Improving the Patient

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Improving the Patient

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Title: Improving the Patient

1
Improving the Patients Experience with
Capecitabine

Reshenthie Govender
Clatterbridge Centre for Oncology
NHS Foundation Trust

2
Overview

Capecitabine
Treatment problems
Capecitabine Counselling Clinic
Objectives
Methods
Results
Future
Conclusion

Capecitabine
Oral fluoropyrimidine ? enzymatic conversion to
5-fluorouracil
Advantages - convenient oral tablet
avoids hospital stay
less burden on staff
However side-effects can be serious
we depend on patients to report side-effects
promptly
NPSA RRR (Nov 03 Jul 07) highlighted risks
of oral chemotherapy
? 3 deaths
? 42 of total incidents involved Capecitabine
Therefore
Patients need greater support education
to ? risks
Staff need ? awareness of hazards seen

4
Treatment of locally advanced T3 or T4 Colorectal
Tumour
Pre-operative Chemo-radiotherapy (CRT)
Inpatient
Outpatient
Capecitabine 825mg/m2 b.d. Mon-Fri x 5
weeks (600mg/m2 if gt 70 years or CrCl 30 -
50ml/min)
5-Fluorouracil 1000mg/m2 i.v. x 24 hours 1st week
last week of radiotherapy
Radiotherapy Mon-Fri x 5 weeks
Radiotherapy Mon-Fri x 5 weeks
Unlicensed (dose and indication)
5

Treatment Problems
Patients given Capecitabine with correct dosing
schedule on label
but given commercially prepared diaries with the
licensed dosing schedule and
no reference to radiotherapy
? Caused patient confusion
? Some followed wrong schedule
Possible inconsistent patient counselling
? patients not reporting side-effects sooner
3. Patients visit involved several clinical
areas within the hospital
Solution
? Improve Service Delivery and Education

Objectives
Improve patient understanding of dosing schedule
through
counselling education
Ensure uniformity of information given
Supply a specific Capecitabine Patient Diary
(Chemo-radiation)
Provide a one stop Multidisciplinary visit for
patient on the 1st
day of radiotherapy
? thereby helping to improve patients overall
experience

7
Methods
Conduct a pilot study
1. Setting up of Capecitabine Counselling Clinic
? one pharmacist ? one consultants
patients ? one day in the week
2. Development of a Counselling Procedure
Document to ensure uniformity of information
given
3. Produce a Capecitabine Patient Diary
specifically for CRT
8
Capecitabine Counselling Clinic
Consultant
Specialist Colorectal Nurse
Pharmacist

Radiotherapy
Chemotherapy Triage Nurse
9
Capecitabine Counselling Clinic
Pharmacist

Spends 30 minutes per patient relative / carer
? provides second check on blood results
? dispenses counsels on Capecitabine
? gives written information Capecitabine
Patient Diary

10
Counselling Procedure Document
11
Capecitabine Patient Diary
12
(No Transcript)
13
Results

Clinic started 22 Oct 07 Oct 08 (12 months)

All but 4 were Capecitabine naïve

59
Total 78

Mean age 64.5 years

14
Results

Significant Interventions Minor Interventions
Warfarin interaction CrCl 35 ml/min cardiac history Warfarin interaction
Allopurinol interaction Regular paracetamol
Allopurinol interaction Diabetic neuropathy
? Hb - blood transfusion required Regular co-dydramol
Methotrexate incorrectly taken CrCl 47ml/min Glucose monitoring CrCl 38 ml/min cardiac history
Haemodialysis allopurinol interaction existing cardiac impairment Course of ondansetron
Glucose monitoring regular paracetamol
Glucose monitoring
Monitoring of glucose LFTs (? Bil GGT)