E. Dewaele Archives

A digital automated health monitoring system for oncology patients during the COVID-19 pandemic: practical issues and lessons for the future

BJMO - volume 15, issue 6, october 2021

J. Robijns PhD, J. Lodewijckx MSc, K. Wijnen PhD, S. Snoekx MSc, R. Hilkens RN , S. Bortels RN , H. Lenders RN , W. Nassen RN , E. Dewaele MD, D. Luyten MD, E. Joosens MD, A. Requilé MD, Y. Verheezen MD, T. Wessels MD, P. Bulens MD, J. Mebis MD

SUMMARY

During the COVID-19 pandemic, patients with cancer are subject to multiple risks (e.g., frequent hospital visits, increased infection risk, more severe clinical course, discontinued cancer treatment). Patients undergoing cancer therapy can face quality of life (QoL) – impairing side effects. Both for COVID-19 positive and negative patients who will continue or discontinue cancer treatment throughout the pandemic, providing supportive care is more important than ever. Digitally monitoring patient-reported outcome measures (PROMs) could offer a solution to improve the supportive care during cancer treatment, and certainly in times of COVID–19.

A prospective cohort trial was performed between August 2020 and February 2021 at the Jessa Hospital (Hasselt, Belgium), evaluating the feasibility and usability of a digital patient monitoring (DPM) system to collect PROMs of oncology patients undergoing chemotherapy during the COVID-19 pandemic. Based on available evidence from our trial, digitalised PROMs could significantly contribute to improved communication, patient satisfaction, supportive care, monitoring cancer treatment, and detecting problems. However, the DPM system needs fine-tuning to lead to a patient and healthcare worker-friendly system, fully incorporated in the electronic health records without losing the personal contact between patient and healthcare team.

(BELG J MED ONCOL 2021;15(6):292-303)

Premedication strategy for paclitaxel, still an unsolved question after 30 years

BJMO - volume 11, issue 2, march 2017

E. Dewaele MD, C. Verschueren MSc, P. Specenier MD, PhD

SUMMARY

Background: For paclitaxel administered 3-weekly, the Food and Drug Administration recommends the use of premedication with dexamethasone 20 mg orally twelve and six hours prior to paclitaxel, histamine–1 and –2 antagonists 30–60 minutes prior to paclitaxel, to prevent hypersensitivity reactions. There are no guidelines for the use of premedication when paclitaxel is given weekly.

Material and methods: MEDLINE was searched using the keywords premedication, dexamethasone, paclitaxel and hypersensitivity in November 2016. Articles were surveyed for additional citations.

Results: We retrieved 28 papers, of which sixteen on prospective trials (four on weekly, nine on 3-weekly paclitaxel). Using a dexamethasone tapering regimen in patients without hypersensitivity reactions after the first weekly paclitaxel administration, hypersensitivity reactions were reported in 1.0%, 2.3% and 5.7% of patients. In five single arm studies, intravenous dexamethasone 20 mg was administered prior to 3-weekly paclitaxel. Hypersensitivity reaction rates varied between 0–15%. Hypersensitivity reaction rates in sequential cohorts, in a single centre, with an intravenous or oral dexamethasone regimen were 14.5% and 5.4%, respectively (p=0.07). In a randomised trial there was no significant difference between an intravenous and oral dexamethasone regimen prior to 3-weekly paclitaxel administration.

Conclusions: Tapering of dexamethasone or no premedication at all seems to be safe in patients without hypersensitivity reactions after the first weekly administration of paclitaxel. Substitution of oral dexamethasone by a single intravenous administration immediately prior to 3-weekly paclitaxel was associated with a higher risk of hypersensitivity reactions, until 17,9%.

(BELG J MED ONCOL 2017;11(2):46–55)