Audit on Subcutaneous Herceptin Administration Reactions
An audit was conducted to monitor reactions to subcutaneous Herceptin administration, with a total of 618 doses given to 110 patients. Only 2.7% of patients experienced reactions. Recommendations on observation requirements post-administration were made based on the findings.
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NECN S/C Herceptin Reactions October 2014 Wendy Anderson Macmillan Nurse Consultant Chemotherapy STNHSFT Melanie Robertson Nurse Consultant Oncology CHS
Background IV Herceptin administration requires 6 hours observation post first cycle 2 hours observation post subsequent cycles Network protocol for IV Herceptin administration requires 6 hours observation post first cycle 2 hours observation post second cycle Subsequent treatments no observation S/C Herceptin licence recommends observation as per IV Local experience within SafeHer clinical trial suggested observation may not be required.
Objectives Monitor the number of patients without administration reactions to S/C Herceptin To specify reactions that were observed or patient reported Report the type severity and timing of any observed reactions Make recommendations re observation requirements following S/C Herceptin administration
Method All NECN cancer centres and units were invited to participate in audit Seven out of nine Trust submitted patient details to the Network Information was collected retrospectively on previous administered cycles
Audit sample 110 number patients received S/C Herceptin 618 doses (at least) of S/C Herceptin were administered in total 87% received S/C Herceptin as single agent 13% received S/C Herceptin concurrently with chemotherapy 78% received S/C Herceptin as adjuvant treatment
Treatment intent Herceptin Audit Treatment Intent 90 80 70 60 50 40 30 20 10 85 25 0 Adjuvant Metastatic
Treatment type 90 80 70 60 50 40 30 20 10 0 Combined with chemo Single agent Not reported
Reactions Of the 618 treatments given to 110 patients 3 patient reactions were seen 2.7% of patients had a reaction to S/C Herceptin Reactions were seen in 0.4% of overall treatments administered. The audit had expected to document what proportion of patients were observed for the required time period but unfortunately failed to do so.
Reactions Of 110 patients and 618 doses given 3 patients had an observed reaction no patients self reported a reaction Reactions as below Other please state pain Reaction Cycle 3 9 1 Reaction Type Rash Rash Fever Reaction type blistering erythema fever Severity Severe Mild moderate Paracetamol Drugs non non Reaction time during admin 2 hours 3 mins 1 2 3 dizziness Subsequent management Reaction 1 subsequent treatment given IV Reaction 2 Continued without intervention Reaction 3 subsequent treatment given with Paracetamol and Chlorampheniramine pre meds
Recommendations NECN Chemotherapy group to consider the following options regarding observation schedule post S/C Herceptin administration Option1 - Observe in accordance with licence Option 2 Observe as per current NECN guidelines (6 hrs first treatment, 2hrs second) Option 3 No observation recommended
