Chemotherapy dose intensity reductions due to adverse drug reactions in an oncology outpatient setting

Llopis-Salvia, P.; Sarrio-Montes, Gema; Garcia-Llopis, Paula; Bargues-Ruiz, Adria

doi:10.1177/1078155209355848

Cited by 5 publications

(4 citation statements)

References 15 publications

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Section: Discussionsupporting

confidence: 90%

“…The most common treatment-related ADRs in this study were nausea and vomiting, which is consistent with Chopra et al 27 However, in the study by Llopis-Salvia et al 29 the most common ADR was leukaemia, while in the study by Sharma et al 30 the most common ADR was body pain. In the current study, gastrointestinal system-related ADRs were the most common, similar to Alagizy et al, 31 whereas blood and lymphatic system-related ADRs were the most common in a study conducted by Sureshkumar et al 32 More than two-thirds of ADRs were associated 'possibly' to suspected anti-cancer drugs in causality evaluation, mild in severity, and the majority of them were preventable, according to Sharma et al, 33 which is similar with the findings of this study.…”

Section: Reported Thatsupporting

confidence: 90%

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Implementation of pharmaceutical care service to elderly cancer patients in a tertiary care hospital in South India

Fariya

Daniel

Raj

et al. 2022

J Oncol Pharm Pract

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Purpose The goal of this study is to identify drug-related problems (DRPs) for elderly cancer patients receiving chemotherapy by implementing pharmaceutical care services. Methods In this interventional study, patients were followed after each cycle till 12 weeks. The MOATT-MASCC teaching tool was used to educate patients about their therapy. The outcome measures included the occurrences of any DRPs such as inappropriate medication dose, dosage form, route of administration, therapeutic duplication, failure of the patient to adhere to the medication regimen, adverse drug reactions (ADRs), and drug–drug interactions (DDIs) and to resolve it. Results On 186 patients, there were 38% ADRs, 16% DDIs, 6% non-adherence to therapy, 4% medical conditions for which no medication was prescribed, and 1% therapeutic duplication and transcribing error was identified. A total of 226 ADRs were documented. Nausea and vomiting were the most frequently occurring ADRs (24%) and platinum compounds caused the highest number of ADRs. Assessments of causality showed that the majority of cases are ‘probable’ (50%). In evaluating the severity of ADRs, 53% of ADRs were ‘moderate’ and 51% of ADRs were ‘probably’ preventable. Upon assessing the DDIs, 35% of the prescriptions had ‘monitor therapy’. All of the DRPs, that were identified were notified to the treating oncologists and resolved without any disagreement. Conclusions Pharmaceutical care is essential for elderly cancer patients. Oncologists and pharmacists should work together to identify and manage DRPs as well as educate patients about their disease. This will help in improved patient care and a better therapeutic outcome.

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Section: Discussionsupporting

confidence: 90%

Section: Reported Thatsupporting

confidence: 90%

Implementation of pharmaceutical care service to elderly cancer patients in a tertiary care hospital in South India

Fariya

Daniel

Raj

et al. 2022

J Oncol Pharm Pract

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“…Another study of 108 elderly patients with a variety of cancer types also identified haematological toxicity to be associated with relative dose intensity in regression analyses ( Luciani et al , 2006 ). A study of 532 patients (all ages) with a variety of tumour groups also looked at the impact of adverse drug reactions on chemotherapy completion ( Llopis-Salvia et al , 2010 ). Of the 3553 chemotherapy cycles, 12.9% were not delivered as planned because of adverse drug reactions.…”

Section: Discussionmentioning

confidence: 99%

The impact of low-grade toxicity in older people with cancer undergoing chemotherapy

et al. 2014

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Background:Significant toxicity in chemotherapy trials is usually defined as grade ⩾3. In clinical practice, however, multiple lower grade toxicities are often considered meaningful. The purpose of this observational cohort study was to identify which level of toxicity triggers treatment modification and early discontinuation of chemotherapy in older people.Methods:Patients aged 65+ were recruited in a central London hospital. A total of 108 patients were recruited at the start of new chemotherapy treatment between October 2010 and July 2012.Results:Mean age was 72.1±5 years, median 72 and range 65–86 years. Of the patients, 50.9% (55) were male with gastrointestinal (49), gynaecological (18), lung (15) and other cancers (26). Chemotherapy was palliative in 59.3% (64/108), curative/ neoadjuvant/adjuvant in the others. Mean number of cycles completed was 4.2±3. Treatment modifications due to toxicity occurred in 60 (55.6%) patients, 35% (21/60) of whom had no greater than grade 2 toxicity. Early treatment discontinuation because of toxicity occurred in 23 patients (21.3%), 39.1% (9/23) of whom had no greater than grade 2 toxicity.Conclusions:Many older patients did not complete treatment as planned. Treatment was modified/discontinued even for one or two low-grade toxicities. Further work is required to clarify whether low-grade toxicity has a greater clinical impact in older people, or whether clinicians have a lower threshold for modifying/discontinuing treatment in older people.

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“…More importantly, the real-world circumstances are often not as ideal as those in clinical trials (32). Patients may discontinue perioperative or adjuvant treatment due to various reasons, e.g., adverse events, low life quality, and financial burdens (33)(34)(35). Because of these, the reduced duration for chemotherapy and other treatments has attracted widespread attention in recent years.…”

Section: Discussionmentioning

confidence: 99%

Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

et al. 2021

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BackgroundsPerioperative chemotherapy (PEC) and neoadjuvant chemotherapy (NAC) have become a vital part of locally advanced gastric cancer (LAGC) treatment, but the optimal duration of PEC has not been studied. The aim of this study was to demonstrate the possibility of duration reduction in PEC in the adjuvant chemotherapy (AC) phase for ypN0 patients.MethodsWe included LAGC patients who achieved ypN0 after NAC in our institution from 2005 to 2018. The risk/benefit of AC and other covariates were majorly measured by overall survival (OS) and progression-free survival (PFS). We developed a survival-tree-based model to determine the optimal PEC duration for ypN0 patients in different classes.ResultsA total of 267 R0 resection patients were included. There were 55 patients who did not receive AC. The 5-year OS was 74.34% in the non-AC group and 83.64% in the AC group with a significant difference (p = 0.012). Multivariate Cox regression revealed that both AC (AC vs. non-AC: HR, 0.49; 95%CI, 0.27–0.88; p = 0.018) and ypT stages (ypT3-4 vs. ypT0-2: HR, 2.00; 95%CI, 1.11–3.59; p = 0.021) were significant protective/risk factors on patients OS and PFS. A decision tree model for OS indicated an optimal four to six cycles of PEC, which was recommended for ypT0-2N0 patients, while a minimum of five PEC cycles was recommended for ypT3-4N0 patients.ConclusionAC treatment is still necessary for ypN0. The duration reduction could be applied for the ypT0-2N0 stage patients but may not be suitable for higher ypT stages and beyond. A multicenter-based study is required.

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Chemotherapy dose intensity reductions due to adverse drug reactions in an oncology outpatient setting

Cited by 5 publications

References 15 publications

Implementation of pharmaceutical care service to elderly cancer patients in a tertiary care hospital in South India

Implementation of pharmaceutical care service to elderly cancer patients in a tertiary care hospital in South India

The impact of low-grade toxicity in older people with cancer undergoing chemotherapy

Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

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