Hensley, M.L., Hagerty, K.L., Kewalramani, T., Green, D.M., Meropol, N.J., Wasserman, T.H., . . . Schuchter, L.M. (2009). American Society of Clinical Oncology 2008 clinical practice guideline update: Use of chemotherapy and radiation therapy protectants. Journal of Clinical Oncology, 27(1), 127–145.
DOI Link
Purpose
STUDY PURPOSE: To update the American Society of Clinical Oncology (ASCO) guidelines on the use of chemotherapy and radiation therapy protectants for patients with cancer
TYPE OF STUDY: Systematic review
Search Strategy
DATABASES USED: MEDLINE, preMEDLINE, Cochrane Collaboration Library
KEYWORDS: Dexrazoxane, mesna, amifostine, and palifermin. These terms combined with neoplasms, cancer, malignancies, and tumors.
INCLUSION CRITERIA: Reviewers limited the search to randomized controlled trials, meta-analyses and systemic reviews. The specific criteria included participants with cancer receiving chemotherapy and/or radiation. Participants were randomly assigned to a protectant arm or a control arm and the outcomes reported included as least one of the following toxicities including but not limited to hemorrhagic cystitis, neurotoxicity, neutropenia, and mucositis. Inclusions looked at included compliance, quality of life, cost effectiveness, and disease-free survival. The main focus was to determine any chemotherapy/radiation therapy-induced toxicity.
EXCLUSION CRITERIA: Prospective or retrospective cohort studies and phase I or phase II randomized trials
Literature Evaluated
TOTAL REFERENCES RETRIEVED: 744
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Evidence summary tables were used to extract data. Originally, 744 studies were identified and reviewed for inclusion. After screening abstracts, 643 were eliminated, leaving 101 to undergo a full review for interventions and outcomes. Of that, 62 were excluded, leaving 39 articles left for inclusion.
Sample Characteristics
FINAL NUMBER STUDIES INCLUDED = 39
TOTAL PATIENTS INCLUDED IN REVIEW = Large volume of patients
KEY SAMPLE CHARACTERISTICS: Patients with non-small cell cancer, head and neck cancer, prostate cancer, ovarian cancer, Ewing’s sarcoma, and multiple blood cancers
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
Results
All the 2002 recommendations were reviewed and addressed. New findings include recommendations against amifostine for the prevention of neutropenia in patients receiving chemotherapy/radiation therapy. Palifermin is recommended for patients undergoing an autologous stem cell transplant and allogeneic with hematologic malignancies to prevent mucositis. No other new evidence or change in guideline recommendation was discovered.
Mesna dosing with standard-dose ifosfamide—Recommended when the ifosfamide dose is less than 2.5 g/m2 per day.
Mesna dosing with high-dose ifosfamide—Evidence is not sufficient to recommend mesna with high-dose ifosfamide.
Mesna with cyclophosphamide—Mesna plus saline diuresis is recommended in the setting of stem cell transplantation.
Conclusions
Using various chemotherapy/radiotherapy protectants is useful in certain malignancies for prevention of toxicity related to therapy. Future trials need to be blinded with placebo-controlled arms to provide key evidence to ensure safe guideline recommendations.
Limitations
Most of the trials lacked a placebo arm in the studies with the quality of the literature reviewed being limited. The panel found that different instruments and/or assessment tools varied for assessing the same outcome in multiple trials.
Nursing Implications
Nurses caring for this patient population need to be aware and understand that there are medications that can be given to prevent certain chemotherapy/radiation toxicities.
Legacy ID
4552
