg to 81 mg (7 days on drug/14 days off per 21-day cycle) was utilized. The schedule was also expanded to continuous dosing/cycle. The phase 2 portion utilized 63 mg daily dosing to evaluate efficacy in approximately 40 taxane-naïve men with mCRPC that have failed at least one androgen receptor targeting agent. Results: In the phase 1b portion of the study, 30 taxane-naïve men with mCRPC and a median age of 76 (61-92) were enrolled. 8 had received prior enzalutamide, 12 abiraterone and 10 both. 8 men had bone mets, 5 lymph node, 5 mixed and 1 had soft tissue metastases at study entry. The MTD of VERU-111 is 72mg (3/11 men had grade 3 diarrhea) and the recommended phase 2 dose is 63mg. Grade 3 diarrhea was not observed at doses ≤ 63mg per day and the most common non-dose limiting AEs were mild to moderate nausea, vomiting, diarrhea, and fatigue, with no observed neurotoxicity or neutropenia. Efficacy was assessed by PSA and bone/CT scans. In men treated for ≥ 4 continuous 21-day cycles, 6/10 (60%) had PSA declines, 4(40%) men had ≥ 30% declines and 2(20%) ≥ 50% declines compared to their 21-day cycle baseline PSA. Median PFS is currently 12 months (6-23+ months) with 3 patients continuing on study, 2 of which have been on study for approximately 2 years. In patients receiving at least a single dose of ≥ 63 mg daily (n=19), objective tumor responses were seen in 3 men (16%). The median rPFS in these patients is currently 12.4 months. In the phase 2 portion of the study, 55% of the patients had bone only metastases, 11% had nodal only, 32% had mixed bone and nodal disease and 3% had visceral disease at study entry. 6/32 (19%) were previously treated with abiraterone alone, 12/32 (38%) with enzalutamide alone, and 14/32 (44%) had abiraterone in combination with enzalutamide, proxalutamide or apalutamide. The phase 2 portion of the study is ongoing and objective tumor responses have been observed including a CR and PRs and PSA decreases &gt;50%. Patients have been on study as long as 9 months. Conclusions: This phase 1b/2 clinical trial, demonstrates that oral daily dosing of VERU-111 has a favorable safety profile and that chronic dosing is feasible. The recommended phase 2 dose of 63mg daily has significant durable antitumor activity. These data support a potential prominent role of VERU 111 for the treatment of men with mCRPC who previously failed an androgen receptor targeting agent and prior to the administration of intravenous chemotherapy. Clinical trial information: NCT03752099.

Impact of chest subcutaneous fat on the occurrence of central venous port-related infectious complications in cancer patients

PurposeThere is no concrete evidence to support the association between the amount of subcutaneous fat area (SFA) in the central venous port-insertion site (precordium) and port-related complications. We aimed to investigate the relationship between SFA in the midclavicular line and postoperative infectious complications in patients undergoing port-insertion surgery.MethodsThis was a single-institute and historical cohort study of 174 patients who underwent first central venous port implantation surgery for chemotherapy between January 2014 and December 2018. SFA in the midclavicular line was measured using preoperative computed tomography scans. The patients were divided into three groups according to SFA amount tertiles, and we investigated the association of SFA with infectious and all-cause complication events within 1 year.ResultsWithin a median follow-up of 306 days, the patients with intermediate SFA had significantly higher infection-free survival than those with low and high SFA (low vs. intermediate vs. high: 80.4% vs. 97.7% vs. 83.4%, respectively, p=0.034). In contrast, there was no significant difference in the overall complication-free survival among the groups (low vs. intermediate vs. high: 80.4% vs. 88.9% vs. 81.8%, respectively, p=0.29). Low SFA was independently associated with high risk of infectious complications (hazard ratio, 9.45; 95% confidence interval, 1.07–83.22, p=0.043).ConclusionLow SFA in the midclavicular line was an independent risk factor for infectious complications in the chemotherapy setting. This practical indicator can be useful for optimizing patients’ nutritional status and when considering other types of vascular access to support administration of intravenous chemotherapy.

Persistent Left Superior Vena Cava: A Finding After Central Venous Catheterization.

Persistence of the left superior vena cava (LSVC) is a rare anatomical variant in the general population, with an estimated incidence of 0.3-0.5% in healthy individuals. It may be diagnosed incidentally after imaging control of the placement of a central venous catheter (CVC) or other device. We present the case of a patient with acute disease who required central venous catheterization for the administration of intravenous chemotherapy. Central venous catheterization proved difficult and imaging control revealed the catheter tip in an unusual position. Computed tomography to verify the catheter tip position revealed the presence of a persistent left superior vena cava. The patient then underwent the planned treatment with no complications associated with the CVC. Although uncommon, persistence of the LSVC can have a significant impact in clinical practice, particularly when invasive procedures are required. Its recognition is important in order to minimize the potential complications inherent to such procedures. Persistence of the left superior vena cava is an uncommon anatomical variant of the central venous vascular anatomy.It is generally asymptomatic, and its diagnosis is often incidentally made after certain procedures (central venous catheterization).Diagnosis through chest x-ray alone is difficult and should be complemented with transthoracic echocardiography and computed tomography in order to minimize the complications inherent to central venous catheterization.

Cost of home vs clinic administration of paclitaxel in metastatic breast cancer

To estimate the costs associated with home administration of oral paclitaxel and encequidar (novel P-glycoprotein pump inhibitor allowing oral paclitaxel bioavailability) compared with clinic/office administration of intravenous (IV) paclitaxel (175 mg/m2) and protein-bound paclitaxel in US patients with metastatic breast cancer. Economic analysis. A cost calculator was constructed from a payer's perspective including all costs related to administration of the chemotherapies, including drug administration, premedications and concomitant medications, oncologist office visits, laboratory testing, and administration-related adverse events. Total administration cost per patient per month (PPPM) and 6-month costs per patient were estimated for oral paclitaxel and encequidar, 175 mg/m2 IV paclitaxel, and protein-bound paclitaxel. Three scenarios for oral paclitaxel and encequidar, a weekly IV paclitaxel scenario (80-100 mg/m2), and univariate sensitivity analyses were conducted. Home administration of oral paclitaxel and encequidar was associated with a total administration cost of $523 PPPM, 64.4% lower than once-every-3-weeks IV paclitaxel (175 mg/m2; $1469 PPPM) and 63.8% lower than protein-bound paclitaxel (260 mg/m2; $1445 PPPM). Difference in costs was driven largely by higher administration and premedication costs associated with IV therapies. Scenario analyses showed that increased clinical experience with home administration of oral paclitaxel and encequidar was associated with reduction in cost of care associated with its administration over time. For the weekly IV (80-100 mg/m2) paclitaxel scenario, the total administration cost was $2510 PPPM (4.8 times higher than for oral paclitaxel and encequidar). Univariate sensitivity analysis demonstrated that the model findings were robust. Home administration of oral paclitaxel and encequidar was associated with lower administration costs compared with once-every-3-weeks IV paclitaxel (175 mg/m2) and protein-bound paclitaxel, resulting in potential cost savings for payers.

Use of antiemetic prophylaxis and oral breakthrough medication for highly emetogenic chemotherapy (HEC) in a large community oncology network.

253 Background: Prophylaxis for highly emetogenic chemotherapy (HEC) is well established in clinical guidelines, but real-world treatment patterns are unclear. Today, consistent use of prophylaxis is more easily accomplished due to the incorporation of ordering premeds into the workflow prior to administration of intravenous chemotherapy. However, prescription of oral agents for treatment of breakthrough chemotherapy induced nausea and vomiting (CINV) is less consistent and standardized and has a scant evidence base. In an effort to standardize utilization, we evaluated the use of prophylaxis and oral breakthrough medications in a large national community oncology network. Methods: Data from electronic medical records at five practices comprising over 100 clinic sites was analyzed to examine the frequency of guideline-recommended triplet 5-HT3 receptor antagonist, NK-1 receptor antagonist, and corticosteroid use for prophylaxis prior to the administration of HEC agents. Oral breakthrough medication use and preference was also analyzed. Data was collected and analyzed at the practice level. Results: We identified 2645 patients that received HEC between 1/1/2019 and 5/8/2020. We found consistently high utilization of guideline-concordant triplet prophylaxis regimens for patients receiving HEC, ranging from 90-100% at each of the five practices. In addition, most patients (mean 83%, range 67% - 94%) received a prescription for at least one oral breakthrough medication, but the agent(s) utilized varied widely across practices (Table). Ondansetron was the most commonly prescribed oral breakthrough medication (mean 68%, range 53% - 88%), while olanzapine use for either prophylaxis or breakthrough CINV across practices ranged from 1% - 4%. Conclusions: In this national community oncology network, standard recommended triplet agent prophylaxis for HEC was delivered successfully. However, opportunity exists to increase appropriate use of olanzapine and reduce variation of oral breakthrough antiemetic medications in order to optimize clinical care. [Table: see text]

The role of sterile chitosan-based dressing in reducing complications related to a peripherally inserted central catheter in patients with hematological tumors.

Intravenous chemotherapy is one of the most common treatments for hematological tumors, a major threat to human health and life. Due to its safety, comfort, and convenience, a peripherally inserted central catheter (PICC) is the preferred route of administration of intravenous chemotherapy. However, some PICC-related complications are drawing increasing attention. In this study, we investigated the use and role of sterile chitosan-based dressing in PICC-related complications in patients with hematological tumors. We retrospectively analyzed the clinical data of 205 patients with hematological tumors who had a PICC placed. The patients were divided into two groups, the observation group (sterile chitosan-based dressing, n=105) and the control group (sterile gauze dressing; n=100). The incidences of bleeding, infection, poor healing, and phlebitis, as well as the risk of bleeding, infection, and poor healing at the puncture site within a week of PICC placement, were analyzed. The overall incidences of bleeding, infection, and poor healing were, respectively, 42.9%, 6.7%, and 6.7% in the observation group and 63.0%, 22.0%, and 34% in the control group (all P<0.05). The risk of local bleeding was significantly lower in the observation group than in the control group [odds ratio (OR) 0.366; 95% confidence interval (CI): 0.211-0.634; P<0.001]. The risk of local bleeding was significantly higher in the platelets <50×109/L group than in the platelets >100×109/L group (OR 3.068; 95% CI: 1.397-6.740; P=0.005), while no significant difference was observed in the risk of bleeding between the platelets 50×109-100×109/L group and the platelets >100×109/L group (OR 0.839; 95% CI: 0.404-1.742; P=0.638). The risk of infection (OR 0.214; 95% CI: 0.088-0.522; P<0.001) and the risk of poor healing (OR 0.139; 95% CI: 0.058-0.331; P<0.001) were significantly lower in the observation group than in the control group. For patients with hematological tumors, sterile chitosan-based dressing after PICC placement reduces the risk of bleeding and infection and promotes healing at the puncture site.

Prevalence of Hematotoxic Effect of Intravenous Chemotherapy among Retinoblastoma Population in Tertiary Hospital in Bandung, Indonesia

Objective: To observe the prevalence of hematotoxic effect in retinoblastoma patients who were given intravenous chemotherapy with vincristine, etoposide, and carboplatin (VEC) regimen. Retinoblastoma is the second most common cancer in children in Indonesia. Standard chemotherapy agents used in retinoblastoma treatment is VEC given in 7 cycles intravenously. The most common side effect of VEC regimen is hematotoxic effect which might lead to chemotherapy failure. Methods: This study used descriptive method with cross sectional study design. Data were collected from medical records of retinoblastoma patients in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from 2014 until 2016 using total sampling technique. Results: Forty-six patients were included in this study. Of those subjects, 36 (78.3%) patients experienced hematotoxic effect. The most common hematotoxic effect occurred were anemia and neutropenia, that occurred in 32 (69.6%) and 18 (39.1%) patients, respectively. The most common hematotoxic effect severity occurred were grade 1 anemia, grade 1 leukopenia, grade 1 neutropenia, and grade 3 thrombocytopenia. Percentage of patients experienced anemia tended to increase until the 7th cycle. Seven (15.2%) patients had anemia prior to chemotherapy administration. Conclusion: The majority (78.3%) of the patients experienced hematotoxic effect on intravenous chemotherapy administration with VEC regimen. Anemia was the most common hematotoxic effect occurred. Keywords: Hematotoxic effect, intravenous chemotherapy, retinoblastoma

Correlates to extravasation among patient receiving chemotherapy at a university hospital

Aim The aim of this study was to examine correlates associated with the occurrence of extravasations among patients receiving chemotherapy at a university hospital. Background Extravasation injuries are a medical emergency that have the potential to cause serious disability, diminish the patient’s quality of life, and leave nurses vulnerable to the risk of malpractice claims. Methods The study was conducted at a university Hospital in Cairo, Egypt. A convenience sample consisting of 300 adult male and female patients as well as all nurses working at the outpatient chemotherapy clinic (10 nurses) constituted the study sample. The following tools were used: (a) Patient Risk Factors Assessment Checklist for Extravasations, (b) Intravenous Administration of Chemotherapy via A peripheral Vein Checklist, and (c) Extravasations Recording Checklist. Results Only 11.4% of the participants had developed signs and/or symptoms of extravasations. The highest incidence rates of extravasations were among patients with age range between 18 and less than 30 years, among female patients, and among those who cannot read and write (17.24, 16.23, and 17.24%, respectively). Similarly, it was highest among those with uterine cancer, those with breast cancer, those with BMI less than 18.5, those having diabetes, those having hypertension, and those receiving nonirritant chemotherapy namely carboplatin (16, 15.3, 12.6, 12.2, 19.56, 14.29%. Conclusion Correlates to extravasations could be categorized as patients, chemotherapy, and environmental and nurses performance-related factors. Conducting periodic in-service training program for nurses and developing a standardized protocol of care in chemotherapy intravenous administration were strongly recommended.

Using Healthcare Failure Mode and Effect Analysis to Reduce Intravenous Chemotherapy Errors in Chinese Hospitalized Patients.

Intravenous chemotherapy administration is a high-risk process; attention must be paid to preventing errors that might occur during the administration of chemotherapy. The aim of this study is to investigate whether the healthcare failure mode and effect analysis (HFMEA) is a valid proactive method to apply to chemotherapy administration in the Chinese oncology inpatient setting. A multidisciplinary team created a flow diagram of the chemotherapy administration process and potential failure modes were identified and evaluated using a hazard-scoring matrix. Using a decision tree, failure mode recommendations were made. Chemotherapy error rates before and after the HFMEA were compared. A total of 5 failure modes were identified with high hazard scores, and 15 recommendations were made. After the intervention, the chemotherapy error rate decreased significantly from 2.05% to 0.17%. The complexity of intravenous chemotherapy makes it vulnerable to error, and with serious consequences. Multiple errors can occur during ordering, preparing, compounding, dispensing, and administering the chemotherapy. The process of HFMEA helped reduce the chemotherapy error rate in Chinese hospitalized patients. Clinicians in oncology can take effective measures to avoid chemotherapy errors using the HFMEA.

Nanoparticle drug-delivery systems for peritoneal cancers: a case study of the design, characterization and development of the expansile nanoparticle.

Nanoparticle (NP)-based drug-delivery systems are frequently employed to improve the intravenous administration of chemotherapy; however, few reports explore their application as an intraperitoneal therapy. We developed a pH-responsive expansile nanoparticle (eNP) specifically designed to leverage the intraperitoneal route of administration to treat intraperitoneal malignancies, such as mesothelioma, ovarian, and pancreatic carcinomatoses. This review describes the design, evaluation, and evolution of the eNP technology and, specifically, a Materials-Based Targeting paradigm that is unique among the many active- and passive-targeting strategies currently employed by NP-delivery systems. pH-responsive eNP swelling is responsible for the extended residence at the target tumor site as well as the subsequent improvement in tumoral drug delivery and efficacy observed with paclitaxel-loaded eNPs (PTX-eNPs) compared to the standard clinical formulation of paclitaxel, Taxol®. Superior PTX-eNP efficacy is demonstrated in two different orthotopic models of peritoneal cancer-mesothelioma and ovarian cancer; in a third model-of pancreatic cancer-PTX-eNPs demonstrated comparable efficacy to Taxol with reduced toxicity. Furthermore, the unique structural and responsive characteristics of eNPs enable them to be used in three additional treatment paradigms, including: treatment of lymphatic metastases in breast cancer; use as a highly fluorescent probe to visually guide the resection of peritoneal implants; and, in a two-step delivery paradigm for concentrating separately administered NP and drug at a target site. This case study serves as an important example of using the targeted disease-state's pathophysiology to inform the NP design as well as the method of use of the delivery system. WIREs Nanomed Nanobiotechnol 2017, 9:e1451. doi: 10.1002/wnan.1451 For further resources related to this article, please visit the WIREs website.

Early tumor response to intraarterial or intravenous administration of carboplatin to treat naturally occurring lower urinary tract carcinoma in dogs.

BackgroundSurvival times and tumor responses associated with malignant neoplasia of the lower urinary tract are poor despite the vast array of current treatments. Therefore, the evaluation of alternative treatments, such as intraarterial administration of chemotherapy (IAC) should be considered.ObjectiveTo describe a technique for superselective catheterization for IAC and to evaluate initial tumor response by ultrasonography after both IAC and intravenous administration of chemotherapy (IVC).AnimalsClient‐owned dogs with lower urinary tract neoplasia treated with either IVC (n = 15) or IAC (n = 11).MethodsRetrospective study. An arterial approach via the carotid or femoral artery was utilized to obtain superselective access and administer chemotherapy in the IAC cases. Medical record review was performed, data were recorded, and recorded variables were evaluated statistically.ResultsIntraarterial chemotherapy was successfully administered in all cases. There was a significantly greater decrease in longest unidimensional measurement in the IAC group as compared to the IVC group (P = .013). The IAC group was also significantly more likely to have a tumor response as assessed by modified RECIST guidelines (P = .049). Dogs in the IAC group were significantly less likely to develop anemia (P = .001), lethargy (P = .010) and anorexia (P = .024).Conclusion and Clinical ImportanceThis study demonstrated the feasibility and efficacy of performing IAC for lower urinary tract neoplasia. Further investigation is necessary as the follow‐up time was short and the impact on long‐term outcome and survival was not determined.

Abstract A41: Harnessing neural stem cell tumor tropism for targeted nanoparticle delivery: Potential for ovarian cancer therapy

Abstract Intraperitoneal as compared to intravenous administration of chemotherapy has shown improved survival rates for stage III ovarian cancer. While this demonstrates that concentrating chemotherapy at the tumors has therapeutic benefit, intraperitoneal therapy was also accompanied by significantly increased toxic side effects. There is thus an urgent need for a targeted delivery system that could localize therapy at the tumors and decrease the side-effects. Here we show that stem cell/nanoparticle hybrids may be used for such targeted therapy. In pre-clinical brain and other invasive and metastatic tumor models, neural stem cells have been shown to overcome a variety of biological barriers and migrate selectively to invasive tumor foci, even penetrating hypoxic tumor regions. Here we present data confirming that neural stem cells also migrate selectively to ovarian cancer. Moreover, the neural stem cells can engineered to transport to the tumors nanoparticles that either contain chemotherapy drugs or can be induced to heat. The combination of neural stem cells and nanoparticles that can either be used for thermal ablation or slowly release chemotherapy drugs offers the potential to realize a modular and general drug targeting system for the treatment of stage III ovarian cancer. Citation Format: Rachael Mooney, Megan Gilchrist, Yiming Weng, Alexander Annala, Sukhada Bhojane, Elizabeth Garcia, Luella Roma, Kenna Schnarr, Thanh Dellinger, Ernest Han, Aboody S. Karen, Jacob M. Berlin. Harnessing neural stem cell tumor tropism for targeted nanoparticle delivery: Potential for ovarian cancer therapy. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: From Concept to Clinic; Sep 18-21, 2013; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2013;19(19 Suppl):Abstract nr A41.

Pancreaticoduodenectomy for Advanced Gastric Carcinoma Patients

Objective : The prognosis for patients with gastric carcinoma that has invaded adjacent organs, especially the pancreas, is very poor. We evaluated the survival of patients following pancreaticoduodenectomy (PD) and the survival benefit of intravenous chemotherapy in these patients.Methods : We reviewed the hospital records of 16 gastric carcinoma patients who underwent PD during the period from 2001 to 2005.Results : Half of the patients undergoing PD had Borrmann type III gastric carcinoma (8/16; 50%). Using Cox’s proportional hazards regression model, only one factor was identified as an independent, statistically significant prognosticate«-: intravenous chemotherapy (risk ratio, 0.054; 95% confidence interval, 0.01–0.45; p < 0.01). The 5-year survival rate was higher for patients who had intravenous chemotherapy than for patients who did not (22.2% vs. 0%; p < 0.01).Conclusion : The results highlight the improved survivorship of gastric carcinoma patients with PD who received intravenous chemotherapy compared with those who did not. We recommend resection in these patients and the administration of intravenous chemotherapy to improve their survival.

Cost comparison of second-line treatment options for late stage non-small-cell lung cancer: cost analysis for Italy

Background:Lung cancer is the leading cause of cancer deaths worldwide (1.38 million cancer deaths, 18.2% of the total) and of cancer morbidity (1.61 million new cases, 12.7% of all new cancers). Currently only three second-line non-small-cell lung cancer (NSCLC) pharmacotherapies are licensed in the European Union: the chemotherapies pemetrexed and docetaxel and the epidermal growth factor receptor tyrosine kinase inhibitor erlotinib. These therapy alternatives have shown a comparable efficacy (survival benefit). In the past, cost comparisons showed that erlotinib was less costly compared to docetaxel, which in turn is cheaper than pemetrexed. Nowadays erlotinib (and docetaxel) are still less expensive than pemetrexed; but docetaxel lost patent protection (basic compound patent) at the end of 2010, so docetaxel drug costs have decreased rapidly and the question remains whether erlotinib is still the least costly therapy alternative in second-line NSCLC.Material and methods:Italy was selected for base case analysis to compare the total therapy costs, estimated by combining country-specific drug costs, administration costs, and adverse event costs of erlotinib and generic docetaxel in second-line NSCLC therapy. Sensitivity analyses on central input parameters have been performed.Results:The total costs of treating one patient with erlotinib therapy of €5121 are lower than the docetaxel costs of €6699 for the Italian health care setting. Although the drug costs of erlotinib are higher than generic docetaxel (incremental €3770): the costs of intravenous chemotherapy administration (incremental −€4510), and the costs of adverse event therapy (incremental −€837) lead to higher total therapy costs for docetaxel compared to the epidermal growth factor receptor tyrosine kinase inhibitor therapy erlotinib.Conclusion:The cost comparison findings for Italy show that erlotinib is still the less costly therapy alternative in second-line NSCLC. These results were robust to changes of central input parameters and robust to further potential price decreases for docetaxel.

Key components of intravenous chemotherapy labeling: A systematic review and practice guideline

To determine the necessary components and formatting of an intravenous chemotherapy label to maximize safe delivery and minimize errors. Date sources. The MEDLINE and EMBASE databases (up to April 2009) were searched for relevant evidence. Reference lists from retained studies were then searched for additional trials. An environmental scan was also conducted to locate other published and unpublished sources of information. Study selection. Relevant articles were selected and reviewed by one methodologist. Articles were selected for inclusion if they were published English language reports of Phases II or III randomized controlled trials, other comparative studies, single-arm studies, practice guidelines, or systematic reviews with or without meta-analyses, which related to the study question. MEDLINE and EMBASE searches yielded 685 potential studies of which 17 met the inclusion criteria. The environmental scan located one guideline. Three additional relevant studies were identified during the external review process. In total, 21 documents met the inclusion criteria. Data extraction. Data were extracted by one methodologist. Quality of systematic reviews was assessed using the AMSTAR tool. All other studies were evaluated based on study characteristics applicable to the particular study design. Data synthesis. The evidence collected and the consensus of expert opinion of Cancer Care Ontario's Chemotherapy Labeling Panel form the basis of a series of recommendations for the generation of intravenous chemotherapy labels including formatting, required information, and order of information. These guidelines inform the efficient, effective, and safe administration of intravenous chemotherapy. Illustrative examples are provided.