Optimisation of steroid prophylaxis schedules in breast cancer patients receiving docetaxel chemotherapy-a survey of health care providers and patients.
OBJECTIVE
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 %).


CONCLUSIONS
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.
The Ottawa Hospital Cancer Center and University of Ottawa, Ottawa, ON, Canada. jacobscarmel@hotmail.com.|Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Box 900, Ottawa, ON, K1H 8L6, Canada. jacobscarmel@hotmail.com.
Carmel
C
Jacobs
University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Brian
B
Hutton
The Ottawa Hospital Cancer Center and University of Ottawa, Ottawa, ON, Canada.
Sasha
S
Mazzarello
The Ottawa Hospital Cancer Center and University of Ottawa, Ottawa, ON, Canada.
Stephanie
S
Smith
Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada.
Anil
A
Joy
Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON, Canada.
Eitan
E
Amir
Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland.
Mohammed F K
MF
Ibrahim
Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON, Canada.
Nancy
N
Gregario
The Ottawa Hospital Cancer Center and University of Ottawa, Ottawa, ON, Canada.
Kelly
K
Daigle
The Ottawa Hospital Cancer Center and University of Ottawa, Ottawa, ON, Canada.
Lori
L
Eggert
The Ottawa Hospital Cancer Center and University of Ottawa, Ottawa, ON, Canada.
Mark
M
Clemons
D000328:Adult; D001943:Breast Neoplasms / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077143:Docetaxel; D004334:Drug Administration Schedule; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000379:methods*; D011795:Surveys and Questionnaires; D043823:Taxoids / Q000627:therapeutic use*; D016903:Drug Monitoring
D043823:Taxoids; D000077143:Docetaxel; D003907:Dexamethasone
Breast cancer; Corticosteroid; Docetaxel; Premedication