Evaluation of cardiac toxicity related to capecitabine chemotherapy: single centre audit of local practice

Evaluation of cardiac toxicity related to capecitabine
chemotherapy: single centre audit of local practice.
Coote J1., McPartlin A2., Lee K1., Misra V1.
1Christie Hospital, Wilmslow Road, Withington, Manchester, M20 4BX: 2University of Manchester, Oxford Road, Manchester, M13 3PL Background:
Results:
Incidence of cardiotoxicity related to capecitabine 9 patients (9%) had a prior history of cardiac disease. chemotherapy is around 3-9%. There are no National or 7 patients developed probable cardiac symptoms whilst International guidelines on the use of capecitabine in on capecitabine therapy. One of these patients had a prior patients at risk of developing cardiac side effects. Based history of cardiac disease, and one a history of atrial on literature review, personal experience, and the New fibrillation and previous transient ischaemic attack. The York Heart Association (NYHA) classification of cardiac remaining five patients experiencing symptoms had no disease1, we have developed a set of standards (see box) to guide its use with respect to cardiotoxicity, 3 patients discontinued capecitabine because of cardiac including dose modifications where a history of cardiac side effects. One patient died suddenly at home within 30 days of receiving chemotherapy (cause unknown). We report the results of an initial audit of practise Were standards met?
1. and 2. Documentation of cardiac history: A cardiac
Standards:
history was taken in 95% patients but documentation of Cardiac history should be taken and documented for all patients being considered for treatment with 2. Where there is a positive cardiac history, the severity of symptoms should be recorded according to 3. All patients should be counselled regarding the risk of cardiac toxicity as part of an informed consent process. 4. Any patient developing possible cardiac symptoms 3. Counselling of cardiac risk: Information about
during a course of capecitabine chemotherapy should cardiac risk is now printed on consent forms for have appropriate cardiac investigations including capecitabine and 5-fluorouracil so this standard was not electrocardiogram (ECG) and cardiac enzymes. Results should be clearly documented in case notes. 4. Appropriate investigations performed and results
5. Capecitabine dose should be electively modified documented: Patients experiencing chest pain usually
according to cycle number and NYHA class (table 1). attend their local accident and emergency department so documentation of cardiac investigations was not always available in our case notes. Where results were Table 1. Recommended dose modifications according available there were no cases of abnormal ECGs or cardiac symptoms and tolerating treatment Methods:
5. Dose modification recommendations followed:
Case notes of 100 consecutive patients receiving Only 2 of the 9 patients with cardiac history had starting capecitabine as adjuvant or metastatic treatment for dose reduced as per guidelines. Dose was not colorectal and gastric cancers in 2008 were reviewed. increased at cycle 3 in either case. Patient demographics were recorded, as well as regime Conclusions and recommendations:
and dose of capecitabine used, dose reductions and early termination of treatment. Toxicity was assessed Documentation of NYHA classification of cardiac using National Cancer Institute Common Terminology disease was poor and results of investigations were Criteria for Adverse Events (CTCAE) version 3 and often not available in our notes. Dose modification documentation of cardiac history and investigations (if Action plan: To raise awareness of guidelines and audit
Results were processed using SPSS software. results to improve documentation and adherence to dose modification recommendations. References:
A re-audit is planned following distribution of these 1. www.hcoa.org/hcoacme/chf-cme/chf00070.htm

Source: http://goingfora.com/docs/oncology/pdf/Coote_2009.pdf