ABSTRACT
Purpose: The off-label (OL) use of antineoplastic drugs for the treatment of various types of tumors in patients of different disease stages is becoming a common occurrence. The objective of this study was to analyze these patterns by quantification and characterization of the OL use of antineoplastic drugs and their level of scientific evidence in a medium/high-complexity Spanish general university hospital. Method: All oncology patients who underwent OL treatment with one or several antineoplastics during the 10 years from 2002 to 2012 were retrospectively selected. The use of these drugs was considered OL if they were used for indications, stages, lines of treatment, or chemotherapy schemes not reflected in the summary of product characteristics published by the European Medicines Agency at the time of prescription. To calculate the prevalence of patients who received one or more OL treatments during the study period, all patients whose primary or secondary diagnosis had been coded with the diagnoses included in the study were selected through the minimum basic data set (MBDS). This database was cross-referenced with that of the Farmatools® program (Dominion®), which collects information on all patients receiving chemotherapy to obtain the total number of patients who received chemotherapy in the hospital during this period. Results: In total, 684 patients and 866 OL treatments were included. The prevalence of patients undergoing OL treatment with antineoplastics was 6%. OL treatments were used mainly for breast, gynecological, lung, and gastric tumors. The most often-used antineoplastic was paclitaxel, followed by gemcitabine, carboplatin, vinorelbine, and capecitabine, which were used mainly in monotherapy and with palliative intent. A total of 56.1% of the OL schemes used had a level of evidence of 2A according to the National Comprehensive Cancer Network, and 55.3% had a level of evidence of 2B according to Micromedex®. Conclusion: The OL use of antineoplastics in oncology patients is limited; their use is mainly focused in a small group of tumors and at advanced stages of disease. OL use of antineoplastics occurs under palliative therapeutic strategies with a limited number of drugs, preferably off-patent drugs. In addition, these OL treatments have high levels of clinical evidence.
ABSTRACT
El cáncer es un problema sanitario de primera magnitud a escala mundial. Su tratamiento es uno de los mayores campos de innovación y desarrollo en medicina. La visión del cáncer como una enfermedad sistémica, heterogénea y de una elevada complejidad hace que los enfermos deban recibir una atención oncológica de calidad, proporcionada por equipos multidisciplinares altamente cualificados. Además de la gran incidencia de malnutrición en estos pacientes, la intervención nutricional precoz puede mejorar su pronóstico, aumentar la calidad de vida y disminuir la tasa de complicaciones de la enfermedad. Por ello, es necesaria una estrecha colaboración entre el oncólogo y el experto en nutrición.
Subject(s)
Neoplasms/complications , Neoplasms/therapy , Nutrition Disorders/etiology , Nutrition Disorders/therapy , HumansABSTRACT
El cáncer es un problema sanitario de primera magnitud a escala mundial. Su tratamiento es uno de los mayores campos de innovación y desarrollo en medicina. La visión del cáncer como una enfermedad sistémica, heterogénea y de una elevada complejidad hace que los enfermos deban recibir una atención oncológica de calidad, proporcionada por equipos multidisciplinares altamente cualificados. Además de la gran incidencia de malnutrición en estos pacientes, la intervención nutricional precoz puede mejorar su pronóstico, aumentar la calidad de vida y disminuir la tasa de complicaciones de la enfermedad. Por ello, es necesaria una estrecha colaboración entre el oncólogo y el experto en nutrición (AU)
Cancer is a health problem of first magnitude worldwide. Treatment is one of the largest fields of innovation and development in medicine. The view of cancer as a systemic disease, heterogeneous and highly complex, makes patients should receive quality cancer care provided by highly qualified multidisciplinary teams. In addition to the high incidence of malnutrition in these patients, early nutritional intervention may improve prognosis, increase quality of life and decrease the rate of complications of the disease. Therefore, close cooperation between the oncologist and nutrition expert is needed (AU)
Subject(s)
Humans , Nutrition Therapy/methods , Neoplasms/diet therapy , Malnutrition/diet therapy , Patient Care Team/organization & administration , Malnutrition/epidemiology , Palliative Care/organization & administration , Disease ProgressionABSTRACT
El tratamiento con quimioterapia puede producir muchos efectos adversos. Aunque no sea un efecto secundario muy estudiado ni al que se le haya prestado mucha atención, uno de los más comunes es la alteración del sentido del gusto y/o del olfato secundarios a citostáticos como el cisplatino, los taxanos y la ciclofosfamida. Hasta un 75% de los enfermos que reciben quimioterapia presentan estas alteraciones y se ha demostrado que altera la calidad de vida de los pacientes. En 1999, estos trastornos fueron incorporados en la escala de toxicidad del Instituto Nacional del Cáncer. Hay una necesidad urgente de prestar una mayor atención a este efecto secundario con una correcta información a los pacientes y un mayor número de estudios que lo investiguen para introducir mejoras en su manejo (AU)
Chemotherapy agents can cause a wide range of adverse effects. Taste related symptoms are a common toxicity of the chemotherapic agents like cisplatin, taxanes or cyclophosphamide. Although the loss of olfactory and gustatory function is not outwardly apparent, it affects the patient substantially in daily life. Subjective taste and smell changes is in 75% of cancer patients undergoing chemotherapy. Taste alterations have been incorporated in the National Cancer Institute Common Toxicity Criteria since 1999. There is evidence that this type of alterations in cancer patients negatively affect quality of life. It is very important to inform the patient about this adverse effect because the recovery process will be slow and may take many months. There is an urgent need for increased attention to this effect, both in research and in clinical practice (AU)
Subject(s)
Humans , Antineoplastic Agents/adverse effects , Taste Disorders/chemically induced , Olfaction Disorders/chemically induced , Neoplasms/psychology , Quality of LifeABSTRACT
Introducción: La actividad laboral en el cáncer de pulmón es un aspecto psicosocial que ha recibido poca atención hasta el momento actual por distintos motivos, a pesar de considerarse una dimensión de la calidad de vida para todo paciente oncológico. Objetivos: Analizar la reinserción y adaptación al entorno laboral en una cohorte de pacientes con un carcinoma de pulmón para describir los factores que influyen en la vuelta al trabajo de estos enfermos. Pacientes y métodos: El estudio incluyó 35 pacientes consecutivos diagnosticados de un cáncer de pulmón y que estaban empleados en el momento del diagnóstico. El cuestionario incluyó aspectos epidemiológicos, clínicos y laborales (32 variables en total) que se relacionaron con la reincorporación al mundo laboral. También se incluyeron percepciones subjetivas de los enfermos respecto a este tema. Resultados: El 96,9% de los pacientes pasaron a inactivos tras comenzar el tratamiento de la enfermedad y un 85,7% lo seguían estando tras éste. La presencia de secuelas fue la variable con mayor influencia en la inactividad laboral. Conclusiones: Éste es el primer estudio exploratorio en nuestro país acerca de la reinserción laboral de los pacientes diagnosticados de un carcinoma de pulmón (AU)
Background: Cancer affects many dimensions determining quality of life, including work. However, the importance of work to cancer survivors has received little attention. Aim: Employment and work-related disability were investigated in a cohort of lung cancer patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 35 lung cancer patients who were employed at diagnosis. The questionnaire included cancer-related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face and 32 variables were recorded. Results: 96,9 per cent of patients were unable to work after diagnosis, but 85,7% returned to work at the end of treatment. Most of the problems reported in the study were linked to the sequelae of their disease and related treatments. Conclusions: This is the first exploratory study in Spain about labour reintegration in lung cancer patients. Further studies are necessary (AU)
