Jacobs Carmel, Hutton Brian, Mazzarello Sasha, Smith Stephanie, Joy Anil, Amir Eitan, Ibrahim Mohammed F K, Gregario Nancy, Daigle Kelly, Eggert Lori, Clemons Mark
The Ottawa Hospital Cancer Center and University of Ottawa, Ottawa, ON, Canada.
Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Box 900, Ottawa, ON, K1H 8L6, Canada.
Support Care Cancer. 2015 Nov;23(11):3269-75. doi: 10.1007/s00520-015-2731-8. Epub 2015 May 3.
Despite the widespread use of steroid prophylaxis schedules for breast cancer patients receiving docetaxel chemotherapy, questions still exist regarding their optimal use. We surveyed health care providers and patients about their experiences with steroid prophylaxis.
Two questionnaires were developed and circulated. One was presented to health care providers (chemotherapy nurses, pharmacists and medical oncologists) involved in the treatment of breast cancer and the second to patients who had received docetaxel chemotherapy for early stage breast cancer.
The health care providers' questionnaire was completed by 184 of 698 invitees: 92/171 (53.8 %) chemotherapy nurses, 56/284 (19.7 %) pharmacists and 36/243 (14.8 %) medical oncologists (overall response rate 26.4 %). Two steroid schedules were found to be the most commonly used: dexamethasone 8 mg BID for 6 doses, with either 3 (79 %) or 2 (11 %) doses taken before docetaxel administration. Suboptimal adherence to steroid premedication had been experienced by 98 % (177/181) of practitioners. Despite the presence of local treatment protocols in 65 % (119/183) of practitioners' institutions, 10 different strategies were commonly used when steroid premedication was taken incorrectly. The patients' questionnaire was completed by 72/87 (82.3 %) invitees. Respondents reported correctly taking their premedication 99 % (70/71) of the time. Patients felt steroids frequently caused side effects, the most common being sleep disturbance (35/72 = 49 %) and skin toxicity (16/72 = 22 %).
Suboptimal adherence to steroid premedication prior to docetaxel administration is a common clinical challenge. There appears to be discordance between the practitioner and the patient experience. A single, universally accepted and used protocol for both pre- and post-medication and management when premedication is not taken as prescribed could improve adherence.
尽管类固醇预防方案在接受多西他赛化疗的乳腺癌患者中广泛使用，但关于其最佳使用仍存在疑问。我们就类固醇预防的使用经验对医疗服务提供者和患者进行了调查。
设计并发放了两份调查问卷。一份发给参与乳腺癌治疗的医疗服务提供者（化疗护士、药剂师和肿瘤内科医生），另一份发给接受早期乳腺癌多西他赛化疗的患者。
698名受邀者中有184人完成了医疗服务提供者问卷：92/171（53.8%）名化疗护士、56/284（19.7%）名药剂师和36/243（14.8%）名肿瘤内科医生（总体回复率26.4%）。发现两种类固醇方案使用最为普遍：地塞米松8毫克，每日两次，共6剂，其中3剂（79%）或2剂（11%）在多西他赛给药前服用。98%（177/181）的从业者曾经历过类固醇预处理依从性欠佳的情况。尽管65%（119/183）的从业者所在机构有局部治疗方案，但在类固醇预处理用药错误时，通常会采用10种不同的策略。87名受邀者中有72/87（82.3%）人完成了患者问卷。受访者报告称，他们99%（70/71）的时间都正确服用了预处理药物。患者认为类固醇经常会引起副作用，最常见的是睡眠障碍（35/72 = 49%）和皮肤毒性（16/72 = 22%）。
多西他赛给药前类固醇预处理的依从性欠佳是一项常见的临床挑战。从业者与患者的体验之间似乎存在不一致。制定一个统一的、被普遍接受和使用的用药前和用药后方案，以及在未按规定进行预处理时的管理方案，可能会提高依从性。
