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

Supportive Care in Cancer volume 23, pages 3269–3275 (2015)Cite this 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.

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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.

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Authors and Affiliations

  1. The Ottawa Hospital Cancer Center and University of Ottawa, Ottawa, ON, Canada

    Carmel Jacobs, Sasha Mazzarello, Stephanie Smith, Kelly Daigle, Lori Eggert & Mark Clemons

  2. University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Brian Hutton

  3. Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada

    Anil Joy

  4. Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON, Canada

    Eitan Amir & Nancy Gregario

  5. Department of Medical Oncology, St. Vincent’s University Hospital, Dublin, Ireland

    Mohammed F. K. Ibrahim

  6. Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Box 900, Ottawa, ON, K1H 8L6, Canada

    Carmel Jacobs

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  1. Carmel Jacobs
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Correspondence to Carmel Jacobs.

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Jacobs, C., Hutton, B., Mazzarello, S. et al. Optimisation of steroid prophylaxis schedules in breast cancer patients receiving docetaxel chemotherapy—a survey of health care providers and patients. Support Care Cancer 23, 3269–3275 (2015). https://doi.org/10.1007/s00520-015-2731-8

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  • DOI: https://doi.org/10.1007/s00520-015-2731-8

Keywords

  • Breast cancer
  • Docetaxel
  • Corticosteroid
  • Premedication