‘Cancer changed everything’ ajp

• For example, as per the consumer medication information leaflet: nilotinib (Tasigna®) should be taken in the morning and evening, about 12 hours apart. It must not be taken with food. Take nilotinib at least 2 hours after eating. Do not eat for at least 1 hour after taking it. This will help you absorb the right amount of medicine to effectively treat your condition.

• Medication adherence may be compromised if the patient has plans which don’t fit the administration schedule – for instance dinner with friends/family/colleagues at 6pm. The practicality of a regimen should be an integral part of counselling. The patient should be informed that there is some flexibility with dosing as long as no food is consumed for 2 hours pre and 1 hour post each dose of nilotinib because food increases the absorption and therefore risk of toxicity.

“Improved adherence” is a misconception with oral chemotherapy. The elderly may be susceptible to non-adherence due to comorbidities, polypharmacy, poor cognition and lack of home support. The young may have poor insight, other priorities and a lack of social support. Social demographics may impact due to education level, low SES and poor psychological state. The possible consequences of non-adherence include: loss of effect, possible shorter time to relapse and poorer quality of life.

Non-pharmacological management involves avoidance of foods that cause/aggravate diarrhoea. For instance, dairy, spicy food, alcohol, caffeine and fat. Also, it is important to avoid drugs that induce diarrhoea. For instance, drugs with prokinetic effects like erythromycin and metoclopramide. Laxatives are another obvious example. Oral rehydration is vital. 8 to 10 large glasses of clear liquids per day is suggested. This can be water, sports drinks, clear juices or broth) or patients may prefer to carry a water bottle and sip throughout the day. Educating patients about self-care measures is important also. For instance, instructing the patient to record the number of stools and report symptoms of infection or dehydration.

• Loperamide is sufficient to control treatment-related diarrhoea in the majority of patients. Loperamide is a non analgesic opioid that decreases intestinal motility by directly affecting the smooth muscle of the intestine. A suggested regimen is: 4 mg at the first onset of diarrhoea followed by 2 mg every 4 hours or after every unformed stool and continued until diarrhoea free for 12 hrs. The normal maximum daily dose is 16 mg; however, for chemotherapy induced diarrhoea higher doses may be used for a short period of time. If diarrhoea persists beyond 24 hours, the dose of loperamide should be increased to 2 mg every 2 hours. If diarrhoea persists beyond 48 hours, the patient’s symptoms should be considered complicated and the patient referred to hospital.

Consisting of papules and pustules affecting the face and upper body, this rash is the most common cutaneous reaction with EGFR inhibitors. Agents which inhibit the epidermal growth factor receptor (EGFR) include monoclonal antibodies like cetuximab and oral small molecule EGFR inhibitors like gefitinib/erlotinib. Acneiform rash occurs as a result of direct EGFR inhibition, and not as an allergic reaction to the therapy. It is associated with a strong inflammatory element and is usually sterile although secondary infection may occur.

• Oropharyngeal pain can be the most significant patient symptom of antineoplastic therapy related mucositis. Early recognition and treatment of pain continues to be an important part of the management of oral mucositis. Topical analgesia includes Difflam alcohol free mouthwash or xylocaine viscous. Systemic analgesia includes non-opioid or low dose opioids if tolerated. NOTE: for patients experiencing difficulty with swallowing, use alternative route of administration (topical patches).

• EviQ: is a freely available online Australian government resource of cancer treatment protocols developed by multidisciplinary teams of cancer specialists. It has a goal to improve patient outcomes and reduce treatment variation. EviQ provides evidence-based information to support health professionals in the delivery of cancer treatments available at the time treatment decisions are being made including on dosing regimens, drug-drug and drug-food interactions and side effects. Patient information is also available