Search

Cancer chemotherapy and immunotherapy is associated with infusion reactions, which are unplanned and range from mild, moderate to severe and life-threatening anaphylaxis. This is an oncologic emergency requiring the interdisciplinary team to have a well-developed, evidence-based approach, where all clinicians demonstrate competency and can respond immediately and ensure safe recovery from the reaction. First responders and the support team need to know their roles and responsibilities and depend on others to do the same during emergency reaction management. The purpose of this project was to share one institution's approach in reviewing and updating a hypersensitivity treatment algorithm in an adult ambulatory oncology clinic. An interdisciplinary team (nursing, pharmacy, allergy service) met to review current practice and outcomes associated with acute infusion reaction management. A literature search was conducted to update the algorithm with current evidence-based interventions needing to be adopted. Based on this review, the existing algorithm was updated, clinicians were educated, and a new algorithm was adopted and implemented. Key updates in this algorithm include: a standard grading scale for reaction severity, guidelines for medication administration based on symptoms and severity, when to draw tryptase levels, administration of glucagon for patients not responding to epinephrine taking beta-blockers, significance and appropriate use of epinephrine, when not to re-challenge with causative agent and the documentation of the allergen in the medical record. This presentation will describe the team review of current practice and evidence-based literature, interventions supporting algorithm implementation, the updated algorithm and ongoing implementation support strategies. Clinician education was the main intervention for implementation of a new acute infusion reaction management algorithm. One month before go-live, an online, interactive education module was assigned to nurses, physicians, pharmacists, nurse practitioners and physician assistants. Successful achievement of this education included completion of the interactive module and a passing test score of 100%. Evaluations of this offering will be presented along with ongoing strategies for compliance. Standardizing an approach for acute infusion reactions in oncology is equally as important as the standards in place for providing basic life support. Interventions must be based on evidence, roles and competency must be defined and re-evaluated and the interdisciplinary team needs to be involved at all phases of reaction management. [ABSTRACT FROM AUTHOR]

Purpose: There is no consensus in the oncology community about the optimal model for anticoagulation management of ambulatory cancer patients. To understand oncologists’ preferences regarding anticoagulation management, we compared the characteristics of patients referred to an oncology-oriented anticoagulation management service with ‘‘usual care’’ patients managed by the patient’s primary oncologist. Methods: We performed a retrospective medical record review of ambulatory oncology patients’ anticoagulation care at a comprehensive cancer center. We examined the characteristics of 33 patients anticoagulated before implementation of a dedicated oncology anticoagulation management service. We compared this group with 33 patients managed by the anticoagulation management service and with 39 usual care patients managed by the primary oncologist after the anticoagulation management service was created. We also examined differences in laboratory test utilization, time in the therapeutic range (for patients anticoagulated with warfarin), and anticoagulation-related adverse events during a 3-month assessment period. Results: Anticoagulation management service patients were more likely to be treated for hematologic malignancies, use erythropoietin stimulating agents, and require warfarin management for previous venous thromboembolic disease compared to usual care patients. In contrast, oncologists were more likely to manage anticoagulation care of patients with advanced solid tumors undergoing active chemotherapy. Anticoagulation management service and usual care patients on warfarin therapy had comparable time in the therapeutic range and complication rates. Conclusion: Oncologists selectively referred patients to the anticoagulation management service. Anticoagulation management service patients’ warfarin control and complication rates were comparable to care provided by the primary oncologist, suggesting that an oncology-specific anticoagulation management service may be a feasible and effective option for anticoagulation management of ambulatory oncology patients. [ABSTRACT FROM AUTHOR]