Search

To identify the technological preferences of aging cancer patients with regard to the delivery services and devices for preventing/solving three common drug-related problems (DRPs): medication nonadherence, lack of knowledge in medications, and side effects management. A survey was conducted at a cancer center from May to August 2011. Delivery services included in the interviewer-administered questionnaire included voice-activated dispensing, voice reminders, electronic messages, helplines, and mobile phone applications, among others. Three devices were proposed—watches, bracelets, and mobile phones. Descriptive statistics and chi-square tests were performed. A total of 361 surveys were analyzed. Median age of respondents was 61 years. The majority of respondents were female (57.3 %), Chinese (88.9 %), and 65 years and younger (73.4 %). More than half (59.0–63.2 %) were receptive to the use of the delivery services. Patients preferred voice reminder alerts (28.0 %) and electronic messages (17.7 %) to help with their medication nonadherence, and helplines for medications (52.6 %) and side effects management (47.4 %). Higher educated patients were more likely to want delivery services to improve their medication adherence (p = 0.045) and knowledge in medications management (p = 0.050). Middle age patients (age 50–65) were also more likely to want delivery services for the latter DRP (p = 0.009). Among those who wanted delivery services, most preferred mobile phones. Middle age and elderly cancer patients are accepting of delivery services to help them with their DRPs. With middle aged patients being more receptive of the delivery services, technology can potentially play an important role in minimizing DRPs.

Introduction Cancer-related fatigue (CRF) has been suggested to be associated with the occurrence of chemotherapy-induced nausea and vomiting (CINV). This study aims to evaluate the potential of CRF in predicting the occurrence of CINV. Method This is a prospective, observational study. Recruited patients received moderately to highly emetogenic single-day chemotherapy regimens. On the day of chemotherapy, patients were instructed to provide a score (Likert scale of 0–10) to describe how CRF interfered with his or her ability to engage in daily activities and a score for how severe it was. Patients were then given a standardized 5-day diary to document their CINV events. Results A total of 473 eligible patients (median age: 55 years, interquartile range (IQR): 48–61 years) were recruited, with most of the patients diagnosed with gastrointestinal (45%) and breast (37%) cancers. The median score of fatigue interference was 3 (IQR: 0–5). After confounders were adjusted for, patients with low fatigue interference scores (≤3) were more likely to achieve complete protection (no nausea, no vomiting, and no breakthrough antiemetics) of CINV (adjusted odds ratio = 1.57, 95%CI [1.05, 2.35], p = 0.027). Conclusion This is the largest study to date to evaluate the association between CRF and CINV. Patients experiencing CRF possessed a higher risk of poor control for CINV. Copyright © 2013 John Wiley & Sons, Ltd.

Many risk factors exist for chemotherapy-induced nausea and vomiting (CINV). This study utilized a multivariate projection technique to identify which risk factors were predictive of CINV in clinical practice. A single-centre, prospective, observational study was conducted from January 2007~July 2010 in Singapore. Patients were on highly (HECs) and moderately emetogenic chemotherapies with/without radiotherapy. Patient demographics and CINV risk factors were documented. Daily recording of CINV events was done using a standardized diary. Principal component (PC) analysis was performed to identify which risk factors could differentiate patients with and without CINV. A total of 710 patients were recruited. Majority were females (67%) and Chinese (84%). Five risk factors were potential CINV predictors: histories of alcohol drinking, chemotherapy-induced nausea, chemotherapy-induced vomiting, fatigue and gender. Period (ex-/current drinkers) and frequency of drinking (social/chronic drinkers) differentiated the CINV endpoints in patients on HECs and anthracycline-based, and XELOX regimens, respectively. Fatigue interference and severity were predictive of CINV in anthracycline-based populations, while the former was predictive in HEC and XELOX populations. PC analysis is a potential technique in analyzing clinical population data, and can provide clinicians with an insight as to what predictors to look out for in the clinical assessment of CINV. We hope that our results will increase the awareness among clinician-scientists regarding the usefulness of this technique in the analysis of clinical data, so that appropriate preventive measures can be taken to improve patients' quality of life.

BACKGROUND: There are little prevalence data in the literature on nonadherence to outpatient antiemetic regimens for prophylaxis of chemotherapy-induced nausea and vomiting (CINV). It is unclear whether adherence with outpatient antiemetic regimens is associated with better CINV control. Our previous survey research supports the work of clinical pharmacists in collaborative practice with medical oncologists in improving adherence with antiemetic therapy in women undergoing highly emetic chemotherapy for breast cancer. OBJECTIVES: To (a) evaluate the impact of adherence to delayed antiemetics (days 2-4 following anthracycline-based chemotherapy) on CINV control in breast cancer patients after anthracycline-based chemotherapy and (b) identify patient-related factors associated with nonadherence to delayed antiemetics. METHODS: A single-center, prospective, observational study was conducted from December 2006 to January 2011 in breast cancer patients receiving anthracycline-based chemotherapy (doxorubicin or epirubicin) and antiemetics at the National Cancer Centre Singapore (NCCS), the largest ambulatory cancer center in Singapore. Included patients were aged 21 years or older with confirmed diagnoses of breast cancer and receiving anthracycline-containing chemotherapy with antiemetics. Patients were excluded if they (a) were diagnosed with intestinal obstruction or received concurrent radiotherapy that predisposed them to nausea and vomiting, (b) had vomited in the 24 hours preceding chemotherapy, or (c) had brain metastases that would impair their judgment. Patients documented in a standardized diary their emesis events, severity of nausea, use of rescue therapy with metoclopramide, and compliance with dose instructions for antiemetic drug therapy for 5 days: day 1 was the day of chemotherapy and first day of antiemetic therapy, and day 5 was the day after completion of delayed antiemetic therapy (days 2-4). Three definitions were used to describe the CINV outcomes: (a) complete response (no emetic episodes and no rescue therapy); (b) complete protection (no emetic episodes, no rescue therapy, and no significant nausea [Likert score 2 or less]); and (c) complete control (no emetic episodes, no rescue therapy, and no nausea). The delayed (days 2-5 post-chemotherapy) phase of these endpoints was analyzed. Nonadherence was defined as missing at least 1 dose of the delayed antiemetics from the prescribed regimen. Pearson chi-square or Fisher’s exact tests and multiple logistic regression analysis were used to assess the relationship between adherence and CINV outcomes. RESULTS: Of 519 eligible patients, 88 (17.0%) patients declined participation; 35 (6.7%) were lost to follow-up; and another 35 (6.7%) were excluded due to the absence of therapy with delayed antiemetics according to guideline protocol. Of the 361 (69.6%) patients included in the final analysis, the mean (SD) age was 50.0 (8.9); the majority was Chinese (80.1%) and diagnosed with stage 2 or higher breast cancer (88.1%). A total of 152 patients (42.1%) self-reported nonadherent use of delayed antiemetics. Among all the nonadherent patients (n = 152), 16.4% (n = 25) achieved complete control; 34.2% (n = 52) achieved complete protection; and 58.6% (n = 89) achieved complete response, compared with rates of 26.8% (n = 56), 39.7% (n = 83), and 62.7% (n = 131), respectively, for adherent patients (n = 209). The rate of adherence to dexamethasone, which was prescribed for all study patients, was low (62.6%). After adjusting for potential confounders (ethnicity, educational level, and disease stage), adherent patients were more likely to achieve complete control of CINV (adjusted odds ratio = 1.74, 95% CI = 1.01-3.01, P = 0.048). Among the demographic and CINV risk-factor variables, higher education, alcohol consumption, and prior exposure to other (nonanthracycline-based) chemotherapy regimens were associated with nonadherence (P

Background Electronic drug interaction databases are often utilized in clinical practice to detect for possible drug-drug interactions between drug pairs. It is uncertain, however, whether most of these detections interactions are clinically important in practice. To demonstrate these issues, this study utilized a comprehensive drug-drug interaction( DDI) electronic database to elucidate the prevalence of DDIs at a cancer centre between antidepressants and oral anticancer drugs( ACDs). Methods Drug utilization reports were retrieved to determine the patients who were prescribed with antidepressants oral ACDs between 2006 and 2009 at a cancer center. Medication records of these patients were retrospectively examined using OncoRx, an internet-based oncology-specific database that allows the identification of DDIs. Results Out of 910 users of antidepressants, about one-third( 281 patients, 30.9%) used an oral ACD and an antidepressant concomitantly. From these patients, about one-fifth( 21.0%) had potential DDIs. These patients were users of 17 potentially interacting drug pairs. Ten out of the 17 drug pairs could potentially cause pharmacokinetic interactions, and the rest were pharmacodynamic interactions, with only three out of the 17 drug pairs were clinically documented to cause interacting events. Conclusion The lack of screening conditions may have led to an over detection of DDI combinations by electronic DDI databases. Many of the detected interactions may not deem high significance in clinical practice. This study exposed a major weakness of current electronic DDI databases for detecting oral ACDs and antidepressants DDIs.

With the expected rise in newly diagnosed cancer cases among the elderly in Singapore, the affordability of cancer treatments, particularly of targeted therapies, will be a growing concern for patients. This study examines the perspectives of aging cancer patients on the financial burden of their cancer treatments. A single-center, prospective study was conducted in the largest ambulatory cancer center in Singapore. Older (50 years old and above) cancer patients receiving treatment were recruited. Patients completed three sets of self-reporting tools assessing their (a) demographics and lifestyles, (b) health-related quality of life, and (c) perceptions of cancer treatment costs. The association between targeted therapy utilities and their perceived financial burden was evaluated using a multivariable logistic regression. Five hundred and sixteen patients were included in the study. The majority of the respondents (69.6 %) were between 50 and 64 years old. The majority were Singaporeans (97.7 %), belonged to the ethnic Chinese group (88.4 %), and most were female (59.1 %). The users of targeted therapies were 2.92 times more likely to perceive that the amount of cash that they spent on cancer treatment was more than expected and 2.52 times more likely to have difficulty paying for cancer treatments. Fortunately, the majority of the respondents (70.6 %) found their existing financial schemes helpful in reducing the necessary out-of-pocket expenses. Although aging cancer patients feel that the financial schemes in Singapore have helped them tremendously, the general perception is that they require further help to offset their out-of-pocket expenses. This is especially true for users of targeted therapies and those who have a poorer health status.

Cancer-related fatigue (CRF) has been suggested to be associated with the occurrence of chemotherapy-induced nausea and vomiting (CINV). This study aims to evaluate the potential of CRF in predicting the occurrence of CINV.This is a prospective, observational study. Recruited patients received moderately to highly emetogenic single-day chemotherapy regimens. On the day of chemotherapy, patients were instructed to provide a score (Likert scale of 0-10) to describe how CRF interfered with his or her ability to engage in daily activities and a score for how severe it was. Patients were then given a standardized 5-day diary to document their CINV events.A total of 473 eligible patients (median age: 55 years, interquartile range (IQR): 48-61 years) were recruited, with most of the patients diagnosed with gastrointestinal (45%) and breast (37%) cancers. The median score of fatigue interference was 3 (IQR: 0-5). After confounders were adjusted for, patients with low fatigue interference scores (≤3) were more likely to achieve complete protection (no nausea, no vomiting, and no breakthrough antiemetics) of CINV (adjusted odds ratio = 1.57, 95%CI [1.05, 2.35], p = 0.027).This is the largest study to date to evaluate the association between CRF and CINV. Patients experiencing CRF possessed a higher risk of poor control for CINV.

State anxiety, a risk factor for chemotherapy-induced nausea and vomiting (CINV), is a subjective symptom and difficult to quantify. Clinicians need appropriate anxiety measures to assess patients' risks of CINV. This study aimed to determine the anxiety characteristics that can predict CINV based on computational analysis of an objective assessment tool. A single-center, prospective, observational study was carried out between January 2007 and July 2010. Patients with breast, head and neck, and gastrointestinal cancers were recruited and treated with a variety of chemotherapy protocols and appropriate antiemetics. Chemotherapy-induced nausea and vomiting characteristics and antiemetic use were recorded using a standardized diary, whereas patients' anxiety characteristics were evaluated using the Beck Anxiety Inventory. Principal component (PC) analysis was performed to analyze the anxiety characteristics. A subset known as principal variables, which had the highest PC weightings, was identified for patients with and without complete response, complete protection, and complete control. Chemotherapy-induced nausea and vomiting events and anxiety characteristics of 710 patients were collated; 51%, 30%, and 20% were on anthracycline-, oxaliplatin-, and cisplatin-based therapies, respectively. Most patients suffered from delayed CINV, with decreasing proportions achieving complete response (58%), complete protection (42%), and complete control (27%). Seven symptoms (fear of dying, fear of the worst, unable to relax, hot/cold sweats, nervousness, faintness, numbness) were identified as potential CINV predictors. This study demonstrates the usefulness of PC analysis, an unsupervised machine learning technique, to identify 7 anxiety characteristics that are useful as clinical CINV predictors. Clinicians should be aware of these characteristics when assessing CINV in patients on emetogenic chemotherapies.

Background: Non-adherence to oral anticancer agents has been identified as a prevalent behavior amongst breast cancer patients. However, the prevalence of non adherence to outpatient antiemetic regimens that are prescribed for delayed emesis prevention in breast cancer patients is limited in the literature. Hence, this study was conducted to evaluate the impact of adherence to delayed antiemetic regimens on chemotherapy induced nausea and vomiting (CINV) control in breast cancer patients, and to identify patient characteristics that may be associated with non-adherence to antiemetic regimens. Methods: This was a prospective, observational study conducted at the largest ambulatory cancer center in Singapore from December 2006 to January 2011. All breast cancer patients receiving anthracycline-based chemotherapy and standardized outpatient antiemetic regimens were recruited. On the day of chemotherapy, patients were given a standardized 5-day diary to document their emesis events and their demographics obtained via interview. Pearson Chi-square test and multiple logistic regression were performed to analyze the impact of adherence on CINV control. Results: A total of 361 eligible patients were included in the final analysis (mean = 50.0±8.9 years). Majority of the patients were Chinese (80.1%) and diagnosed with Stage 2 and above breast cancer (88.1%). Almost half of the patients (42.1%) were non-adherent to their prescribed delayed antiemetics regimens, with dexamethasone usage being the least adhered to (non adherence: 37.4%). After adjusting for potential confounders (ethnicity, education level and stage of disease), patients who were adherent to antiemetics were more likely to achieve complete CINV control (defined as no emetic episodes, no nausea, and no rescue therapy required) than patients who were non adherent (NNT=9.6; Adjusted OR=1.74, 95% CI: 1.01 3.01). In addition, young women aged between 21−40 years old, pursued higher education, and diagnosed with Stage 1 breast cancer were associated with non adherence to antiemetics (p < 0.05). Conclusion: This is the largest study to date to evaluate the prevalence of non-adherence to delayed antiemetics among breast cancer patients. Our findings indicate that a substantial amount of Asian breast cancer patients (42.1%) were not adherent to their antiemetic regimens, which may have resulted into poor control of CINV.

Background: XELOX (combination therapy of capecitabine and oxaliplatin) is known to cause nausea and vomiting, despite adequate administration of antiemetics. Furthermore, specific risk factors that may increase the risk of nausea and vomiting are unknown. Methods: This was a single-centre, prospective, cohort study. Patients were recruited on the day of chemotherapy, and were followed up after 5 days to assess nausea, vomiting, and use of antiemetics. Patients were assessed for nausea and vomiting control, as well as complete response, complete protection, and complete control of antiemetics. Use of delayed and breakthrough antiemetics were assessed, and multivariable logistic regression was done to evaluate risk factors that predisposed patients to nausea and vomiting despite use of antiemetics. Findings: 156 patients were included in this analysis. The median age was 60 years (IQR 55–65) with 88 (56.4%) men and 68 (43.6%) women. The proportion of patients achieving complete response, complete protection, and complete control within 24 hours after chemotherapy was 87.8%, 80.8%, and 62.8%, respectively. These proportions continued to decline throughout the follow-up period to 76.9%, 64.7%, and 48.7%, respectively, at the end of the 5 days. Patients who had fewer than three risk factors (odds ratio [OR] 3.13, p=0.006), who received oxaliplatin less than 100mg/m2 (OR 3.23, p=0.009), and who received capecitabine less than 1500mg/m2 (OR 5.00, p=0.04) were more likely to achieve complete response to antiemetics. Interpretation: This study showed that an unacceptably high proportion of patients receiving XELOX were unable to attain adequate control of nausea. Future research should focus on the optimisation of antiemetic therapy for patients receiving XELOX. Funding: National University of Singapore, Faculty of Science start-up grant. The authors declared no conflicts of interest.