Patients' self-reported adherence to capecitabine on XELOX treatment in metastatic colorectal cancer: findings from a retrospective cohort analysis.

BACKGROUND: Capecitabine plus oxaliplatin (XELOX) has been established as a first-line treatment for metastatic colorectal cancer. Adherence is particularly important with capecitabine to maintain appropriate curative effect. In this study, we monitored the adherence to capecitabine on XELOX treatment and investigated which factors might decrease compliance. METHODS: The study included 242 consecutive patients who received XELOX treatment for metastatic colorectal cancer between October 2009 and March 2012. Adherence to capecitabine was checked by pharmacists with a patient-reported treatment diary at a pharmaceutical outpatient clinic. Adherence rate was defined as the number of times that a patient took capecitabine in a 14-day cycle/28 prescribed doses. We retrospectively surveyed median relative dose intensities of capecitabine and the factors deteriorating adherence across eight cycles from electronic patient records and examined differences in compliance rates according to age. RESULTS: The study included 144 male and 98 female patients. The overadherence rate was 1.5% (n=23). The median adherence rate was 93.5% (n=242) in the first cycle of XELOX treatment, which gradually rose to 96.1% (n=148) in the eighth cycle. The median relative dose intensity of capecitabine was 79.2%. The main factors contributing to decreased adherence to capecitabine were diarrhea (22.5%, 352 instances) and nausea/vomiting (13.8%, 215 instances). The rate of missed dose was 12.1%. Analysis of adherence issues in relation to patient age showed a trend toward worse adherence to capecitabine therapy in the group of patients aged ≥80 years (hazard ratio =3.83; 95% confidence interval 2.48-5.91, P<0.001 versus 70-80 years group and versus <70 years group, chi-square test). CONCLUSION: Patient-reported adherence to capecitabine on XELOX treatment in clinical practice is high but adversely affected by side effects. Patients aged 80 years or more exhibit a significant decrease in compliance compared with younger patients.

[Efficacy of preventive treatment for delayed emesis induced by FOLFOX4 chemotherapy].

The control of delayed emesis is very important in order to continue ambulatory chemotherapy. We performed retrospective study that examined the efficacy of preventive treatment (granisetron+dexamethasone+domperidone) for delayed emesis induced by FOLFOX4 chemotherapy for advanced and recurrent colorectal cancer. The subjects were 92 patients who underwent FOLFOX4 chemotherapy at the Cancer Institute Hospital of JFCR (group with preventive treatment: 50, group without preventive treatment: 42), and the observation period was set as the 1st-9th cycle. The complete nausea inhibition rate was 50.0% in the group with and 21.5% in the group without preventive treatment, showing a significantly higher inhibition rate in the former (p=0.0047). The complete vomiting inhibition rates were 86.0% and 66.7%, respectively, again showing a significantly higher inhibition rate in the former (p=0.015). On multivariate analysis (multiple logistic analysis), the development of nausea/vomiting and preventive treatment for delayed emesis were significantly associated, showing that the treatment was an independent preventive factor. All adverse reactions induced by preventive treatment were mild, suggesting no safety-related problem. These findings suggested the usefulness of preventive treatment with granisetron, dexamethasone, and domperidone for FOLFOX4 chemotherapy-induced delayed emesis.

[Preparation of a brochure for patients undergoing FOLFIRI chemotherapy based on survey of adverse reactions].

We have retrospectively been collecting data on adverse reactions to FOLFIRI chemotherapy in our hospital from September 2005 to August 2006, by electronic medical records. The retrospective study was of 67 patients who received FOLFIRI for advanced colorectal cancer. Survey results showed high incidences of vomiting(58.2%), anorexia(91.4%), constipation (47.8%), diarrhea (61.2%) and alopecia(71.6%). The first cycle using FOLFIRI therapy, vomiting (20.9%), anorexia(53.7%), constipation ( 14.9%), and diarrhea (23.9%)were observed. We sought to minimize inter-individual differences in pharmaceutical care and drug consultation by clinical pharmacists and to ensure the accurate understanding of patients. We are sure that this kind of activity will help us to provide better pharmaceutical care for patients.