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Background: In those receiving chemotherapy, renal and hepatic dysfunction can increase the risk of toxicity and should therefore be monitored. We aimed to develop a machine learning model to identify those patients that need closer monitoring, enabling a safer and more efficient service. Methods: We used retrospective data from a large academic hospital, for patients treated with chemotherapy for breast cancer, colorectal cancer and diffuse‐large B‐cell lymphoma, to train and validate a Multi‐Layer Perceptrons (MLP) model to predict the outcomes of unacceptable rises in bilirubin or creatinine. To assess the performance of the model, validation was performed using patient data from a separate, independent hospital using the same variables. Using this dataset, we evaluated the sensitivity and specificity of the model. Results: 1214 patients in total were identified. The training set had almost perfect sensitivity and specificity of >0.95; the area under the curve (AUC) was 0.99 (95% CI 0.98–1.00) for creatinine and 0.97 (95% CI: 0.95–0.99) for bilirubin. The validation set had good sensitivity (creatinine: 0.60, 95% CI: 0.55–0.64, bilirubin: 0.54, 95% CI: 0.52–0.56), and specificity (creatinine 0.98, 95% CI: 0.96–0.99, bilirubin 0.90, 95% CI: 0.87–0.94) and area under the curve (creatinine: 0.76, 95% CI: 0.70, 0.82, bilirubin 0.72, 95% CI: 0.68–0.76). Conclusions: We have demonstrated that a MLP model can be used to reduce the number of blood tests required for some patients at low risk of organ dysfunction, whilst improving safety for others at high risk. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to investigate the rates of hypersensitivity reactions (HSRs) in patients receiving paclitaxel chemotherapy, with and without a histamine‐2 (H2) antagonists. Method: This prospective, multi‐centre, cohort study compared patients receiving paclitaxel treated with premedication regimens containing chlorphenamine, dexamethasone and an H2 antagonist vs patients treated without an H2 antagonist. Rates of HSRs were described and logistic multivariable regression was used to investigate any associations with H2 antagonist treatment, adjusting for confounding variables. Results: A total of 1043 individuals were included in the study; of these, 638 (61%) patients received an H2 antagonist and 405 (49%) were not given an H2 antagonist. Incidence of HSR in the cohort treated with H2 antagonists was 11.31% (n = 70) vs 9.86% (n = 41) in the cohort without. There was no statistically significant difference between the rates of HSR observed in those receiving and not receiving an H2 antagonist (odds ratio 1.04, 95% CI 0.65, 1.66, P =.9). Conclusions: Results presented within the study are consistent with other recently published evidence to suggest that H2 antagonists do not confer any advantage as part of premedication regimens in reducing the incidence of HSR in patients treated with paclitaxel. [ABSTRACT FROM AUTHOR]

Purpose: In response to the COVID-19 pandemic, changes to chemotherapy services were implemented as a means of managing imposed workload strains within health services and protecting patients from contracting COVID-19. Given the rapidly evolving nature of the pandemic many changes were rapidly adopted and were not substantiated by robust evidence. This study aimed to describe the changes adopted internationally to chemotherapy services, which may be used to guide future changes to treatment delivery. Methods: A survey was developed to understand the impact of COVID-19 on the delivery of systemic anti-cancer therapies (SACT). It comprised 22 questions and examined the strategies implemented during the pandemic to prioritise and protect patients receiving SACT and the participants' professional opinion of the strategies employed. The survey was available in English, Spanish and French and was distributed via professional bodies. Results: 129 responses were obtained from healthcare professionals working across 17 different countries. 45% of institutions had to implement treatment prioritisation strategies and all hospitals implemented changes in the delivery of treatment, including: reduction in treatments (69%), using less immunosuppressive agents (50%), allowing treatment breaks (14%) and switching to oral therapies (45%). Virtual clinic visits were perceived by participants as the most effective strategy to protect patients. Conclusions: The pandemic has forced chemotherapy healthcare professionals to adopt new ways of working by reducing health interactions. Many areas of research are needed following this period, including understanding patients' perceptions of risks to treatment, utilisation of oral treatments and the impact of treatment breaks on cancer outcomes. [ABSTRACT FROM AUTHOR]

Background: On average 20% of patients require a systemic anti-cancer treatment (SACT) delay.1 The risk of toxicity-related dose delays, with SACT, should be included as part of pre-treatment education and be considered by clinicians upon prescribing chemotherapy. An objective measure of individual risk could influence clinical decisions, such as the escalation of standard supportive care and stratification of some patients, to receive proactive toxicity monitoring. The understanding of this risk may also support the advanced preparation of treatments for those that have a lower risk of delay. Data available within hospital systems can support the understanding of risk through the development of a risk score. In this study, we developed and validated a score to assess the risk of a SACT dose delay of 7 days (delay-7 score). Objectives: To develop and internally validate a risk score to predict the occurrence of a 7-day dose delay for patients receiving cycle 1 treatments for breast and colorectal cancers and diffuse large b-cell lymphomas. To assess the discrimination and calibration of the model. Methods: Four hospitals were included in our study, recruited through BOPA. Data were collected for patients aged 18 or over, identified through the chemotherapy prescribing systems at each hospital for the period of 1 January 2013 to 1 January 2018. The first chemotherapy treatment date was used as the index date for entry to the cohort during the study period. The study data was restricted to the following three tumour groups: breast, colorectal and diffuse large B-Cell lymphoma. Data included hospital treatment, age at the start of SACT, gender, ethnicity, body mass index, cancer diagnosis, chemotherapy regimen, colony-stimulating factor use, first cycle dose modifications and baseline blood values. Baseline blood values included neutrophils, platelets, haemoglobin, creatinine and bilirubin. A risk prediction model was developed using multivariable logistic regression and all analysis methods complied with the Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD).2 Shrinkage was used to adjust for over-optimism of predictor effects. For internal validation (of the full models in the development data) we computed the ability of the models to discriminate between those with and without poor outcomes (c-statistic), and the agreement between predicted and observed risk (calibration slope). Results: A total of 4604 patients were included in our study of which 628 (13.6%) incurred a 7-day delay to the second cycle of chemotherapy. Delay-7 showed good discrimination and calibration, with a c-statistic of 0.68 [95% confidence interval (CI) 0.66–0.7], following internal validation and calibration-in-the-large of −0.006. Conclusions: Delay-7 predicts a patient’s individualised risk of a treatment-related delay at cycle two of treatment. The score can be used to stratify interventions to reduce the occurrence of treatment-related toxicity. However, to be used in the clinical setting a prospective study should be conducted to ensure the reliability of the score. Nonetheless, we have identified that the score can be useful to support advance preparation in pharmacy aseptic units and a small validation in this setting is planned. [ABSTRACT FROM AUTHOR]

Introduction: Systemic anti-cancer treatment (SACT) requires toxicity assessment prior to initiation to ensure adequate bone marrow, renal and liver function. The timing of these assessments is determined locally, with the results guiding clinicians to delay treatment or request for repeated blood tests if the desired range is not attained. The time to obtain these tests is ideal on the day chemotherapy commences, however, this is not practical within the NHS. Common practice is for patients to undergo these assessments prior to the treatment day with some policies1 recommended earlier at five or six days prior to initiations with potential impact on patient experience. This research aims to study the main policies relating to pre-chemotherapy assessment in three cancer groups: early breast cancer, colorectal cancer and DLBCL. Objectives: (1) Examine the policies on the time-periods used to perform toxicity assessment prior to chemotherapy at hospitals in the United Kingdom (UK). (2) Identify if there is variation reported within the same hospital sites. Methods: A cross-sectional online survey (Qualtrics) was sent out to members of the BOPA and ACP society between 1 July 2020 and 31 July 2020. The survey was validated by four experts in survey design and chemotherapy regimen. The sample size was calculated based on the total population of hospitals in the UK (n = 256). Based on a 95% CI, n = 131 was needed. Data was exported and analysed on STATA 15 and presented as counts and percentages. Ethics was obtained and findings have been recently published in objective 1 only. Results: • 91 participants completed the questionnaire in full. • 25 hospitals had more than one profession/participant responding. • 12 hospitals had complete responses for each question from each participant. • Two hospitals had participants responding within the same time frame. In both settings, the responses were from the same profession. • Hospital A: × 2 participants (pharmacists) • Hospital B: ×4 participants (medical oncologists) • 10 hospitals had different responses despite the profession with a difference in the time frame from 1 to 4 days between respondents. Discussion/conclusion: Toxicity assessments guide clinicians on dose delay and dose intensity of chemotherapy. Policies on when to conduct these assessments vary across the UK irrespective of the chemotherapy in all three cancer groups. Results demonstrate there is variation at the same hospital site despite professional background. As cancer patient numbers are growing and advanced preparation is vital, many hospitals are investigating extending the validity period of blood. Depending on the chemotherapy regimen, between 13 and 15 sites are currently practicing using between 4 and 7 days. However, the more this is extended there may be a need for duplicate blood where patients do not reach desired thresholds.1 Further evidence is required in this area and the need to reduce variation in pre-chemotherapy blood assessments at the same site and across sites within the UK. This study was limited by its method of dissemination, with the majority of respondents receiving a response from their membership societies, where members pay to join. [ABSTRACT FROM AUTHOR]

Inter-cycle delays to chemotherapy are often required to manage drug toxicity. The impact of delays on mortality is poorly characterised. This retrospective cohort study examined the association of treatment delay with all-cause mortality in early-stage breast cancer. This real-world analytical study included adult women with stage 2 or 3 breast cancer receiving first-line (neo-)adjuvant chemotherapy between 01/01/2014 and 31/12/2015 in England. Inter-cycle delays > 7 days during the treatment period were calculated, and the association of treatment delay with 5-year all-cause mortality was investigated. Survival was compared between patients experiencing treatment delay and those completing treatment to schedule using landmark methodology and Kaplan-Meier (KM) estimator. Cox proportional hazards regression was used to investigate the impact of delay on survival, using inverse probability of treatment weighting to adjust for confounding variables. 8567 patients were included. 17 % (1448) experienced inter-cycle delay > 7 days during the treatment period. 1120 (13 %) women had died at the end of the 5-year follow up period. Median follow-up time was 5.5 years. Survival probability was significantly lower in patients experiencing treatment delay by KM estimator analysis (p < 0.0001). Cox proportional hazards regression demonstrated a significant positive association between delay and 5-year all-cause mortality (HR 1.33 95 % CI 1.12–1.61, p < 0.001). This is the largest study of its kind demonstrating an association between treatment delay and all-cause mortality. These findings support interventions to improve toxicity management allowing completion of chemotherapy to schedule where patients experience treatment delay due to treatment-related toxicity or hospital capacity pressures. • Delays between chemotherapy cycles were evaluated in women with early breast cancer. • 1448 (17 %) women of 8567 were delayed > 7 days during six cycles of chemotherapy. • Delays were associated with reduced 5-year survival (HR 1.33, 95 % CI 1.12, 1.61). • Relative dose intensity was significantly reduced by delay (82 %) vs no delay (94 %). • Completing chemotherapy to schedule should be prioritised to maximise treatment benefit. [ABSTRACT FROM AUTHOR]