Cebollero Julianna, LaFollette Jennifer A, Walton Suzanne M, Adams Curry Marjorie
Grady Health System, Department of Pharmacy and Medical Nutrition, Atlanta, GA.
Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.
J Oncol Pharm Pract. 2023 Jun;29(4):802-809. doi: 10.1177/10781552221079855. Epub 2022 Feb 14.
Intravenous anticancer therapy can be associated with hypersensitivity- and/or infusion-related reactions (IRRs) which may result in life-threatening symptoms. As part of a quality improvement project, oncology pharmacists developed and implemented a nurse-driven, symptom-based IRR protocol. The objective of the evaluation was to evaluate IRR treatment failure after implementation of a symptom-based protocol in an ambulatory infusion center. Secondary objectives included determining the most common anticancer agents requiring IRR treatment documentation of ED visits or hospital admissions within 72 h of treatment, documentation of mortality due to an IRR, and evaluating whether there were multiple documented IRRs to the same medication.
A total of 456 patients, who received an infusion of anticancer therapy at Grady Health System (GHS) between February 2014 and March 2018, were retrospectively evaluated. Patients were included if they received a protocol-specific medication for infusion reaction management of a parenterally administered anticancer agent. The primary outcome was the rate of treatment failure within 72 h of treatment for an IRR.
Seventy-eight patients experiencing 108 IRRs were included in the analysis. Five percent of IRRs consisted of rigors only, 57% of IRRs were mild/moderate severity, 31% of IRRs were severe/anaphylactic severity and 7% of IRRs were rigors in addition to a mild/moderate/severe reaction. Of the 108 IRRs, treatment failure within 72 h was observed in eight reactions; six were evaluated in the emergency department and two required a hospital admission. Overall, 93% of reactions resolved in the infusion center and patients were discharged home; there were no patient deaths. The most common offending agents were paclitaxel and oxaliplatin.
Following implementation of a novel pharmacist-developed, symptom-based nurse-driven protocol, infusion reaction treatment failure occurred in 7% of IRRs evaluated. Although the failure rate was low, additional nurse education and improved access to protocol-directed medications may optimize use of the protocol.
静脉内抗癌治疗可能会引发超敏反应和/或输液相关反应（IRR），这些反应可能导致危及生命的症状。作为质量改进项目的一部分，肿瘤药师制定并实施了一项由护士主导的、基于症状的IRR方案。评估的目的是评估在门诊输液中心实施基于症状的方案后IRR治疗失败的情况。次要目标包括确定在治疗后72小时内需进行IRR治疗记录、急诊就诊或住院治疗的最常见抗癌药物，记录因IRR导致的死亡率，并评估是否存在针对同一药物的多次记录的IRR。
对2014年2月至2018年3月期间在格雷迪健康系统（GHS）接受抗癌治疗输液的456例患者进行回顾性评估。如果患者接受了用于胃肠外给药抗癌药物输液反应管理的方案特定药物，则纳入研究。主要结局是IRR治疗后72小时内的治疗失败率。
分析纳入了78例发生108次IRR的患者。5%的IRR仅表现为寒战，57%的IRR为轻度/中度严重程度，31%的IRR为重度/过敏严重程度，7%的IRR除轻度/中度/重度反应外还伴有寒战。在108次IRR中，有8次反应在72小时内出现治疗失败；6次在急诊科进行评估，2次需要住院治疗。总体而言，93%的反应在输液中心得到解决，患者出院回家；没有患者死亡。最常见的致病药物是紫杉醇和奥沙利铂。
在实施由药师制定的、基于症状的新型护士主导方案后，在评估的IRR中，7%出现了输液反应治疗失败。尽管失败率较低，但进一步的护士教育和改善方案指导药物的获取可能会优化该方案的使用。
