Supportive Care in Cancer

, Volume 23, Issue 11, pp 3269–3275 | Cite as

Optimisation of steroid prophylaxis schedules in breast cancer patients receiving docetaxel chemotherapy—a survey of health care providers and patients

  • Carmel Jacobs
  • Brian Hutton
  • Sasha Mazzarello
  • Stephanie Smith
  • Anil Joy
  • Eitan Amir
  • Mohammed F. K. Ibrahim
  • Nancy Gregario
  • Kelly Daigle
  • Lori Eggert
  • Mark Clemons
Original Article

Abstract

Purpose

Despite the widespread use of steroid prophylaxis schedules for breast cancer patients receiving docetaxel chemotherapy, questions still exist regarding their optimal use. We surveyed health care providers and patients about their experiences with steroid prophylaxis.

Methods

Two questionnaires were developed and circulated. One was presented to health care providers (chemotherapy nurses, pharmacists and medical oncologists) involved in the treatment of breast cancer and the second to patients who had received docetaxel chemotherapy for early stage breast cancer.

Results

The health care providers’ questionnaire was completed by 184 of 698 invitees: 92/171 (53.8 %) chemotherapy nurses, 56/284 (19.7 %) pharmacists and 36/243 (14.8 %) medical oncologists (overall response rate 26.4 %). Two steroid schedules were found to be the most commonly used: dexamethasone 8 mg BID for 6 doses, with either 3 (79 %) or 2 (11 %) doses taken before docetaxel administration. Suboptimal adherence to steroid premedication had been experienced by 98 % (177/181) of practitioners. Despite the presence of local treatment protocols in 65 % (119/183) of practitioners’ institutions, 10 different strategies were commonly used when steroid premedication was taken incorrectly. The patients’ questionnaire was completed by 72/87 (82.3 %) invitees. Respondents reported correctly taking their premedication 99 % (70/71) of the time. Patients felt steroids frequently caused side effects, the most common being sleep disturbance (35/72 = 49 %) and skin toxicity (16/72 = 22 %).

Conclusion

Suboptimal adherence to steroid premedication prior to docetaxel administration is a common clinical challenge. There appears to be discordance between the practitioner and the patient experience. A single, universally accepted and used protocol for both pre- and post-medication and management when premedication is not taken as prescribed could improve adherence.

Keywords

Breast cancer Docetaxel Corticosteroid Premedication 

Notes

Acknowledgments

The authors wish to acknowledge Flay Charbonneau for her help with survey distribution.

Conflict of interest

BH has previously received consultancy fees and remuneration from Amgen Canada. All other authors have no conflicts of interest or disclosures to declare.

Compliance with ethical standards

This study was approved by the Ottawa Health Sciences Network Research Ethics Board, protocol number #20140027-01H. The study complies with the laws of the countries in which it was performed.

Supplementary material

520_2015_2731_MOESM1_ESM.docx (24 kb)
Appendix 1 (DOCX 24 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Carmel Jacobs
    • 1
    • 6
  • Brian Hutton
    • 2
  • Sasha Mazzarello
    • 1
  • Stephanie Smith
    • 1
  • Anil Joy
    • 3
  • Eitan Amir
    • 4
  • Mohammed F. K. Ibrahim
    • 5
  • Nancy Gregario
    • 4
  • Kelly Daigle
    • 1
  • Lori Eggert
    • 1
  • Mark Clemons
    • 1
  1. 1.The Ottawa Hospital Cancer Center and University of OttawaOttawaCanada
  2. 2.University of Ottawa and Ottawa Hospital Research InstituteOttawaCanada
  3. 3.Department of Oncology, Division of Medical OncologyUniversity of Alberta, Cross Cancer InstituteEdmontonCanada
  4. 4.Division of Medical OncologyPrincess Margaret HospitalTorontoCanada
  5. 5.Department of Medical OncologySt. Vincent’s University HospitalDublinIreland
  6. 6.Division of Medical OncologyThe Ottawa Hospital Cancer CentreOttawaCanada

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