Management Of Chemotherapy-related Toxicities Research Articles

1788P - Clinical utility of a systematic toxicity assessment form (STAF) in patients with breast cancer receiving adjuvant or neoadjuvant therapy

BackgroundProper evaluation and management of chemotherapy-related toxicity (CRT) is critical to cancer patients. We aimed to assess the clinical utility of STAF in patients with breast cancer receiving chemotherapy. MethodsThe STAF is a systematic form including common CRT lists and grades to help clinicians to assess CRT comprehensively as opposed to assessing CRT individually by cases. Using data from clinical data warehouse, the CRT profile was analyzed in patients with breast cancer receiving adjuvant or neoadjuvant therapy during two time periods; before (n=1874) and after (n=981) using STAF in the clinic at Asan Medical Center. The two cohorts were matched by age and chemotherapy, leaving conventional practice (A; n=333) and STAF (B; n=333) groups. The rates of unscheduled hospital utilization (outpatient department [OPD], emergency room [ER] and hospitalization) were compared between group A and B. ResultsNo significant differences were noted in baseline characteristics between the two groups, except for a higher proportion of patients living near the hospital in group A compared to group B (67.0 vs 56.2%; P=0.004). The completion rate of planned chemotherapy was 96.7% and 97.6% (P=0.704), and the rate of dose reduction was 12.3% and 10.8% (P=0.473), respectively, in group A and B. The median dose intensity was lower in group A than group B (0.92 vs. 0.95; P<0.001). Higher reporting of CRT was observed in group B (P<0.001). Despite a similar rate of unscheduled hospital utilization during cycle 1, since cycle 2, group B had a lower frequency of unexpected OPD (3.3 vs 6.6%, P=0.050) and ER visits (9.6 vs 16.8%, P=0.006), and hospitalization (8.4 vs 12.6%; P=0.077) than group A.Table1788PTableUnscheduled utilization since cycle 2 of chemotherapyGroup A (n=333, %)Group B (n=333, %)POPD22 (6.6)11 (3.3)0.050ER56 (16.8)32 (9.6)0.006Hospitalization42 (12.6)28 (8.4)0.077 ConclusionsUsing the STAF may facilitate to capture CRT in clinical practice and reduce the rates of unscheduled hospital utilization in patients with breast cancer receiving adjuvant or neoadjuvant therapy. Legal entity responsible for the studyThe authors. FundingKorean Foundation for Cancer Research. DisclosureAll authors have declared no conflicts of interest.

Usability Evaluation of a Mobile Phone-Based System for Remote Monitoring and Management of Chemotherapy-Related Side Effects in Cancer Patients: Mixed-Methods Study.

BackgroundAs most chemotherapy is administered in the outpatient setting, patients are required to manage related side effects at home without direct support from health professionals. The Advanced Symptom Management System (ASyMS) has been developed to facilitate the remote monitoring and management of chemotherapy-related toxicity in patients with cancer, using patient-reported outcomes questionnaires and a clinician alerting system.ObjectiveThis study aims to evaluate the usability of the ASyMS, a mobile phone–based technology, from the perspective of Canadian patients with cancer receiving chemotherapy to identify existing design, functionality, and usability issues and elicit their views, experiences, and satisfaction with the ASyMS.MethodsWe used a mixed-method approach to data collection with user-based testing, a think-aloud technique, semistructured interviews, and short answer questionnaires with a purposive sample of 10 patients with cancer. Participants attended usability testing sessions at the Centre for Global eHealth Innovation, University Health Network, and performed specific tasks on the ASyMS device. The test was videorecorded and each task was timed during the test. After the usability sessions, participants completed a posttest questionnaire and participated in a semistructured qualitative interview. A thematic analysis was used to code and categorize the identified issues into themes that summarized the type and frequency of occurrence.ResultsThe thematic analysis generated 3 overarching themes as follows: ASyMS user-friendliness; usefulness of ASyMS (content quality and richness); and intention to use. Results from the posttest questionnaire indicated that 80% (8/10) of participants had great motivation to use the ASyMS, 70% (7/10) had positive perceptions of the successful use of the ASyMS, and all (10/10, 100%) had a positive attitude toward using the ASyMS in the future. Most identified design and functionality issues were related to the navigation of the ASyMS device and a desire for a more attractive design with advanced functionality and features. The main general design recommendations were as follows: enhance the readability of the screen; implement advance options (eg, search option); and support better navigation.ConclusionsThe ASyMS has shown positive perceptions of patients in usability testing and qualitative interviews. An evaluation of the effects of the ASyMS on symptom outcomes in a clinical trial is needed.

The assessment and management of chemotherapy-related toxicities in patients with breast cancer, colorectal cancer, and Hodgkin's and non-Hodgkin's lymphomas: A scoping review.

The purpose of the eSMART (Electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology) study is to evaluate the use of mobile phone technology to manage chemotherapy-related toxicities (CRTs) in people with breast cancer (BC), colorectal cancer (CRC), Hodgkin's lymphoma (HL), and non-Hodgkin lymphoma (NHL)) across multiple European sites. One key objective was to review the published and grey literature on assessment and management of CRTs among patients receiving primary chemotherapy for BC, CRC, HL, and NHL to ensure that ASyMS remained evidence-based and reflected current and local practice. Three electronic databases were searched for English papers, with abstracts available from 01/01/2004-05/04/2014. For the grey literature, relevant clinical practice guidelines (CPGs)/evidence-based resources (EBRs) from the main international cancer organisations were reviewed as were symptom management (SM) protocols from the sites. After full-text screening, 27 publications were included. The majority (n=14) addressed fatigue and focused on BC patients. Relevant CPGs/EBRs were found for fatigue (n=4), nausea/vomiting (n=5), mucositis (n=4), peripheral neuropathy (n=3), diarrhoea (n=2), constipation (n=2), febrile neutropenia/infection (n=7), palmar plantar erythrodysesthesia (PPE) (n=1), and pain (n=4). SM protocols were provided by >40% of the clinical sites. A need exists for empirical research on SM for PPE, diarrhoea, and constipation. Research is needed on the efficacy of self-care strategies in patients with BC, CRC, HL, and NHL. In general, consistency exists across CPGs/EBRs and local guidelines on the assessment and management of common CRTs.

Comparative effectiveness and resource utilization of nab-paclitaxel plus gemcitabine (nab-P+G) versus FOLFIRINOX (FFX) in first-line treatment of advanced pancreatic adenocarcinoma (PDAC) in a U.S. community oncology setting.

433 Background: Both nab-P+G and FFX demonstrated superior overall survival (OS) over gemcitabine monotherapy for the treatment of PDAC; but there is no real-world effectiveness and utilization study of nab-P+G vs. FFX. The objective of this study is to compare real-world treatment patterns of patients receiving nab-P+G vs. FFX as first-line treatment for advanced PDAC. Methods: A retrospective cohort study was performed using fully de-identified data from a nationally representative electronic medical record platform of 1,300 community oncology physicians. Patients diagnosed with PDAC between September 2013 and October 2014 who received either nab-P+G or FFX as 1st line therapy were included in the analysis. We calculated median time to treatment discontinuation (TTD) and database persistence (DP), a proxy for OS, using the Kaplan Meier method, and assessed supportive care usage with Poisson regression. Results: 202 (out of 851) patients met eligibility criteria (nab-P+G, n = 122; FFX, n = 80). Patients on nab-P+G were older than patients on FFX (mean age 67.0 v 61.4; p &lt; 0.01), but other baseline characteristics were comparable. TTD (3.4 v 3.8 mos) and DP (8.6 v 8.6 mos) were not statistically different for nab-P+G and FFX, respectively. The rate of AE-related discontinuation was similar in patients on nab-P+G and FFX (18% v 21%); however patients on nab-P+G utilized less doses of granulocyte-colony stimulating factor (GCSF) agents (2.0 v 4.4; p &lt; 0.01), but needed more doses of erythropoietin-stimulating agents (ESA) (0.9 v 0.1; p &lt; 0.01) and steroids (7.9 v 5.8; p &lt; 0.01) per 100 days. Conclusions: TTD and DP for patients with advanced PDAC did not differ significantly between nab-P+G and FFX, although supportive care medications differed. Patients treated with nab-P+G required fewer doses of GCSF and more doses of ESA and steroids, though AEs leading to discontinuation was not statistically different. Management of chemotherapy related toxicities may incur substantial burden on the U.S. healthcare system, especially if an alternative therapy exists with similar clinical outcomes.

Early and Late Long-Term Effects of Adjuvant Chemotherapy

Adjuvant chemotherapy continues to play an important role in breast cancer management. Exposure to chemotherapy can lead to a variety of early and late long-term toxicities, including ovarian failure (with resultant infertility and sexual dysfunction), bone loss, weight gain, neurotoxicity, neurocognitive changes, cardiac toxicity and secondary malignancy. Although chemotherapy effects may vary in medical severity, all effects have the potential to lead to a decrease in quality of life and a decrement on overall health status. Improved understanding of the etiology and management of chemotherapy-related toxicity may allow optimization of patient selection for treatment and ameliorate the concerns of patients who are considering embarking on a chemotherapy program. This article presents an overview of relevant early and late long-term toxicities, with a focus on recent advances and clinical management.

Early and Late Long-Term Effects of Adjuvant Chemotherapy

Adjuvant chemotherapy continues to play an important role in breast cancer management. Exposure to chemotherapy can lead to a variety of early and late long-term toxicities, including ovarian failure (with resultant infertility and sexual dysfunction), bone loss, weight gain, neurotoxicity, neurocognitive changes, cardiac toxicity and secondary malignancy. Although chemotherapy effects may vary in medical severity, all effects have the potential to lead to a decrease in quality of life and a decrement on overall health status. Improved understanding of the etiology and management of chemotherapy-related toxicity may allow optimization of patient selection for treatment and ameliorate the concerns of patients who are considering embarking on a chemotherapy program. This article presents an overview of relevant early and late long-term toxicities, with a focus on recent advances and clinical management.

Evaluation of a mobile phone-based, advanced symptom management system (ASyMS©) in the management of chemotherapy-related toxicity

To evaluate the impact of a mobile phone-based, remote monitoring, advanced symptom management system (ASyMS) on the incidence, severity and distress of six chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand-foot syndrome and diarrhoea) in patients with lung, breast or colorectal cancer. A two group (intervention and control) by five time points (baseline, pre-cycle 2, pre-cycle 3, pre-cycle 4 and pre-cycle 5) randomised controlled trial. Seven clinical sites in the UK; five specialist cancer centres and two local district hospitals. One hundred and twelve people with breast, lung or colorectal cancer receiving outpatient chemotherapy. A mobile phone-based, remote monitoring, advanced symptom management system (ASyMS). Chemotherapy-related morbidity of six common chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand-foot syndrome and diarrhoea). There were significantly higher reports of fatigue in the control group compared to the intervention group (odds ratio = 2.29, 95%CI = 1.04 to 5.05, P = 0.040) and reports of hand-foot syndrome were on average lower in the control group (odds ratio control/intervention = 0.39, 95%CI = 0.17 to 0.92, P = 0.031). The study demonstrates that ASyMS can support the management of symptoms in patients with lung, breast and colorectal cancer receiving chemotherapy.

Nurse's perceptions and experiences of using of a mobile-phone-based Advanced Symptom Management System (ASyMS ©) to monitor and manage chemotherapy-related toxicity

Many people diagnosed with cancer will receive chemotherapy as a core component of their care. Recent changes in the delivery of cancer services mean that patients frequently receive care on an out-patient basis and are therefore often required to manage related side effects at home without direct support from oncology health professionals. The use of information and communications technology may be seen as a means of supporting patients receiving chemotherapy in the home care setting. This mixed methods study, reports on the perceptions of nurses (n=35) who participated in a randomised controlled trial of a mobile phone based, Advanced Symptom Management System (ASyMS), in the management of chemotherapy-related toxicity in patients with breast, lung and colorectal cancer. Nurses' perceptions of ASyMS were evaluated at the start and the end of the study. Overall, they could see the benefits of ASyMS in the remote monitoring of chemotherapy toxicity and its role in facilitating early intervention and subsequent management, demonstrating the potential utility of the system within clinical practice.

Case Studies in the Treatment of Bladder Cancer

Objectives To illustrate the multiple factors that can influence the selection of treatments for bladder cancer, and to instruct the reader in the management of chemotherapy-related toxicities. Data Sources Actual cases drawn from the author's clinical experience and scientific studies. Conclusion Patients treated for bladder cancer often experience toxicities. Some patients being treated with novel agents may achieve stable disease. Implications for Nursing Practice Oncology nurses must be aware of and able to manage treatment-related toxicities with appropriate interventions. Patients can be effectively instructed in preventing and managing side effects, such as constipation, with the nurse's guidance.