Background and importance Dose banding (DB) is a strategy used to optimise the individualisation of antineoplastic treatments in order to reduce dose errors and achieve the highest efficiency.
Aim and objectives The aim of this work was to implement a DB system and analyse its impact on the efficiency and safety of patients treated with 5-fluorouracil (5-FU) elastomeric pumps and oxaliplatin, paclitaxel and gemcitabin solutions.
Material and methods Retrospective 5-month study, including 147 patients treated with antineoplastic agents (44 with 5-FU, 28 oxaliplatin, 36 paclitaxel and 39 gemcitabin). 5-FU was prepared in an elastomeric pump (Autofuser UFSC-2); the remaining drugs were prepared for infusion with NaCl 0,9% in a Freeflex plastic container.
Patients were divided into two groups for each drug, depending on the theoretical calculated doses adjusted to their body surface area (BSA): P1 higher-doses, P2 lower-doses. Dose-range was established with a ±5% variability.
In order to measure the efficiency, the number of elaborations, expired preparations and percentage of saved vials were noted.
Safety was determined comparing leucocyte (5-FU) and neutrophil levels (oxaliplatin, paclitaxel and gemcitabine) the day before the treatment and preceding the next dose.
Statistical association was investigated by applying Student’s t-test, and Wilcoxon and Shapiro–Wilks tests. Non-statistical significance was considered a favourable outcome.
Results Six 5-FU, oxaliplatin and paclitaxel doses were standardised covering 93.6%, 100% and 72% of patients, respectively, and seven gemcitabin doses covering 97.5%.
A total of 1527 preparations were elaborated (412 5-FU, 312 oxaliplatin, 431 paclitaxel and 372 gemcitabin) and the percentages of expired preparations were 6.3%, 15.6%, 4.4% and 11.8%, respectively. The efficient use of vials allowed a significant saving: 23.4% for 5-FU vials, 32.2% for oxaliplatin, 52.6% paclitaxel and 22.2% gemcitabin.
There were no statistical differences between leucocyte/neutrophil levels measured before and after the treatment in either group (5-FU: p=0.99/p=0.57; oxaliplatin: p= 0.71/p=0.57; paclitaxel: p=0.90/p=0.26; gemcitabin: p= 0.32/p=1).
Conclusion and relevance The implementation of the project turned out to be simple and satisfactory. The process proved to be efficient after the stock adjustment (oxaliplatin and gemcitabine). The DB did not compromise safety of patients in terms of haematological toxicity. Thus, DB represents a cost-effective technique that might be taken into account.
Conflict of interest No conflict of interest
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