Oral Chemotherapy Treatment Research Articles

Pharmacogenomics: An Update Review

Pharmacogenomics studies how genetics affects how drugs affect the human body. The terms genomics and pharmacology are the sources of the field's name, which represents the intersection of genetics and medicine. The discovery of the laws of heredity in 1866 marked the beginning of the area of pharmacogenetics (PGx). The FDA has established PGx testing recommendations, so whenever these 250+ drugs are being reviewed, testing should be considered. Physicians in the fields of pain management, mental health, and cardiovascular health are among those who provide PGx recommendations. Antidepressant medications offer several therapeutic options that are similar, which makes them a prime candidate for the use of PGx. It makes sense that pharmaceutical companies are hesitant to use pharmacogenomics in clinical investigations given its relative youth. Clinical trials and pharmacogenomic testing together have many advantages. Finding populations with risk factors unrelated to the medication itself may also be facilitated by pharmacogenetics. Oral anticoagulants and chemotherapy treatment regimens are now recommended based on a patient's pharmacogenetic condition. When it comes to patient dosing, pharmacogenetic techniques are gradually replacing the traditional method of depending solely on trial and error. The present therapeutic application of pharmacogenetics can also be applied to drug research and development.

Profile of Caregivers Caring for Patients with Cancer Undergoing Oral Chemotherapy

Chemotherapy is a type of cancer treatment that uses drugs to destroy cancer cells. Oral chemotherapy is used by cancer patients at home; this requires the role of the family as caregivers in their treatment; this is important considering the complexity of oral chemotherapy drugs with protocols and drug effects. This research contributed to obtaining a profile picture of caregivers of cancer patients. The method used in this research is descriptive quantitative. This research was conducted at a hospital in Yogyakarta. The number of samples in qualitative research was 49. The results of this study were that most caregivers were aged 45-54 years (32.65%), and the majority were female (65.31%). The majority of caregivers are also married (56.10%). Most caregivers hold bachelor's degrees (34.69%), and most caregivers have a husband and wife-relationship with the patients they care for (38.78%). In general, caregivers have many years of experience in treating cancer patients, namely one year or less (38.78%). The most common type of cancer among patients receiving treatment is breast cancer (49.94%). Conclusion: This profile data can be used as a basis for further research regarding patient care at home by the family as caregivers, especially in patients receiving oral chemotherapy treatment.

Advanced practice nurse management in multiple myeloma treated with oral therapy

Therapeutic approaches in Multiple Myeloma (MM) have considerably changed over the last few years, with effective oral chemotherapy and continuous treatment. In this context, the objective of this study was to examine the circuitry of an advanced practitioner nurse (APN)-led intervention that provided supportive care for MM patients treated with oral chemotherapy. This population-based study was conducted at the hematology department-Institut de Cancérologie Lucien Neuwirth (ICLN, Saint-Priest-en-Jarez), from April 2017 to September 2020. A follow-up program was established with a specialized APN in oncology. All APN interventions were recorded, representing 1240 phone calls and 162consultations for 42MM patients. Eighty-two calls were referred to the physician with 45consultations triggered. Most of the calls were frequent within the few first months, with a high request for information and reassurance, especially for treatment-naive or relapsed patients. In our study, the APN was able to manage multiple side effects through care organization (i.e., hospitalizations, transfusions) and a careful coordination between the primary care team and the hospital. In order to respond to the high need for care pathway and safety improvement, especially in elderly population, we have initiated an original follow-up by an APN for MM patients treated with oral chemotherapy. While the role of APN has become prominent in the oncology field in recent years, its holistic approach has to be emphasized in further studies to bring a comprehensive perspective to health care coordination in the future.

Provider responses to the expansion of public subsidies in healthcare: The case of oral chemotherapy treatment in Australia

We examine provider responses to the expansion of public subsidies in 2015 for innovative oral chemotherapy treatment, in a health system where providers were free to determine their own prices. The new treatment was known to have similar efficacy to its traditional intravenous alternative and was preferred by patients for its at-home administration. However, from a policymaker's perspective, the potential for misalignment between patient and provider preferences was significant given the shift to full reimbursement for the oral chemotherapy medication but no change in fee-for-service payments for associated chemotherapy services. Under this scenario, a shift away from traditional intravenous chemotherapy may entail reduced activity and revenues associated with infusions for providers, and we hypothesise that it may result in unintended policy consequences such as reduced take-up of the new therapy or higher prices. We implement a difference-in-difference model using national administrative data on services provided, and chemotherapy medications prescribed, by providers to 1850 patients in New South Wales, Australia. Our estimates indicate that the subsidies expanded access to oral chemotherapy for newly eligible patients by 15 percentage points. However, prices charged by providers for an episode of care rose by 23 percent, driven mostly by increases in service volumes. The results illustrate the importance of understanding differential provider responses to policy changes in financial incentives.

Elaboration of an educational flyer for patients on oral antineoplastic treatment in a highly complex oncology center

The incidence of cancer is growing in Brazil at a pace that accompanies the aging population due to increased life expectancy. Given the increase in supply and adherence to treatment using oral chemotherapy, we found the need for a nursing action extended to the home, proposing an orientation model for oncology patients about oral chemotherapy treatment, through a printed informative folder. Exploratory research, action research type, carried out from the identification of the needs of patients on oral antineoplastic treatment of a High Complexity Oncology Center of a teaching hospital, reference in oncology. Elaborated from a review of literature published in printed book format and through the MEDLINE, LILACS, SIELO databases, publications of the National Cancer Institute (INCA), in the period between 2015 and 2020. Our main contribution is to favor the understanding and adherence to oral home chemotherapy treatment, synthesize the main guidelines given in medical and/or nursing consultation in printed material - folder, so that he can consult it whenever he feels the need.

Oral Chemotherapy Laboratory Monitoring and Follow-Up: A Review of the Literature.

There are many inefficiencies related to oral chemotherapy (OC) laboratory monitoring and follow-up in the ambulatory clinic setting. Patients with cancer prescribed OC have a higher risk of adverse events when there is inconsistent laboratory test result reporting and follow-up from their oncology provider. The aim of this article is to improve OC laboratory monitoring by identifying potential barriers and opportunities for reliable communication between patients and providers in the outpatient clinical setting. A literature review found 76 articles, of which 15 were selected for review. Six themes were synthesized and discussed. Healthcare systems use technology, standard pathways, and clear patient-provider communication following laboratory testing to ensure patient safety. Implementing and testing evidence-based solutions and structured frameworks to identify gaps in outpatient laboratory monitoring and follow-up can improve patient satisfaction and safety during OC treatment.

Effect of chemotherapy and radiation therapy on the swallowing of patients with head and neck cancer.

Objective: To determine the effect of Chemotherapy and Radiation Therapy on the swallowing of Patients with Head and Neck Cancer. Study Design: Cross Sectional study. Setting: Jinnah Hospital Lahore. Period: August 2020 to April 2021. Material & Methods: It was performed on forty-nine adults of age range 19-58 years in having head and neck cancer and Glasgow coma scale score above 10. and purposive sampling technique was used. Patients who have received 50-70 Gy dosage and have completed at least 10 fractions of radiation therapy treatment or received 500-1000 Mg dosage and have completed at least 2 cycles of oral chemotherapy treatment were included. Sydney Swallow Questionnaire consisting of 17 questions, each with a 100mm long visual analogue scale for marking response except question 12, was filled by all participants and their responses were recorded. After 2 months of initial recordings same patients were asked to fill the same questionnaire. During therapy and post therapy results were recorded and paired sample T test was done on the data by using SPSS. Results: The results of SSQ shows 10.20% had scores depicting no swallowing difficulty. 40.82% scored 235-500 on SSQ scale showing mild symptoms of dysphagia, 30.61% show moderate swallowing impairment, 16.33% had moderately severe and 2.04% claimed severe dysphagia before the chemo and radio therapy. It represented that after chemo-radiation treatment, 4.06% had normal swallowing, 12.24% had mild issues, 24.49% had moderate, 32.65% patients claimed moderately severe dysphagia and 26.53% have severe dysphagia. Conclusion: Severity of swallowing difficulty was increased after the Chemotherapy and Radiation therapy.

Low social and family well-being is associated with greater RAGE ligand s100A8/A9 and interleukin-1 beta levels in metastatic breast cancer patients

Greater inflammatory signaling has been shown to promote breast cancer disease progression and poorer clinical outcomes. Lower social support and social well-being have been related to greater inflammatory signaling and poorer clinical outcomes in women with non-metastatic breast cancer, and this appears to be independent of depression. However, little is known about these associations in women with metastatic disease. s100A8/A9 and interleukin 1 beta (IL-1β) proteins are widely studied in breast cancer and are considered as biomarkers of cancer progression or as having a causal role in carcinogenesis and cancer progression and metastasis via inflammatory signaling. The aim of this study was to examine the associations between less social/family well-being (SWB) and S100A8/A9 and IL-1β levels in women diagnosed with metastatic breast cancer. Sixty women (Mean age 58.95 ​± ​1.49) with a diagnosis of metastatic breast cancer participated in the study. The Functional Assessment of Cancer Therapy (FACT) social and family well-being (SWB) subscale and the Hospital Anxiety Depression Scale (HADS) were administered to patients undergoing a first- or second-line endocrine or oral chemotherapy treatment and who were not experiencing brain metastasis or visceral crisis. Salivary s100A8/A9 and IL-1β levels were assessed at 5PM on two consecutive days and averaged. Multiple regression tested the independent contribution of SWB on s100 A8/A9 and IL-1b while controlling for depression. Lower levels of SWB were associated with greater S100A8/A9 (ß ​= ​−0.345, p ​= ​0.007) and IL-1β (ß ​= ​−0.286, p ​= ​0.027) levels and these associations remained significant after controlling for depression. This work provides new evidence for the role of decreased SWB and greater s100A8/A9 and IL-1b levels in patients diagnosed with metastatic breast cancer. Psychosocial interventions that promote social support and positive social interactions through interpersonal skills may help metastatic breast cancer patients to improve their SWB. This may have salutary effects on cancer-promoting processes, which could provide psychological and physical health benefits.

CN41 Advanced practice nurse management in multiple myeloma treated with lenalidomide dexamethasone: “A new challenge”?

Therapeutic approaches in Multiple Myeloma (MM) have considerably changed over the last few years, with an increase in effective oral chemotherapy and continuous treatment. In line with the 2014-2019 cancer plan and its goals of improving oral chemotherapy safety and coordination, an innovative follow-up protocol by advanced practice nurse (APN) has been implemented at the ICLN (Institut de Cancérologie de la Loire Lucien Neuwirth). While the role of APN is well defined in North America, it is still in its infancy in France and new within haematology.

Bacterial Antigens Reduced the Inhibition Effect of Capsaicin on Cal 27 Oral Cancer Cell Proliferation.

Oral cancer is a major global health problem with high incidence and low survival rates. The oral cavity contains biofilms as dental plaques that harbour both Gram-negative and Gram-positive bacterial antigens, lipopolysaccharide (LPS) and lipoteichoic acid (LTA), respectively. LPS and LTA are known to stimulate cancer cell growth, and the bioactive phytochemical capsaicin has been reported to reverse this effect. Here, we tested the efficacy of oral cancer chemotherapy treatment with capsaicin in the presence of LPS, LTA or the combination of both antigens. LPS and LTA were administered to Cal 27 oral cancer cells prior to and/or concurrently with capsaicin, and the treatment efficacy was evaluated by measuring cell proliferation and apoptotic cell death. We found that while capsaicin inhibits oral cancer cell proliferation and metabolism (MT Glo assay) and increases cell death (Trypan blue exclusion assay and Caspase 3/7 expression), its anti-cancer effect was significantly reduced on cells that are either primed or exposed to the bacterial antigens. Capsaicin treatment significantly increased oral cancer cells’ suppressor of cytokine signalling 3 gene expression. This increase was reversed in the presence of bacterial antigens during treatment. Our data establish a rationale for clinical consideration of bacterial antigens that may interfere with the treatment efficacy of oral cancer.

Empowering patient education on self-care activity among patients with colorectal cancer \u2013 a research protocol for a randomised trial

BackgroundChemotherapy-induced side effects may have a negative effect on nutrition intake, thus increasing the risk of malnutrition and consequently, other serious complications for patients with cancer. The prevalence of malnutrition is common among patients with colorectal cancer. Nurse-led empowering education may have a positive effect on self-care activity in this patient group. Therefore, our purpose is to develop an empowering educational nursing intervention and test its effect on self-care activation and knowledge level among patients with colorectal cancer during chemotherapy. Secondary outcomes are quality of life and risk of malnutrition.MethodsAn interdisciplinary expert group developed a face-to-face empowering educational intervention using teach-back method. A two-arm, single-centre, superiority trial with stratified randomisation (1:1) and pre-post measures will be used to assess the effect of the intervention compared to standard care. Patients (N = 40 + 40) will be recruited in one university hospital outpatient clinic in Finland. Eligibility criteria are adult patients diagnosed with colorectal cancer starting oral fluoropyrimidine or combination chemotherapy treatment. A registered nurse experienced in oncology will deliver the intervention 2 weeks after the first chemotherapy. Outcomes are measured before intervention (M0) and after a two-month follow-up period (M1).DiscussionThis study will assess whether nurse-led empowering education using teach-back method is effective on self-care activity among patients with colorectal cancer. If the intervention has a positive effect, it may be implemented into patient education in a corresponding context.Trial registrationClinicalTrials.gov: NCT04160650 Registered 12 November 2019 - retrospectively registered

The Effect of Educational Follow-Up with the Motivational Interview Technique on Self-Efficacy and Drug Adherence in Cancer Patients Using Oral Chemotherapy Treatment: A Randomized Controlled Trial.

This study aimed to determine the effect of educational follow-up with the motivational interview technique on drug adherence and self-efficacy in patients with cancer using at least one oral chemotherapy drug. A total of 80 patients with cancer were randomly allocated to the intervention group or the control group. Educational follow-up with the motivational interview technique was applied to the patients with phone calls during weeks 1, 3, 6, and 9. Patients in the intervention and control groups were evaluated during both the first interview and at week 12 using a questionnaire, the medication adherence self-efficacy scale (MASES), and oral chemotherapy adherence scale (OCAS). At the end of the study, the level of drug adherence and self-efficacy of patients who received educational follow-up with the motivational interview technique by phone call increased significantly (P < .001). Additionally, the level of drug self-efficacy of patients increased (P < .001). This study emphasizes treatment compliance problems of patients with cancer using oral chemotherapy. Designed with communication techniques that will be added to our counseling process, interventions can allow nurses to use their time effectively.

Cancer Patients' Perceived Value of a Smartphone App to Enhance the Safety of Home-Based Chemotherapy: Feasibility Study.

BackgroundOral anticancer therapies can be self-administered by patients outside the hospital setting, which poses challenges of adherence to a drug plan and monitoring of side effects. Modern information technology may be developed and implemented to address these pertinent issues.ObjectiveThe aim of this study was to explore how a smartphone app developed through a stepwise, iterative process can help patients using oral chemotherapy to take their drug, and to report adherence and side effects in a reliable and verifiable manner.MethodsFourteen patients starting capecitabine treatment were included in this study and used the smartphone app in addition to regular follow up of capecitabine treatment. Nine of these patients fulfilled the treatment plan and were interviewed based on a semistructured interview guide and the System Usability Scale (SUS). In addition, two focus groups were completed with 7 oncologists and 7 oncology nurses, respectively. Interview data were analyzed in accordance with the principles of systematic text condensation. Features of the app were also assessed.ResultsThe smartphone app provided the patients with a feeling of reassurance regarding correct adherence of their oral chemotherapy treatment. They used the app as a memory tool about their treatment and possible serious side effects, as well as for treatment education. Patients expressed concerns about using the app to report side effects that were not considered to be obviously serious, fearing overreporting. The health personnel expressed an overall positive attitude to integrate this new tool in their everyday work.ConclusionsPatients on oral chemotherapy treatment at home felt safe and found the app to be helpful. The app promoted learning about their treatment and made the patients more independent of the cancer clinic, reducing the need for the clinic’s limited resources for follow up of patients on oral anticancer medications.

Access to Oral Chemotherapy Treatments in the Brazilian Private Healthcare System

In the Brazilian epidemiological scenario, neoplasms represents an important cause of mortality. Its impact has repercussions...

The Asian Approach to the Management of Gastrintestinal Cancer Patients During the COVID-19 Pandemic Era

The Asian Approach to the Management of Gastrintestinal Cancer Patients During the COVID-19 Pandemic Era

Pilot study for the use of wearable devices for patients undergoing oral chemotherapy.

e14103 Background: The rapid development of digital technology holds enormous potential to transform the delivery of cancer care. Despite these digital innovations, we still face significant challenges in healthcare in using these emerging digital technologies in the clinical setting. Clinicians generally underestimate the severity and extent of chemotherapy toxicity of patients. This project seeks to conduct an exploratory field study to collect patient feedback on their experiences, and the design/functionality of the prototype of the digital health service platform designed to monitor their symptoms. Methods: Using the National Cancer Institute item library addressing the most common symptoms for chemotherapy toxicity, a digital health platform was designed by Samsung Research America (SRA) and University Hospitals. Patients age ≥ 18 years old, willingness to agree to the consent document, ability to understand use of wearable device and willingness to answer patient reported outcomes questions were included in this study. Patients who are not undergoing oral chemotherapy treatment for their cancer were excluded. Patients were given a phone that had our designed platform along with a watch. The watch had the capability of tracking blood pressure, heart rate, and pulse oximetry. Patients were set up with an electronic account that queried them on patient Reported Outcomes (PRO) regarding potential toxicity they may be experiencing. They were also able to track medication consumption and input their weight. Subjects were be asked to use the wearable device and phone for at least 28 days and no more than 90 days. At the end of the study, a phone survey was attempted. Results: Total patients enrolled: 21. 18/21 (85.7%) patients completed the 90 days of the study. Only 9 patients provided PRO with total number of side effects reported 28 times. Watch device was only utilized by 15/21 (71.4%) patients. On an average across 90 days, these patients wore the watch 430 minutes per day. At the end of the treatment, 5 patients agreed to participate in the phone survey. Three patients stated that they would do similar study in the future noting that the digital platform helped them stay on track and monitor symptoms accurately. Every patient questioned had a complaint regarding the watch functionality. Patients also found it difficult to carry a second phone in addition to their personal phone. Conclusions: Improving our digital health service platform will get us closer to achieving effective bi-lateral patient communication and ultimately improving patient care.

Evaluation of a Pharmacist Led Oral Chemotherapy Clinic: A Pilot Program in the Gastrointestinal Oncology Clinic at an Academic Medical Center.

Oral chemotherapy represents a major patient-centric advancement in therapy convenience. However, ownership of safe and correct administration of these agents requires significant patient education. To address this challenge, an in-person pharmacist-led oral chemotherapy education clinic in gastrointestinal oncology patients within an academic medical center was created and assessed. In this pilot program, a medication-specific quiz was administered to patients before and after education performed by a pharmacist to assess patient understanding of their new oral chemotherapy. A five-question satisfaction survey was also administered at the conclusion of the pharmacist clinic visit. Primary outcome was the percentage difference between pre-and post-education quiz scores. Secondary outcomes included patient satisfaction, time to treatment initiation, and number of pharmacist interventions. Frequencies and medians were used to describe categorical and continuous variables, respectively. Of the 18 patients analyzed, 50% were male and median age was 59.5 years. Approximately 28% had colon cancer, and 61% were treated with capecitabine. The median post-education scores improved from a pre-education score of 75% to 100%. Overall, seventeen of the eighteen patients responded with “strongly agree” to all satisfaction survey statements. An in-person oncology pharmacist-led oral chemotherapy education session demonstrated an improvement in patients’ understanding of their new oral chemotherapy treatment.

Exploring perceptions and experiences of oral chemotherapy in people with cancer

The increasing use of oral chemotherapy treatment for cancer offers benefits in terms of care closer to home. However, these formulations are associated with a significant number of adverse events. One source of error is patient non-adherence, resulting in treatment resistance, increased toxicity, disease progression and even death. This literature review explores how people with cancer perceive and experience adherence to oral chemotherapy. Thematic analysis identified four main themes: my own way of doing things, understanding how oral chemotherapy works, not being alone and things beyond my control. Barriers to adherence included health beliefs, medication side effects and lack of access to ongoing advice and support. The authors argue that adherence to oral chemotherapy is a complex and multifaceted phenomenon. They recommend that healthcare practitioners should provide personalised counselling at the point of prescription and review, as well as accessible support between appointments.

CN33 - Patient safety and the power of nursing presence

BackgroundThe goal of patient safety is to reduce and eliminate preventable harm resulting from processes of care including the safe delivery of medication. Patient and occupational safety challenges are increasing in cancer care with the expanded use of oral chemotherapy, immunotherapy, and other novel treatments. In the United States, the Food and Drug Administration approved 59 novel drugs in 2018 including 19 applications of new cancer drugs and biologics as well as 38 supplemental indications and four biosimilars. Many of these novel agents will be delivered in settings that may not include the presence of a cancer nurse. Presence is a fundamental concept of nursing practice that involves active listening to facilitate understanding and meaningful connection between the patient and family and other members of the healthcare team. The safe delivery of cancer treatment is a critical component of the EONS Cancer Nursing Education Framework which defines the pivotal role of the presence of the cancer nurse in educating patients and caregivers about the safe use of cancer and symptom management medications, early recognition of side effects, and appropriate self-management approaches. As cancer care moves from traditional settings of the hospital, ambulatory clinic, or oncology provider’s office, nurses will be confronted with the need to redefine nursing presence in an era of increasingly complex healthcare delivery systems. MethodsA literature search will be presented drawn from a review of PubMed, CINAHL, and EBSCO data bases using search terms related to “patient safety”, “nursing presence”, “vigilance”, and “medication safety”. ResultsNot applicable. ConclusionsThis presentation will explore current literature related to the role of presence of the cancer nurse in safeguarding patient outcomes and quality cancer care. The session will include discussion and recommendations to increase the effective use of nursing presence and intentional communication by cancer nurses in diverse settings. Legal entity responsible for the studyThe author. FundingHas not received any funding. DisclosureThe author has declared no conflicts of interest.

CN15 - Opinions and experiences of patients receiving oral chemotherapy: A qualitative study

Background: The importance of oral chemotherapy in cancer patients is increasing day by day. Oral chemotherapy drugs provide many advantages in terms of social and economic. The desired impact in oral chemotherapy treatment can be achieved with patient adherence. The aim of this study was to investigate the opininons and experiences of who are receiving oral chemotherapy. Methods: This research was designed as a qualitative study. The study is conducted on eighteen patients who were admitted to the oncology clinic of a university hospital in January 2018. The patients who agreed to participate in the study were included in the study. There is no limitation in the type of cancer disease in the practice of the study. In this study a semi structured interview form was used, this form created as a result of review of the literature. Data were collected through face-to-face individual interviews. All interviews were recorded with voice recorder with permission from the patients. The data obtained from the interviews were transcripted after each interview and evaluated with the thematic content analysis method. Results: As a result of the content analysis identified five main themes. These themes were prescribing oral chemotherapy, administering oral chemotherapy, side effects and control of oral chemotherapy, approach of health professionals, support of family and relatives. In the interviews, the majority of patients were using capecitabine as oral chemotherapy. Patients stated that health professionals for drug use may differ in their recommendations. patients stated that they had problems such as constipation, nausea / vomiting, change of taste, fatigue and mouth instability, and that information on side effect control was made by the physician at the beginning of the treatment. Conclusions: Interdisciplinary approaches are needed to increase compliance of patients with treatment, to monitor treatment side effects and to ensure safe use of medications. It is necessary for nurses to take an active role in patient education and counseling in order to determine the weaknesses and opportunities for recovery of patients during oral chemotherapy. Legal entity responsible for the study: Sevinç Kutlutürkan. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.