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It would be nice if we could do a skin test and have a better idea of who’s going to react. Especially the platiniums drugs. It’s a real unknown when and who’s going to react. At least taxanes reactions are usually in the first 15 minutes.
When I was working at SSCBC infusion I saw the medical team go back and forth, on whether or not premeds could be eliminated after the patients was exposed to the drug at least twice. I always found this interesting on why the chose one way or the other.
Hello, my name is Patti and I work in the Post-discharge/Triage Nurse team. Jodi, Thanks for leading this journal club.
What was the knowledge gained from the article? These articles gave me a nice review of the risk of reaction for paclitaxel and docetaxel. Paclitaxel 10% risk of reactions despite giving premedication with antihistamines and a corticosteroid. Docetaxel has a 5% risk of reaction. I also found it interesting that nonimmediate HSRs to taxanes can present as skin eruption, described as maculopapular and sometimes as flushing, with onset from several hours to 15 days after the drug infusion. When working with this patient population they often receive dexamethasone and it can cause facial erythema which is seen as an adverse side effect of drug.
Carboplatin HSR affect an estimated 5% of the general oncologic population and occur at a rate of approximately 1% of all platinum administrations. When administering this drug in the oncology infusion clinics it seemed more prevalent than 5%. Maybe it was because the patient population I served received more than 7 cycles because the incidence of HSR in up to 27% of patients receiving seven or more cycles of carboplatin has been reported.Will the research/information in this article change or influence your practice? If so how? In my current role as a triage nurse I’m definitely going to try to assess more for the delayed reactions when assessing patients after they’ve received their chemo.
What other questions does the article raise about current practice? When I was working in the SSCBC infusion we stopped giving premeds which included pepcid abnd benadryl to our docetaxel patients because the studies showed that patient were going to react to this drug no matter if premeds are given or not. Patient still received the decadron day before, day of, and day after. However, our patients that were diabetic only received decadron day of usually. This surprised me that an antihistamine didn’t prevent a hypersentivity reaction.
Lynne Brophy-
The article by Baumrucker and Grigorian (2022) states that risk factors for AIMSS include less than 5 years from menopause, history of taxane-based chemotherapy, obesity and past medical history of arthritis or osteoporosis.I found this patient population had a higher likelihood of gaining weight despite exercising and diet modifications.
I didn’t see many patients on glucosamine sulfate or chondroitin sulfate when I worked with the breast cancer population. I would be curious to know if the providers don’t find the evidence to be convincing. I did see duloxetine prescribed at times.
Hello, my name is Patti, and I just started working on the James After Hour nurse line.
1. When assessing a patient with joint pain, what is the difference you look for to tell if the patient has potential arthritis pain in a joint or joints vs. arthralgia? Arthritis is joint pain with inflammation so I would say it would be pain that last longer. Arthralgia is joint pain. Arthritis seems to be more than one joint in my experience.
2. Tell me what patient population you work with. What risk factors for arthralgias does your patient population possess? Maybe share 2-3? I cover all James patients including Breast Cancer patients.
3. Name a pharmacologic intervention that has not been effective for arthralgia.
Vitamin d 600 IU showed no significant difference according to the article Current and future advances in practice: aromatase inhibitor induced arthralgia.
4. Name two non-pharmacologic interventions which might be effective for arthralgia. Yoga, exercise and tai chi.
5. Could working toward a healthy weight be helpful in arthralgia management? (By the way, working toward a healthy weight can reduce risk of cancer in the first place but can also reduce the risk of recurrence of certain cancers.)
A healthy weight would be helpful when managing arthritis.
6. What is the role of physical activity in arthralgia treatment?
Physical therapy greatly decreases joint pain.
7. Have you ever asked the treatment team for a referral to the James cancer exercise program (which is a PT referral with “James cancer exercise program” in the comments. I have never asked for this referral. I have however asked for PT referral. This information will be useful going forward in my clinical practice.I know that tylenol and ibuprofen have a risk of masking a fever but directing the patient to take their temperature prior to taking these antipyretics would help decrease that risk.
Moore, D. C., & Pellegrino, A. E. (2017) mention that a dose reduction of pegfilgrastim can be an option to reducing the adverse side effect of bone pain. It was discussed that the risk of Febrile Neutropenia was higher for those who received the lower dose of pegfilgrastim.
Does neupogen the short acting growth factor have a lower incidence of bone pain? You may adjust dose easier with the short acting drug.Hello my name is Patti and I currently work at SSBC infusion. My breast cancer patients often receive pegfilgrastim with their chemotherapy regimens.
What was the knowledge gained from the article?
The articles provided a great review on the drug mechanism. I didn’t realize that bone pain was as prevalent as 45%. I wasn’t aware of providers suggesting famotidine as a treatment option. The breast cancer providers often recommend claritin.Will the research/information in this article change or influence your practice? If so how? I will continue to encourage the patient to use antihistamines. I will let patients know that they can use both claritin and famotidine so that bot histamine 1 and 2 receptors are blocked.
What other questions does the article raise about current practice?
I think another journal participant brought this up but What non-pharmacological methods could be used for pain management?
The SSCBC infusion patients received reiki during their infusion prior to COVID. I witnessed the benefit this had on many patients and their pain, fatigue, and anxiety.I see the providers at Sscbc using dexamethasone suspension with the severe cases. I can’t speak to whether or not patients are on chemotherapy or immune therapy. In the literature it states it would be used for immune-related mucosal toxicity.
I also found it interesting that honey made the list for management of oral mucositis.
The morphine suspension is an interesting treatment option. In my experience providers are very hesitant to prescribe any narcotics.
Hello my name is Patti (infusion nurse at SSCBC)
What was the knowledge gained from the article?
Efficacy of Oral Cryotherapy in the Prevention of Oral Mucositis Associated with Cancer Chemotherapy: Systematic Review with Meta-Analysis and Trial Sequential Analysis provided me with a good refresher oral mucositis. I had forgotten oral mucositis causes atrophy and destruction of the mucosal lining of the mouth leading to ulcer.
Targeted and immune therapies have shown to also cause mouth sores.
Will the research/information in this article change or influence your practice? If so how?
I will assess my targeted and immune therapies for mouth sores.
Do you agree/disagree with the conclusions of the author, why?
I do agree cryotherapy helps prevent mouth sores when receiving bolus IV chemos. We recommend all of our Adriamycin patients use cryotherapy while their adria is being administered.
These articles reinforced the importance of not underestimating the potential of severe adverse side effects from receiving checkpoint inhibitors.
