Symptom-based protocol improves management of anticancer therapy infusion reactions

Implementation of a novel pharmacist-developed, symptom-based, nurse-driven protocol has led to a low failure rate in infusion reaction treatment among infusion-related reactions (IRRs) assessed, results of a study have shown.

“Although the failure rate was low, additional nurse education and improved access to protocol-directed medications may optimize use of the protocol,” the authors said.

In this study, retrospective evaluation was done in 456 patients, who received an infusion of anticancer therapy at Grady Health System in Atlanta, US, between February 2014 and March 2018.  Those who received a protocol-specific medication for infusion reaction management of a parenterally administered anticancer agent were eligible for analysis.

The rate of treatment failure within 72 hours of treatment for an IRR was the primary outcome.

Of the patients, 78 who experienced 108 IRRs in total met the eligibility criteria. Of the IRRs evaluated, 5 percent consisted of rigors only, 57 percent were mild or moderate in severity, 31 percent were severe or anaphylactic, and 7 percent were rigors in addition to a mild/moderate/severe reaction.

Eight of the 108 IRRs failed treatment, while six and two were evaluated in the emergency department and required hospital admission, respectively. Majority of the reactions (93 percent) resolved in the infusion centre, and patients were discharged home; none of them died.

Notably, paclitaxel and oxaliplatin were the most common offending agents.

“Intravenous anticancer therapy can be associated with hypersensitivity and/or IRRs which may result in life-threatening symptoms,” the authors said. “As part of a quality improvement project, oncology pharmacists developed and implemented a nurse-driven, symptom-based IRR protocol.”