Outcomes of Developments Titration in Combination with Premedication Regarding Hypersensitivity Reactions in Lung Cancer Patients Undergoing Paclitaxel Chemotherapy at Rajavithi Hospital
DOI:
https://doi.org/10.14456/jdms.2023.21Keywords:
Hypersensitivity reactions, Paclitaxel, Premedication, Lung Cancer, TaxanesAbstract
Background: Achieving optimal nursing practice outcomes in chemotherapy administration is crucial for reducingthe incidence and severity of hypersensitivity reactions, which can lead to fatal anaphylactic shock. Objective: This study aims to compare the outcomes in starting titration rate between 40 ml/hr and 20 ml/hr by giving dexamethasone (20 mg) more than 30 minutes (no longer than 1 hour) before paclitaxel injection and dexamethasone (20 mg) at 30minutes before paclitaxel injection. Method: The study was a cross-sectional observational study design. Participantswere 320 lung cancer patients treated with paclitaxel and carboplatin, aged over 18. Data were collected frompatient’s history, risk profile, and medical records from 1 October 2016 - 31 December 2019. Statistical analyses,including chi-square tests, Fisher’s exact tests, and independent t-tests, were used to analyze the data. Results: Thegeneral characteristics were not different between the two groups, except hematocrit/hemoglobin in cycles 1-2 wasassociated with HSRs significantly (P<.05). The titration rate of 40 ml/hr was not different by giving dexamethasone(20 mg) for more than 30 minutes and at 30 minutes before paclitaxel injection. However, the titration rate of 20ml/hr, when dexamethasone (20 mg) was administered for more than 30 minutes or at 30 minutes using a smartpump, resulted in a statistically significant reduction in hypersensitivity reactions during cycles 1 and 4. Conclusion: Paclitaxel at the rate of 20 ml/hr was better than the original administration, particularly when the premedicationsare given at 30 minutes before chemotherapy.
References
National Cancer Control Programmes, Department of MedicalServices, Ministry of Public Health [Internet].2018-2022[cited 2019 Jul 5]. Available from http://www.nci.go.th/ th/File_download/D_index. National Cancer Control Programmes.pdf
National Cancer Control Programmes, Department of MedicalServices, Ministry of Public Health [Internet]. 2013-2017[cited 2019 Jul 5]. Available from https://www.nci.go.th/ th/File_download/D_index/NCCP_2556-2560.pdf
National Cancer Institute, Department of Medical Services. Hospitalbased cancer registry Annual Report 2017 [Internet]. 2017 [cited2019 Jul 5]. Available from https://www.nci.go. th/th/File_download/Nci%20Cancer%20Registry/Hospital based.pdf
Health Information Unit, Strategy and Planning Division, Ministry ofPublic Health. Public Health Statistics A.D.2018 [Internet]. 2018 [cited2019 Jul 5]. Available from https:// bps.moph.go.th/new_bps/sites/default/files/statistic%2061.pdf
Borovik R, Steiner M, Atad J, Sneiderman B, Rosenberg T, Palti S. [Taxol(paclitaxel) as second-line therapy in breast and ovarian cancer].Harefuah 1998; 134(6):605-8
Bernstein BJ. Docetaxel as an alternative to paclitaxel afteracute hypersensitivity reactions. Ann Pharmacother 2000; 34(11):1332-5.
Markman M, Kennedy A, Webster K, Peterson G, Kulp B,Belinson J. An effective and more convenient drug regimen forprophylaxis against paclitaxel-associated hypersensitivity reactions.J Cancer Res Clin Oncol 1999; 125(7):427-9.
Hong DIC. Desensitization for Allergic Reactions to Chemotherapy.Yonsei Med J 2019; 60(2):119-25.
Peereboom DM, Donehower RC, Eisenhauer EA, McGuire WP, OnettoN, Hubbard JL, et al. Successful re-treatment with taxol after majorhypersensitivity reactions. J Clin Oncol 1993; 11(5):885-90.
Markman M, Kennedy A, Webster K, Kulp B, Peterson G,Belinson J. Paclitaxel-associated hypersensitivity reactions:experience of the gynecologic oncology program of theCleveland Clinic Cancer Center. J Clin Oncol 2000; 18(1):102-5.
Kietpeerakool C. Hypersensitivity Reactions Induced byPaclitaxel: Focus on Premedication. Srinagarind Med J 2005; 20(2):99-104.
Maleehuan O, Wangnum K, Maneejavakajorn J, Laohavinij S. FactorsRelated of Hypersensitivity Reactions with Lung Cancer PatientsReceiving Chemotherapy in Paclitaxel. Journal of the department ofmedical services 2016; 41:105-17.
Feldweg AM, Lee CW, Matulonis UA, Castells M. Rapiddesensitization for hypersensitivity reactions to paclitaxel anddocetaxel: a new standard protocol used in 77 successful treatments.Gynecol Oncol 2005; 96(3):824-9.
Kumsopha N, Hongthai S. A comparative study of hypersensitivityreaction between slow rate and usual rate taxanes infusion amongcancer patients. Chonburi hospital journal 2018; 43:75-82.
Lee CW, Matulonisb UA, Castellsa MC. Rapid inpatient/outpatientdesensitization for chemotherapy hypersensitivity: Standard protocoleffective in 57 patients for 255 coursesi. J allergy Clin Immunol 2008;122:574-80.
Schwartz JR. Dexamethasone premedication for prophylaxis of taxanetoxicities: Can the doses be reduced when paclitaxel or docetaxelare given weekly? J Oncol Pharm Practice 2011; 18:250-56.
Scripture CD, Figg WD, Sparreboom A. Peripheral Neuropathy Inducedby Paclitaxel: Recent Insights and Future Perspectives. Curr Neuropharmacol 2006; 4(2):165-72.
Castells MC, Tennant NM, Sloane DE, Hsu FI, Barrett NA,Hong DI, et al. Hypersensitivity reactions to chemotherapy: Outcomesand safety of rapid desensitization in 413 cases. J allergy Clin Immunol2008; 122(3):574-80.
Lee CW, Matulonisb UA, Castells MC. Rapid inpatient/outpatientdesensitization for chemotherapy hypersensitivity: Standard protocoleffective in 57 patients for 255 courses. Gynecologic Oncology 2005;99(2):393–9.
Papich MG. Dexamethasone. 4th ed. Saunders Handbook of VeterinaryDrugs: Small and Large Animal. St. Louis: Missouri, USA; 2016.
Supachutikul A. New HA Standards: Risk management through riskregister. The Healthcare Accreditation Institute [powerpoint/pdf]. 2018[cited 2020 February 05]. Available from: http://www.rh12.moph.go.th.
Kosmas C, Tsavaris N. A simplified premedication protocol forone-hour paclitaxel Infusion in various combinations. Med Sci Monit2006; 12(11):CR462-6.
Sendo T, Sakai N, Itoh Y, Ikesue H, Kobayashi H, Hirakawa T,et al. Incidence and risk factors for Paclitaxel hypersensitivity duringovarian cancer chemotherapy. Cancer chemotherapy Pharmacol2005; 56(1):91-6.
Hansen S, Baptiste KE, Fjeldborg J, Horohov DW. A review of the equineage-related changes in the immune system : comparisons betweenhuman and equine aging, with focus on lung-specific immune-aging.Ageing Res Rev 2005; 20:11-23.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Department of Medical Services, Ministry of Public Health
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของกรมการแพทย์ กระทรวงสาธารณสุข
ข้อความและข้อคิดเห็นต่างๆ เป็นของผู้เขียนบทความ ไม่ใช่ความเห็นของกองบรรณาธิการหรือของวารสารกรมการแพทย์
