Transcript NECN SC Herceptin Reactions

NECN S/C Herceptin Reactions
October 2014
Wendy Anderson Macmillan Nurse Consultant Chemotherapy STNHSFT
Melanie Robertson Nurse Consultant Oncology CHS
Background
• IV Herceptin administration requires
– 6 hours observation post first cycle
– 2 hours observation post subsequent cycles
• Network protocol for IV Herceptin administration
requires
– 6 hours observation post first cycle
– 2 hours observation post second cycle
– Subsequent treatments no observation
• S/C Herceptin licence recommends observation
as per IV
• Local experience within SafeHer clinical trial
suggested observation may not be required.
Objectives
• Monitor the number of patients without
administration reactions to S/C Herceptin
• To specify reactions that were observed or
patient reported
• Report the type severity and timing of any
observed reactions
• Make recommendations re observation
requirements following S/C Herceptin
administration
Method
• All NECN cancer centres and units were
invited to participate in audit
• Seven out of nine Trust submitted patient
details to the Network
• Information was collected retrospectively on
previous administered cycles
Audit sample
• 110 number patients received S/C Herceptin
• 618 doses (at least) of S/C Herceptin were
administered in total
• 87% received S/C Herceptin as single agent
• 13% received S/C Herceptin concurrently with
chemotherapy
• 78% received S/C Herceptin as adjuvant
treatment
Results
Treatment intent
Herceptin Audit
Treatment Intent
90
80
70
60
50
40
30
20
10
85
25
Adjuvant
Metastatic
0
Treatment type
90
80
70
60
50
40
30
20
10
0
Combined with chemo
Single agent
Not reported
Reactions
• Of the 618 treatments given to 110 patients
– 3 patient reactions were seen
– 2.7% of patients had a reaction to S/C Herceptin
– Reactions were seen in 0.4% of overall treatments
administered.
• The audit had expected to document what
proportion of patients were observed for the
required time period but unfortunately failed to
do so.
Reactions
•
•
•
•
Of 110 patients and 618 doses given
3 patients had an observed reaction
no patients self reported a reaction
Reactions as below
Reaction
1
2
3
Cycle
3
9
1
Reaction Type
Rash
Rash
Fever
Other please
Reaction type state
Severity
blistering
pain
Severe
erythema
Mild
fever
dizziness
moderate
• Subsequent management
Drugs
non
non
Paracetamol
Reaction time
during admin
2 hours
3 mins
– Reaction 1 subsequent treatment given IV
– Reaction 2 Continued without intervention
– Reaction 3 subsequent treatment given with Paracetamol
and Chlorampheniramine pre meds
Recommendations
• NECN Chemotherapy group to consider the
following options regarding observation
schedule post S/C Herceptin administration
• Option1 - Observe in accordance with licence
• Option 2 – Observe as per current NECN
guidelines (6 hrs first treatment, 2hrs second)
• Option 3 – No observation recommended