title: Management of temozolomide toxicity by nurse practitioners in neuro-oncology.
abstract: OBJECTIVE
  To investigate the toxicity of temozolomide (TMZ) in patients with brain tumors and appropriate nursing interventions.
  
  
  METHODS
  Explorative analysis of prospective data.
  
  
  METHODS
  A TMZ clinic led by a nurse practitioner (NP).
  
  
  METHODS
  Group A (n = 71) received a standard dose of TMZ daily for five days 200 mg/m2 every four weeks; group B (n = 19) received a dose-intense schedule of TMZ daily for 21 days 75 mg/m2 every four weeks.
  
  
  METHODS
  Toxicities were scored according to National Cancer Institute Common Terminology Criteria, and results in the two groups were compared.
  
  
  METHODS
  Thrombopenia, neutropenia, and lymphopenia; nausea and vomiting; and NP interventions.
  
  
  RESULTS
  Of observed toxicities during six cycles, grade 3-4 thrombopenia was seen most frequently in group A. Neutropenia and subsequent interventions occurred more frequently in group A than in group B. Subsequent interventions consisted of dose delays and reductions. When patients were treated for a longer duration of time with TMZ, grade 3-4 lymphopenia occurred significantly more often in group B, necessitating Pneumocystis carinii pneumonia prophylaxis.
  
  
  CONCLUSIONS
  Degree of toxicity using a 5-day 200 mg/m2 or 21-day 75 mg/m2 schedule every four weeks was similar to that found in other studies.
  
  
  CONCLUSIONS
  Through awareness of toxicity in relation to knowledge of brain tumors, NPs can become more effective in active management of TMZ toxicity.
authors.affiliation: Department of Neurology, Medical Centre Haaglanden, Netherlands. h.zwinkels@mchaaglanden.nl
authors.forename: Hanneke
authors.initials: H
authors.lastname: Zwinkels
authors.forename: Krista
authors.initials: K
authors.lastname: Roon
authors.forename: Frank J F
authors.initials: FJ
authors.lastname: Jeurissen
authors.forename: Martin J B
authors.initials: MJ
authors.lastname: Taphoorn
authors.forename: Wim C J
authors.initials: WC
authors.lastname: Hop
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Vecht
mesh_terms: D000704:Analysis of Variance; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects; D001932:Brain Neoplasms / Q000188:drug therapy / Q000451:nursing; D016009:Chi-Square Distribution; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000451:nursing; D005910:Glioma / Q000188:drug therapy / Q000451:nursing; D006801:Humans; D008231:Lymphopenia / Q000139:chemically induced; D009325:Nausea / Q000139:chemically induced; D009426:Netherlands; D009503:Neutropenia / Q000139:chemically induced; D009722:Nurse Practitioners / Q000458:organization & administration*; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D009859:Oncology Nursing / Q000458:organization & administration*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D000077204:Temozolomide; D013921:Thrombocytopenia / Q000139:chemically induced; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide