Chemotherapy Safety Standards in the Developing World: is G CSF the Only Option?
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 1
Abstract
The developing world poses a new set of challenges for the ever more demanding field of oncology. Not only that one has to cope with the concept of new treatments, there are different patient expectations and difficulties with compromised and limited services in remote areas. Issues such as language barriers, paucity of trained staff and lack of health educators are common and need to be kept in check before confirming any treatment options. In this environment there are tough challenges like suitability for appropriate chemo regimen particularly in the palliative setting, safety of treatment delivery and monitoring. Furthermore there is little if any expertise available in remote areas that can cope with different treatment related toxicities. Combined with reluctance of people to travel considerable distances to reach medical facilities, problems are often overlooked and present at a stage too late for salvage. In this environment will it be safe to rely on measures such as G CSF only and a bigger question will this be enough? In accordance with the available evidence, hematological toxicity from chemotherapy, neutropenic complications in particular are the most fearsome. This is counted to be the most common cause for serious events in chemotherapy related treatments as well as commonest reasons for hospital admissions as well as delay in subsequent chemotherapy cycles that can prove to be detrimental in patients overall outcome [1]. In line with the proposed guidelines NCCN as well as EORTC guidance updated in 2011, there are recommendations for prophylactic as well as therapeutic usage of G CSF. This is based on percentage risk of FN (febrile neutropenia) associated with a particular regimen. This has been classified as High risk based on the 20% or more incidence of FN with a known chemo regimen or Intermediate i.e. between 10-20% risks of FN. In addition there are identifiable patient related factors such as age and co morbidities that have also been suggested as important in decision algorithms for the use of G CSF [2-5]. Risk assessment dictates the approach to therapy, including the need for inpatient admission, IV antibiotics, and prolonged hospitalization Low-risk patients are defined as those who are expected to be neutropenic (absolute neutrophil count [ANC] <500 cells/microL) for ≤7 days and those with no comorbidities or evidence of significant hepatic or renal dysfunction. Most patients receiving chemotherapy for solid tumors are considered to be low-risk for complications requiring hospitalization or prolonging hospitalization.
Authors and Affiliations
Arif Adnan Shaukat, Touqeer Ahmed Siddiqui
Keywords
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- EP ID EP567592
- DOI 10.26717/BJSTR.2017.01.000155
- Views 165
- Downloads 0
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