Counselling and adverse event management for patients with myelodysplastic syndromes undergoing azacitidine therapy: A practice standard for Canadian nurses

Abstract

Azacitidine (5-azacytidine, VIDAZA ® ) is a disease-modifying agent that improves survival, reduces transfusion dependence, and reduces progression to acute myeloid leukemia in patients with higher risk myelodysplastic syndromes. Azacitidine injection is associated with characteristic adverse events (AEs) that must be managed in order for patients to stay on therapy and achieve optimal therapeutic outcomes. These AEs include injection-site reactions, cytopenias, and gastrointestinal effects. Oncology nurses are uniquely positioned to provide patient support and counselling, thereby helping patients and their families set clear expectations for azacitidine therapy. This article presents a nursing standard designed to support Canadian oncology nurses in the key areas of counselling for patients initiating and continuing azacitidine, as well as nursing strategies for prevention and management of azacitidine-associated AEs. Many of the general principles discussed in this nursing standard can be applied broadly to many diseases and treatments.

Subcutaneous Administration of Bortezomib: Strategies to Reduce Injection Site Reactions

“…agents are administered by registered nurses. Injection site reactions have been reported in clinical trials and postmarketing experiences for chemotherapeutic agents administered using the SC route (Kurtin & Demakos, 2010;Murray et al, 2012). Although injection site reactions are rarely severe, they may be associat-ed with discomfort, body image concerns due to visible skin changes, and emotional distress for the patient.…”

“…Experiences gained from the SC administration of 5-azacitidine, a hypomethylating agent used to treat myelodysplastic syndromes, have provided insight into strategies to reduce local injection site reactions in patients receiving SC chemotherapeutic agents. Use of the "air sandwich" technique has been effective in limiting the severity of injection site reactions during azacitidine administration (Kurtin & Demakos, 2010;Murray et al, 2012); see Table 2 for details. Injection site reactions are common but generally mild with SC administration of bortezomib.…”