Liposomal doxorubicin-associated acute hypersensitivity despite appropriate preventive measures

10.1177/1078155207080117Journal of Oncology Pharmacy Practice132105-107JOPP

Cutaneous reaction associated with weekly docetaxel administration

10.1177/1078155208096111Journal of Oncology Pharmacy Practice15129-34JOPP

Application of unsupervised learning in clinical oncology practice - exploring anxiety characteristics in chemotherapy-induced nausea and vomiting through principal variables

State anxiety is a risk factor for chemotherapy-induced nausea and vomiting (CINV). However, anxiety is a subjective symptom and is difficult to quantify in clinical practice. Clinicians need appropriate anxiety measures to assess patients’ risks of CINV. We illustrate how unsupervised learning techniques can be applied in oncology practice to explore anxiety characteristics that can be used for the clinical surveillance of cancer patients with CINV. A single-centre, prospective, observational study was done on 49 head-and-neck cancer patients on cisplatin-based chemotherapy and appropriate antiemetic therapy. CINV events and antiemetic use were recorded using a standardized diary, while patients’ anxiety characteristics were evaluated using the Beck Anxiety Inventory. Principal component analysis (PCA) was used as an exploratory technique for statistical analysis. Three anxiety characteristics (indigestion, faintness, numbness) were identified as potential clinical predictors of CINV through the use of principal variables. The potential of PCA as a technique for characterizing anxiety in patients with CINV is indeed appealing. Despite the need to address several key issues before PCA finds widespread applications in cancer supportive care, we hope this study shows the usefulness of PCA as a potential technique in analyzing clinical populations, so as to ultimately improve patients’ quality of life

Impact of adherence to antiemetic regimens on outcome of nausea and vomiting control among asian breast cancer patients receiving anthracycline-based chemotherapy

Background: Non-adherence to oral anticancer agents has been identified as a prevalent behavior amongst breast cancer patients. However, the prevalence of non adherence to outpatient antiemetic regimens that are prescribed for delayed emesis prevention in breast cancer patients is limited in the literature. Hence, this study was conducted to evaluate the impact of adherence to delayed antiemetic regimens on chemotherapy induced nausea and vomiting (CINV) control in breast cancer patients, and to identify patient characteristics that may be associated with non-adherence to antiemetic regimens. Methods: This was a prospective, observational study conducted at the largest ambulatory cancer center in Singapore from December 2006 to January 2011. All breast cancer patients receiving anthracycline-based chemotherapy and standardized outpatient antiemetic regimens were recruited. On the day of chemotherapy, patients were given a standardized 5-day diary to document their emesis events and their demographics obtained via interview. Pearson Chi-square test and multiple logistic regression were performed to analyze the impact of adherence on CINV control. Results: A total of 361 eligible patients were included in the final analysis (mean = 50.0±8.9 years). Majority of the patients were Chinese (80.1%) and diagnosed with Stage 2 and above breast cancer (88.1%). Almost half of the patients (42.1%) were non-adherent to their prescribed delayed antiemetics regimens, with dexamethasone usage being the least adhered to (non adherence: 37.4%). After adjusting for potential confounders (ethnicity, education level and stage of disease), patients who were adherent to antiemetics were more likely to achieve complete CINV control (defined as no emetic episodes, no nausea, and no rescue therapy required) than patients who were non adherent (NNT=9.6; Adjusted OR=1.74, 95% CI: 1.01 3.01). In addition, young women aged between 21−40 years old, pursued higher education, and diagnosed with Stage 1 breast cancer were associated with non adherence to antiemetics (p < 0.05). Conclusion: This is the largest study to date to evaluate the prevalence of non-adherence to delayed antiemetics among breast cancer patients. Our findings indicate that a substantial amount of Asian breast cancer patients (42.1%) were not adherent to their antiemetic regimens, which may have resulted into poor control of CINV

Evolving roles of oncology pharmacists in Singapore: A survey on prescribing patterns of antiemetics for chemotherapy induced nausea and vomiting (CINV) at a cancer centre

10.1177/1078155207084009Journal of Oncology Pharmacy Practice14123-29JOPP

Feasibility and acceptance of a pharmacist-run tele-oncology service for chemotherapy-induced nausea and vomiting in ambulatory cancer patients

Background: The use of telemedicine for cancer patients is limited, particularly in Asia. These patients need to be monitored because more are being treated as outpatients, so that any treatment-related side effects can be managed. We assessed the feasibility and acceptance of a pharmacist-run tele-oncology service to monitor chemotherapy-induced nausea and vomiting (CINV) in ambulatory cancer patients. Patients and Methods: A single-center, prospective study was conducted at a local cancer center. Patients' CINV symptoms were monitored through short message service (SMS) for 5 days post-chemotherapy. Feasibility was measured by patients' adherence to the service, patient satisfaction, and number of pharmacist interventions. Acceptance was measured by the accrual rate. Results: The accrual rate was 37.6% (68/181 patients). Sixty patients (median age, 49.5 years) completed the study. Overall adherence was 73.3%. The majority (90.0%) were comfortable with the duration of SMS monitoring, especially adherent patients (95.5% versus 75.0%, p=0.038). Over half (61.7%) found the SMS advice useful. Twenty-two intervention calls were made by pharmacists for uncontrolled CINV. Conclusions: A pharmacist-run tele-oncology service for real-time monitoring of CINV is feasible in ambulatory cancer patients. Incorporating the monitoring of other side effects will enhance its value and acceptance by patients for post-chemotherapy symptom management

A Pilot Study to Evaluate the Role of Therapeutic Drug Monitoring of Pegfilgrastim in Lymphoma Patients Receiving Chemotherapy

Background: Despite primary prophylaxis of febrile neutropenia (FN) with pegfilgrastim, studies have demonstrated a significant number of breakthrough FN events among Asian lymphoma patients receiving chemotherapy. This study was designed to investigate the association of pegfilgrastim concentrations during the lowest point of absolute neutrophil count (ANC nadir) after chemotherapy administration and the occurrence of breakthrough FN, to evaluate whether Therapeutic drug monitoring of pegfilgrastim can guide management of FN. Methods: This was a single-centre, prospective cohort study of Asian lymphoma patients who received prophylactic pegfilgrastim after completion of their chemotherapy. Pegfilgrastim serum concentrations were measured from blood samples taken during ANC nadir and at development of breakthrough FN using an enzyme-linked immunosorbent assay. Descriptive statistics, t-tests and correlation curves were used in the statistical analyses. Results: Nineteen patients were recruited from May to August 2012 and received 21 cycles of pegfilgrastim. Three (15.8%) developed breakthrough FN. The median pegfilgrastim concentration among patients who developed breakthrough FN was 0.257 (0.231–0.631) ng/ml, compared to 0.299 (0.001–0.829) ng/ml in patients who did not (p=0.740). Baseline ANC levels were significantly lower in patients with breakthrough FN (3.59 × 10 9 /L, range 2.71–3.87) versus those who did not (5.36 × 10 9 /L, range 2.80–16.48; p=0.014). Conclusion: There was no difference in pegfilgrastim levels during ANC nadir between patients who developed breakthrough FN and those who did not, but the study was underpowered. Therapeutic drug monitoring of pegfilgrastim cannot be recommended at this time

Impact of colony-stimulating factors to reduce febrile neutropenic events in breast cancer patients receiving docetaxel plus cyclophosphamide chemotherapy

10.1007/s00520-010-0843-8Supportive Care in Cancer194497-504SCCA