Effective management of adverse effects while on oral chemotherapy: implications for nursing practice

Abstract

HARROLD K. (2010) European Journal of Cancer Care19, 12–20 Effective management of adverse effects while on oral chemotherapy: implications for nursing practice The publication of guidelines by the United Kingdom National Patient Safety Agency and the National Confidential Enquiry into Patient Outcome and Death which looked into deaths within 30 days of systemic anticancer therapy and the more recent position statement from the United Kingdom Oncology Nursing Society have all highlighted the need for an improvement in the care and management of patients receiving oral chemotherapy. While it is essential that patients are aware of the rationale behind dose interruption and modification if they are to effectively deal with toxicities and complications that may arise, they also require access to a clear line of communication in order to facilitate early intervention. The value of pre treatment patient education and ongoing support for these patients has already been extensively documented and while a multidisciplinary team approach in this is vital, nurses are ideally placed to take a leading role in these two aspects of treatment management. This article aims to detail and review current best management practices for the most commonly reported toxicities associated with capecitabine, an oral chemotherapeutic agent used in the management of patients with colorectal cancer. Only if both the patient and the health care professional supporting them are aware of best management practices will the impact of toxicities be minimised and treatment outcomes optimised.

Continuing disparities in survival rates between younger and older cancer patients in Europe. Might oral chemotherapy provide one solution to the problem?

“…Yap et al. (2007) have also raised the question of ‘how low can you go?’ in relation to the use of capecitabine as a first‐line treatment for metastatic breast cancer in their retrospective audit of patients receiving twice daily capecitabine at 1000 mg/m 2 , and there is clearly a suggestion that we might be able to treat older patients on even lower, longer regimens than we do at present (Kotsori et al., 2010), thus mitigating many of the side effects reported in this issue of the Journal and elsewhere (Brearley et al., 2010; Harrold, 2010).…”

“…Treatment related toxicities and occasional treatment related deaths do occur (National Patient Safety Agency, 2008; O'Shaughnessy et al., 2001), although older patients usually commence treatment on a decreased dose and/or subsequently have their dosage reduced due to treatment related toxicities. The need for appropriate prescribing, dose modification guidelines, careful monitoring, assessment and reporting of adverse events is crucial therefore, and I am delighted to see these and other issues related to the management of oral chemotherapy addressed in the supplement accompanying this issue of the Journal (Irshad and Maisey, 2010; Harrold, 2010).…”

Considerations when choosing oral chemotherapy: identifying and responding to patient need

“…Patient education concerning the importance of individual dose adjustment in the management of adverse events is critical. Patients must be reassured that efficacy will not be impaired if toxicities necessitates dose reduction, as overdosing can lead to increased potentially serious toxicity as discussed further in the 4 th article in this supplement (Harrold 2010).…”

Introducing the United Kingdom Oncology Nursing Society's (UKONS) Position Statement on Oral Chemotherapy'

“…The second and third articles focus on patient management from a nursing perspective. In the first, Harrold (2010) reviews the evidence for nursing management of adverse effects from therapy. She also refers to the UK Colorectal Practical Guidance Group guidelines on the use of capecitabine in colorectal cancer in order to identify appropriate dosing regimens and the rationale for dose modifications.…”