Background Capecitabine is used as a first-line treatment for gastrointestinal (GI) tract cancers. Common toxicities of capecitabine include diarrhea and hand-foot syndrome, which frequently require dose reduction, interruption, or discontinuation. While racial and ethnic differences in capecitabine toxicities have been suggested, they have not been evaluated in a diverse “real-world” setting. We examined differences in capecitabine-related toxicities in different racial and ethnic populations. Methods The electronic medical records of patients receiving first-line capecitabine-containing regimens for GI malignancies were reviewed. Patients on irinotecan-containing regimens or radiation were excluded because of overlapping toxicities. Multiple logistic regression models were used to test the association between race or ethnicity and capecitabine toxicities while adjusting for other demographic characteristics. Results One hundred twenty-five patients diagnosed with colon (N=76, 60.8%), rectal (N=22, 17.6%), gastric (N=16, 12.8%), or other GI cancers (N=11, 8.8%) were included. In logistic regression analysis, diarrhea occurrence was significantly lower in the African-American/non-Hispanic (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.08-0.75; P=0.01) compared to Caucasian non-Hispanic population. The occurrence of dose-reduction was significantly higher in the African-American/non-Hispanic population (OR 5.83, 95%CI 1.49-22.80; P=0.01) and in the Caucasian/Hispanic population (OR 4.49, 95%CI 1.09-18.42; P=0.03) compared to Caucasian non-Hispanic population. Conclusions We have identified racial and ethnic differences in the incidence of capecitabine toxicities, which may help clinicians counsel patients with GI malignancies on capecitabine. There is a need for prospective studies to confirm our findings and to understand the relationship between the incidence of toxicities and dose reductions or discontinuation.
Purpose: This study examined medication use by individuals with tinnitus who were seeking help for their tinnitus by means of a psychological intervention. Method: This study used a cross-sectional survey design and included individuals with tinnitus enrolled in an Internet-based cognitive behavioral therapy trial ( n = 439). Study participants provided demographic details, completed various structured questionnaires and provided details about the medications used. The self-reported medications were classified using the United States Pharmacopeial Medicare Model Guidelines v7.0. Results: Current medication use was reported by 67% ( n = 293) of the study participants. Those currently using medication were older; had consulted their primary care physician, had greater tinnitus severity, depression, anxiety, and insomnia when compared with those not reporting any current medication use. The top 10 medication used included cardiovascular agents ( n = 162; 55.3%), antidepressants ( n = 80; 27.3%), electrolytes/minerals/metals/vitamins ( n = 70; 23.9%), respiratory tract/pulmonary agents ( n = 62; 21.2%), anxiolytics ( n = 59; 20.1%), hormonal agents/stimulant/replacement/modifying (thyroid; n = 45; 15.4%), gastrointestinal agents ( n = 43; 14.7%), analgesics ( n = 33; 11.3%), blood glucose regulators ( n = 32; 10.9%), and anticonvulsants ( n = 26; 8.87%). Some associations between type of medication used and demographic or tinnitus-related variables were noted especially for the cardiovascular agents, electrolytes/minerals/metals/vitamins, and anxiolytics. Conclusions: This exploratory study indicated a large percentage of patients using medication and a range of medications. Further studies are required to assess the effects of such medications on the tinnitus percept and concurrent medication moderate treatment effects.
Purpose: Capecitabine is commonly used as a first-line treatment for gastrointestinal (GI) tract cancers. Common toxicities of capecitabine include diarrhea and hand-foot syndrome (HFS), which frequently lead to dose reduction, interruption, and even discontinuation. While racial and ethnic differences in capecitabine toxicities have been suggested by case reports, they have not been systematically evaluated in diverse ‘real-world’ populations. This study examined differences in capecitabine-related diarrhea, HFS, dose-reduction, and discontinuation among patients of different racial and ethnic backgrounds. Methods: In this retrospective chart review study, the electronic medical records of patients receiving first-line capecitabine-containing regimens for GI malignancies were reviewed. Patients on regimens containing irinotecan or radiation were excluded due to overlapping toxicities. Concurrent non-neoplastic medications were also recorded. Multiple logistic regression models were used to test for an association between race/ethnicity with any capecitabine toxicities while adjusting for other demographic characteristics. Results: One hundred twenty-five patients diagnosed with either colon [N=76 (60.8%)], rectal [N=22 (17.6%)], gastric [N=16 (12.8%)], or other GI cancers [N=11 (8.8%)] were included. In logistic regression analysis, diarrhea occurrence was significantly lower in the African-American/non-Hispanic [OR(95% CI): 0.25 (0.08, 0.75) p value<0.01] compared to Caucasian non-Hispanic population. There was increased risk of HFS in African-American/non-Hispanic [OR (95% CI): 2.26 (0.86, 5.95); p value=0.09], although this result did not reach statistical significance. Additionally, the occurrence of dose-reduction was significantly higher in the African- American/non-Hispanic population [OR(95% CI): 5.83(1.49, 22.80) p value<0.01] and in the Caucasian/Hispanic population [OR(95% CI): 4.49(1.09, 18.42) p value<0.05] as compared to Caucasian non-Hispanic population. Conclusion: By identifying racial and ethnic differences in the incidence and onset of capecitabine toxicities in patients with GI malignancies, our study may help clinicians risk stratify, counsel, and manage patients receiving capecitabine-containing regimens. Our study also emphasizes the need to understand the relationship between the incidence of toxicities and dose reductions or discontinuation of therapy in racial and ethnic minorities. Citation Format: Soham D. Yande, Alicia Brazelton, Rita Pope, Michael Johnson, Benjamin Musher, Meghana V. Trivedi. Racial and ethnic differences in capecitabine toxicity in colorectal cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-007.
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