Management of temozolomide toxicity by nurse practitioners in neuro-oncology.
Management of temozolomide toxicity by nurse practitioners in neuro-oncology.
复制标题
神经肿瘤科执业护士对替莫唑胺毒性的管理。
作者：
H. Zwinkels;K. Roon;F. Jeurissen;M. Taphoorn;W. Hop;C. Vecht
目的/目标
目的探讨替莫唑胺（TMZ）治疗脑肿瘤患者的毒性反应及相应的护理措施。
设计
前瞻性数据的探索性分析。
设置
由执业护士（NP）领导的TMZ诊所。
样品
A组（n = 71）给予标准剂量TMZ 200 mg/m2，每日1次，共5 d，每4周1次; B组（n = 19）给予TMZ 75 mg/m2，每日1次，共21 d，每4周1次。
方法
根据美国国家癌症研究所通用术语标准对毒性进行评分，并比较两组的结果。
主要研究变量
血小板减少症、中性粒细胞减少症和淋巴细胞减少症;恶心和呕吐;和NP干预。
结果
在6个周期内观察到的毒性中，3-4级血小板减少症在A组中最常见。A组中性粒细胞减少和后续干预的发生频率高于B组。随后的干预措施包括延迟给药和减量。当患者接受TMZ治疗的时间较长时，B组中3-4级淋巴细胞减少症的发生率明显更高，需要预防卡氏肺孢子虫肺炎。
结论
使用5天200 mg/m2或21天75 mg/m2方案每4周一次的毒性程度与其他研究中发现的相似。
对护理的影响
通过了解与脑肿瘤相关的毒性，NP可以在TMZ毒性的主动管理中变得更有效。
PURPOSE/OBJECTIVES
To investigate the toxicity of temozolomide (TMZ) in patients with brain tumors and appropriate nursing interventions.
DESIGN
Explorative analysis of prospective data.
SETTING
A TMZ clinic led by a nurse practitioner (NP).
SAMPLE
Group A (n = 71) received a standard dose of TMZ daily for five days 200 mg/m2 every four weeks; group B (n = 19) received a dose-intense schedule of TMZ daily for 21 days 75 mg/m2 every four weeks.
METHODS
Toxicities were scored according to National Cancer Institute Common Terminology Criteria, and results in the two groups were compared.
MAIN RESEARCH VARIABLES
Thrombopenia, neutropenia, and lymphopenia; nausea and vomiting; and NP interventions.
FINDINGS
Of observed toxicities during six cycles, grade 3-4 thrombopenia was seen most frequently in group A. Neutropenia and subsequent interventions occurred more frequently in group A than in group B. Subsequent interventions consisted of dose delays and reductions. When patients were treated for a longer duration of time with TMZ, grade 3-4 lymphopenia occurred significantly more often in group B, necessitating Pneumocystis carinii pneumonia prophylaxis.
CONCLUSIONS
Degree of toxicity using a 5-day 200 mg/m2 or 21-day 75 mg/m2 schedule every four weeks was similar to that found in other studies.
IMPLICATIONS FOR NURSING
Through awareness of toxicity in relation to knowledge of brain tumors, NPs can become more effective in active management of TMZ toxicity.