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Supportive Care in Cancer
Published in: Supportive Care in Cancer 11/2015

01-11-2015 | Original Article

Optimisation of steroid prophylaxis schedules in breast cancer patients receiving docetaxel chemotherapy—a survey of health care providers and patients

Authors: Carmel Jacobs, Brian Hutton, Sasha Mazzarello, Stephanie Smith, Anil Joy, Eitan Amir, Mohammed F. K. Ibrahim, Nancy Gregario, Kelly Daigle, Lori Eggert, Mark Clemons

Published in: Supportive Care in Cancer | Issue 11/2015

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Abstract

Purpose

Despite the widespread use of steroid prophylaxis schedules for breast cancer patients receiving docetaxel chemotherapy, questions still exist regarding their optimal use. We surveyed health care providers and patients about their experiences with steroid prophylaxis.

Methods

Two questionnaires were developed and circulated. One was presented to health care providers (chemotherapy nurses, pharmacists and medical oncologists) involved in the treatment of breast cancer and the second to patients who had received docetaxel chemotherapy for early stage breast cancer.

Results

The health care providers’ questionnaire was completed by 184 of 698 invitees: 92/171 (53.8 %) chemotherapy nurses, 56/284 (19.7 %) pharmacists and 36/243 (14.8 %) medical oncologists (overall response rate 26.4 %). Two steroid schedules were found to be the most commonly used: dexamethasone 8 mg BID for 6 doses, with either 3 (79 %) or 2 (11 %) doses taken before docetaxel administration. Suboptimal adherence to steroid premedication had been experienced by 98 % (177/181) of practitioners. Despite the presence of local treatment protocols in 65 % (119/183) of practitioners’ institutions, 10 different strategies were commonly used when steroid premedication was taken incorrectly. The patients’ questionnaire was completed by 72/87 (82.3 %) invitees. Respondents reported correctly taking their premedication 99 % (70/71) of the time. Patients felt steroids frequently caused side effects, the most common being sleep disturbance (35/72 = 49 %) and skin toxicity (16/72 = 22 %).

Conclusion

Suboptimal adherence to steroid premedication prior to docetaxel administration is a common clinical challenge. There appears to be discordance between the practitioner and the patient experience. A single, universally accepted and used protocol for both pre- and post-medication and management when premedication is not taken as prescribed could improve adherence.
Appendix
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Metadata
Title
Optimisation of steroid prophylaxis schedules in breast cancer patients receiving docetaxel chemotherapy—a survey of health care providers and patients
Authors
Carmel Jacobs
Brian Hutton
Sasha Mazzarello
Stephanie Smith
Anil Joy
Eitan Amir
Mohammed F. K. Ibrahim
Nancy Gregario
Kelly Daigle
Lori Eggert
Mark Clemons
Publication date
01-11-2015
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 11/2015
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-2731-8

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