[Implementation of a nurse-driven educational program improves management of sorafenib's toxicities in hepatocellular carcinoma].
BACKGROUND
Sorafenib is the standard treatment for advanced hepatocellular carcinoma (HCC). Due to its peculiar toxicities, improving patient's tolerance may need close follow-up. Nurses can play a crucial role, by driving a patient education program (EP). We aimed to prove that adding EP to usual care (UC) improves patient's care.


METHODS
Since 2011, oncologists referred patients treated by sorafenib to the EP, driven by clinical nurses. It consisted in a visit before first administration, weekly telephone calls and a visit before each oncologist consultation. We retrospectively compared patients followed by the EP to those followed by oncologist in usual care (UC) and patients included in a clinical trial (CT).


RESULTS
Since 2005, 129 patients were treated with sorafenib for HCC, 31 (24%) in the EP, 22 (17%) in CT and 76 (59%) with UC. Seventy-one percent of patients in the EP had toxicities identified during a telephone call, which prompted symptomatic measures in 65% of patients, leading to treatment modification before the planned on-site visit in 29% of patients. EP patients required less dose reductions (39% vs. 61% for UC, P=0.04), and median time to first dose reduction was shorter with EP than with UC (25 days vs. 45 days, P=0.036).


CONCLUSIONS
This study suggests a clinical benefit of EP, with a better toxicity's management of sorafenib, leading to less dose reduction. Different types of EP should be compared prospectively, focusing on quality of life.
Centre Eugene-Marquis, oncologie médicale, 35042 Rennes, France.
Angélique
A
Brunot
Centre Eugene-Marquis, oncologie médicale, 35042 Rennes, France.
Amel
A
M'Sadek
CHU Pontchaillou, hépatologie, 2, rue Henri-le-Guilloux, 35033 Rennes, France.
Florence
F
Le Roy
Centre Eugene-Marquis, oncologie médicale, 35042 Rennes, France.
Marielle
M
Duval
Centre Eugene-Marquis, oncologie médicale, 35042 Rennes, France.
Samuel
S
Le Sourd
Centre Eugene-Marquis, oncologie médicale, 35042 Rennes, France.
Elodie
E
Ventroux
Centre Eugene-Marquis, oncologie médicale, 35042 Rennes, France.
Laurence
L
Crouzet
CHU Pontchaillou, hépatologie, 2, rue Henri-le-Guilloux, 35033 Rennes, France.
Anne
A
Guillygomarc'h
Centre Eugene-Marquis, oncologie médicale, 35042 Rennes, France.
Eveline
E
Boucher
Centre Eugene-Marquis, oncologie médicale, 35042 Rennes, France.
Nadine
N
Lelievre
Centre Eugene-Marquis, oncologie médicale, 35042 Rennes, France.
Brigitte
B
Laguerre
Centre Eugene-Marquis, oncologie médicale, 35042 Rennes, France. Electronic address: j.edeline@rennes.unicancer.fr.
Julien
J
Edeline
D000284:Administration, Oral; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001247:Asthenia / Q000139:chemically induced / Q000451:nursing; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000451:nursing; D003967:Diarrhea / Q000139:chemically induced / Q000451:nursing; D005260:Female; D060831:Hand-Foot Syndrome / Q000451:nursing; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000451:nursing; D008297:Male; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010353:Patient Education as Topic; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D057184:Practice Patterns, Nurses'; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D000077157:Sorafenib
D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D009536:Niacinamide; D000077157:Sorafenib
Clinical nurse specialist; Educational program; Infirmières; Quality of life; Qualité de vie; Targeted therapies; Thérapies ciblées; Toxicity; Toxicité; Éducation thérapeutique