Skin toxicities and unmet supportive care needs of patients with cancer undergoing EGFR-inhibitor therapy / Toxische Hautreaktionen und Unterstützungsbedarf von KrebspatientInnen im Zuge einer EGFR-Antikörpertherapie. Eine deskriptive Studie

Background: Targeted therapies, such as the EGFR (epidermal growth factor receptor) inhibitor therapy, are being used to treat patients with various solid and metastatic tumours. Skin toxicities are a common side effect of this therapy. Aim: The aim of this study was to assess the effects of skin toxicities on quality of life of patients with cancer undergoing EGFR inhibitor therapy, as well as their unmet supportive care needs. Method: Embedded design. A standardised quantitative survey was administered and analysed. In addition, memos and audiotaped material of insightful conversations with the patients after survey administration were included in the analyses. Results: Among the three domains of the effects of skin toxicities on quality of life, physical symptoms (e. g. itching skin, rash) were most frequently reported to impair quality of life, while associated emotional and functional impairments were less frequently reported. Patients don't consider the management of skin toxicities to be a priority during their treatment, skin toxicities are rather perceived in context of the total symptom burden. Yet, we observed significant correlations between the assessed quality of life and unmet supportive care need domains, especially concerning physical and psychological needs. Conclusions: Although no clinically significant impairment of quality of life of patients undergoing EGFR inhibitor therapy was found, skin changes should be addressed in supportive interventions embedded in routine symptom management.

Nursing Management of Cutaneous Toxicities From Epidermal Growth Factor Receptor Inhibitors.

BACKGROUND: Personalized targeted therapies have become an emerging paradigm in cancer treatment. Although generally more tolerable than other chemotherapeutic agents, one therapy, epidermal growth factor receptor inhibitors (EGFRIs), commonly results in the formation of cutaneous toxicities, which can negatively affect patients' treatment adherence and quality of life. OBJECTIVES: The aim of this article is to review nursing management strategies for EGFRI-related cutaneous toxicities. METHODS: A systematic literature review was performed, including database searches in PubMed/MEDLINE®, CINAHL®, Cochrane Library, PsycINFO®, and Web of Science. FINDINGS: Nurses are essential to the management of EGFRI-related cutaneous toxicities and are in an ideal position to provide supportive care throughout the course of the EGFRI treatment. The aim of nursing management is to maintain patients' treatment adherence and quality of life by employing a preemptive and proactive approach. Patient education is the most frequently reported management strategy. However, treatment options and management strategies are largely anecdotal and based on individual reports and expert opinions. Although no evidence-based management strategies exist, nurses can rely on existing assessment tools and guidelines to provide patients with symptom management and supportive care.

[Cutaneous adverse drug reactions in childhood and adolescence]. / Kutane Arzneimittelreaktionen im Kindes- und Jugendalter.

Adverse drug reactions (ADR) occur in nearly 10% of hospitalized children and in about 1.5% of ambulatory pediatric patients. The skin is the most frequently affected target organ in drug hypersensitivity (DH) reactions, which account for 20% of all ADR. Due to its pathophysiological heterogeneity and the ensuing morphological diversity, DH often represents a clinical and therapeutic challenge. Urticarial and maculopapular eruptions are usually restricted to the skin and rarely require systemic treatment or hospital admission once the culprit drug has been withdrawn. However, extracutaneous affections should be ruled out promptly in individuals with polymorphous rashes accompanied by fever and lymphadenopathy as well as in patients with bullous skin lesions. Children affected by severe drug reactions usually require in-hospital surveillance and interdisciplinary supportive therapy.

Strategies for assessing and managing the adverse events of sorafenib and other targeted therapies in the treatment of renal cell and hepatocellular carcinoma: recommendations from a European nursing task group.

PURPOSE: As a group of European nurses familiar with treating patients with renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC) using targeted/chemo- therapies, we aimed to review strategies for managing adverse events (AEs) associated with one targeted therapy, sorafenib. METHOD: Focusing on the AEs we considered the most difficult to manage (hand-foot skin reaction [HFSR], diarrhoea, fatigue and mucositis/stomatitis), we reviewed the literature to identify strategies relevant to sorafenib. Given the paucity of published work, this included strategies concerning targeted agents in general. This information was supplemented by considering the wider literature relating to management of these AEs in other tumour types and similar toxicities experienced during conventional anti-cancer therapy. Together with our own experience, this information was used to compile an AE management guide to assist nurses caring for patients receiving sorafenib. RESULTS: Our collated experience suggests the most commonly reported AEs with sorafenib and other targeted agents are HFSR, diarrhoea, fatigue, rash and mucositis/stomatitis; these generally have an acute (appearing at ∼0-1 months) or delayed onset (appearing at ∼3 months). Most management strategies in the literature were experience-based rather than arising from controlled studies. However, strategies based on controlled studies are available for HFSR and mucositis/stomatitis. CONCLUSIONS: Evidence, especially from controlled studies, is sparse concerning management of AEs associated with sorafenib and other targeted agents in RCC/HCC. However, recommendations can be made based on the literature and clinical experience that encompasses targeted and conventional therapies, particularly in the case of non-specific toxicities e.g. diarrhoea and fatigue.

Managing adverse events associated with sorafenib in renal cell carcinoma.

Sorafenib, a multi-targeted kinase inhibitor, is approved in Europe for the treatment of patients with advanced renal cell carcinoma whose treatment with an interferon or interleukin-2-based therapy has previously failed, or who are unsuitable for such therapy. Unlike some first-generation anti-cancer therapies, sorafenib is generally associated with moderate and manageable adverse events. Some of the most common adverse events include a hand-foot skin reaction, diarrhoea and rash. As nurses provide an interface between the patient and the clinical team, it is important that they understand how sorafenib-related adverse events impact on patients. It is equally vital that nurses are able to recognize and manage these adverse events. Our experience has shown that with patient education, early reporting, monitoring and treatment, the adverse events of sorafenib therapy can be easily and effectively managed. Optimal adverse event management helps ensure treatment compliance and ensures that patients receive maximum benefit from therapy.

Clinical approaches to minimize rash associated with EGFR inhibitors.

PURPOSE/OBJECTIVES: To present a systematic approach for managing the skin rash associated with epidermal growth factor receptor (EGFR)-targeted therapies. DATA SOURCES: Clinical research literature, published abstracts, and clinical experience. The approach presented in this article is based on a combination of clinical experience and consultations with dermatologists, oncologists, and pharmacists familiar with EGFR inhibitor-associated rash. DATA SYNTHESIS: A proactive approach that includes patient education and the use of a grade-based treatment algorithm. The goal of the approach is to minimize the effects of the rash on patients' quality of life and the course of cancer treatment. CONCLUSIONS: Using the approach described in this article to treat the rash associated with the use of EGFR inhibitors, nurses can lessen patient discomfort and help ensure that patients will continue cancer treatment for as long as necessary. IMPLICATIONS FOR NURSING: The approach described in this article should help nurses to recognize, grade, and treat the skin rash associated with EGFR inhibitors.

Clinical management of EGFRI dermatologic toxicities: the nursing perspective.

All nursing personnel actively participate in the nursing process, with the registered nurse taking primary responsibility. Five steps in the nursing process include assessment, diagnosis, planning, implementation, and evaluation. Health-care professionals have more than 10 years of experience with EGFR inhibitors in the oncology setting. To date, the application of the nursing process to assist in patient management has not been previously published or thoroughly described in the literature. This article will apply the nursing process utilizing current recommendations regarding the assessment and management of dermatologic toxicities associated with EGFR inhibitors.

Maculopapular skin rashes associated with high-dose chemotherapy: prevalence and risk factors.

PURPOSE/OBJECTIVES: To determine the prevalence of and risk factors for maculopapular skin rashes associated with high-dose chemotherapy. DESIGN: Observational pilot study. SETTING: A bone marrow transplant hematology-oncology unit in a private city hospital. SAMPLE: Data were collected on 14 patients who developed maculopapular rashes out of 127 patients who received high-dose chemotherapy (purposive sampling). METHODS: Observation of the distribution and nature of skin rashes in relation to chemotherapy, disease, adjuvant medications, and white blood cell counts. MAIN RESEARCH VARIABLES: Diseases, chemotherapy protocols and doses, adjuvant medications, and blood counts. FINDINGS: Skin reactions ranged from mild, scattered macular or maculopapular rashes to severe rashes. Patients newly diagnosed with acute myelogenous leukemia (AML) who received induction protocols containing cytarabine had the most rashes, affecting 6 of 11 patients (55%). No rashes were observed on patients treated with the protocol that included high-dose corticosteroids. Patients rarely had recurrence of the rash with further courses of chemotherapy. CONCLUSIONS: Cytarabine doses higher than 700 mg/m2 may be a cause of maculopapular skin rashes. Patients most at risk were those newly diagnosed with AML who received induction therapy. Corticosteroids may prevent the development of skin rashes. IMPLICATIONS FOR NURSING: No useful nursing strategy exists to prevent, lessen the intensity of, or shorten the course of a delayed hypersensitivity rash. Knowing which patients are most at risk is useful to enable close monitoring and patient and staff education.

Therapeutic options in the management of colon cancer: 2005 update.

Recently, major developments in the treatment of colon cancer have emerged. These developments include improvements in surgical technique and staging and the introduction of new molecularly targeted pharmacologic agents. Improvements in surgical management involve enhanced staging techniques, allowing more accurate determination of risk of recurrence. Newer agents, such as oxaliplatin, cetuximab, and bevacizumab, now are approved for the treatment of colon cancer. The data associated with use of oxaliplatin in adjuvant and metastatic settings continue to mature; survival benefits are expected to become more fully apparent in the next two years. Bevacizumab, a monoclonal antibody that neutralizes vascular endothelial growth factor, when combined with irinotecan, 5-fluorouracil, and leucovorin (IFL), was superior to IFL alone in achieving median and progression-free survival. Cetuximab, a monoclonal antibody directed against the epidermal growth factor receptor, when given in combination with irinotecan, achieved an increased objective response and increased time to progression, compared with cetuximab alone, in patients refractory to irinotecan-containing regimens. In addition to surgical and pharmacologic developments, the recognition that genetics and molecular markers play an important role in carcinogenesis has heightened research to integrate this knowledge into practice. Nurses play a pivotal role in the care of patients with colon cancer and must be conversant in the new advances in treatment.

What's your assessment? Dermatitis medicamentosa.

The "What's Your Assessment?" series includes a short case presentation and differential diagnosis. It is followed by a discussion of the disease or condition and the rationale used in each step of the assessment.