Nurse-lead clinics for capecitabine: A prospective audit evaluating changes in toxicity profile and efficacy.

Abstract

564 Background: Oral chemotherapy offers patients equal efficacy but fewer visits to hospital and less time spent traveling, but there are concerns about toxicity and compliance. Nursing and physician interactions with patients are different, and when a nurse-lead oral chemotherapy service was developed in NE Scotland in 2003 a prospective audit was begun to monitor safety and efficacy. Methods: Patients with colorectal cancer who declined or were not eligible for appropriate clinical trials had their course of adjuvant or palliative capecitabine chemotherapy prospectively monitored through a nurse-lead clinic. At every clinic visit data was collected on patient demographics, blood and imaging results, and adverse events (AEs). Any decision to change dose was made by the colorectal oncology medical staff. Results: From September 2003 to November 2006 there were 177 patients prospectively monitored through the nurse-lead clinics. Palliative patients (n = 100), median age 69 (range 43-89) and majority PS 0 or 1. Initial dose reduction in 30% due to low GFR and 13% due to being >75 years old. Overall 77% of patients completed on the starting dose. AE's, shown in table, and efficacy compared with capecitabine registration data (younger age group). Median overall survival 47.7 weeks (cf 56.6 weeks). Adjuvant patients (n = 77), median age 64 (range 40-88) and all PS 0 or 1. Initial dose reduction in 19% due to low GFR and 2% due to being >75 years old. Overall 58% completed on the starting dose (= X-ACT study). AEs, other than 5% G3/4 lethargy, and efficacy similar when compared with X-ACT data, including 3 year DFS of 64% (cf X-ACT 64%). Conclusions: Using nurses to assess patients receiving capecitabine does not seem to significantly alter efficacy but does alter the AE profile compared with the registration data, particularly in the palliative patients. Differences in the nurse-patient relationship with nurses seen as less busy, more approachable and not taking treatment decisions can improve the quality of care in patients receiving capecitabine chemotherapy. [Table: see text] [Table: see text]

Interventions to Improve Oral Chemotherapy Safety and Quality

“…Within the 7984 peer reviewed citations, 24 abstracts without a corresponding article met inclusion criteria . An additional 7 abstracts were identified through a manual search of the gray literature.…”