Optimisation of steroid prophylaxis schedules in breast cancer patients receiving docetaxel
chemotherapy – a survey of Health Care Providers and Patients
Survey for Oncology Nurses, Pharmacists and Medical Oncologists
Carmel Jacobs1, Brian Hutton2, Sasha Mazzarello1, Stephanie Smith1, Anil Joy3, Eitan Amir4,
Mohammed FK Ibrahim5, Nancy Gregario4, Kelly Daigle1, Lori Eggert1, Mark Clemons1
1The
Ottawa Hospital Cancer Center & University of Ottawa, Ottawa, Ontario, Canada.
2University
of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
3Department
of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer
Institute, Edmonton, Alberta, Canada
4Division
of Medical Oncology, Princess Margaret Hospital, Toronto, Canada
5 Department
of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
CORRESPONDENCE TO
Carmel Jacobs MBChB; Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501
Smyth Road, Box 900, Ottawa, Ontario, K1H8L6, Canada.
Phone: 1-613-798-5555 ext. 73466; Fax: 1-613-247-3528; E-mail: cjacobs@toh.on.ca
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Survey for Oncology Nurses, Pharmacists and Medical Oncologists
Docetaxel (Taxotere®) is a commonly used chemotherapy drug in Canada for breast cancer.
Pre- and post medication with a corticosteroid, most commonly dexamethasone, is
recommended. From our personal experience, we find patients often forget to take, or
incorrectly take their prescribed dexamethasone (steroid) premedication. This can lead to
confusion about how to manage such a scenario and ultimately lead to missed or delayed doses
of chemotherapy and poorer patient outcomes.
We are therefore undertaking a survey of Canadian Oncology Nurses, Oncology Pharmacists,
Medical Oncologists and breast cancer patients questioning the frequency of steroid
premedication non-adherence and the local management practices of such non-adherence in
breast cancer patients receiving docetaxel containing chemotherapy as part of their adjuvant or
neoadjuvant treatment.
This survey is anonymous and cannot be linked to you or your institution in any way. Please
note we are discussing steroid use for breast cancer patients receiving docetaxel (Taxotere) and
NOT patients receiving paclitaxel (Taxol).
Thank you for participating.
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Questions 1-7 are about you and your clinical practice:
1. Are you an
a. Oncology Nurse
b. Pharmacist
c. Medical Oncologist
d. Other? Please state:
2. You are:
a. Female
b. Male
3. What is your age:
a. <35 yrs
b. 35 – 45 yrs
c. 46 – 55 yrs
d. >55 yrs
4. How long have you been in your current role?
a. <5 yrs
b. 5 – 10 yrs
c. 11 – 20 yrs
d. >20 yrs
5. In what province do you primarily work?
a. NFLD
b. NS
c. NB
d. PEI
e. QC
f. ON
g. MAN
h. SK
i. AB
j. BC
k. Yukon / NWT / Nunavut
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6. In what setting do you primarily work (the majority of your time, >50%)?
a. An academic (teaching) hospital with a cancer centre
b. A non-academic (community) hospital with a cancer centre
c. An academic (teaching hospital) without a cancer centre
d. A non-academic (community) hospital without a cancer centre
e. Private practice clinic
f. Other? Please specify:
7. Does your institution have a standard protocol for steroid based premedication for docetaxel
containing chemotherapy for breast cancer?
a. Yes
b. No
c. Unsure
8. What is your standard (i.e. most commonly used) steroid premedication for docetaxel containing
chemotherapy for breast cancer?
a. Dexamethasone 8mg bid starting 24 hours before chemotherapy and continuing for 3
doses after chemotherapy (i.e. 3 doses before and 3 doses after chemotherapy)
b. Dexamethasone 8mg 12 hours before chemotherapy, 3 hours before chemotherapy and
immediately prior to chemotherapy (i.e. 3 doses before chemotherapy)
c. Dexamethasone 20mg 12 hours before chemotherapy and dexamethasone 20mg 6 hours
before chemotherapy
d. Dexamethasone 20mg once prior to chemotherapy
e. Other? Please specify:
f. Variable schedules are used
g. Unsure Please specify
9. In a typical week, how many women receiving docetaxel containing chemotherapy for breast
cancer do you personally see OR review prescriptions for?
a. None
b. 1 or 2 at most
c. 3 – 5 patients (1 patient a day on average)
d. 6 – 10 patients (2 patients a day on average)
e. >10 patients per week (more than 2 a day on average)
f. Other – please state
10. Do you or someone at your institution check with patients prior to administration of docetaxel
containing chemotherapy if they have taken their steroid premedication as prescribed?
a. Yes - if yes, who?
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b. No
11. How often on average will you see a breast cancer patient receiving docetaxel containing
chemotherapy who has not taken their steroid premedication as prescribed?
a. Once a day
b. Once a week
c. Once a month
d. Less than once a month
e. Other – please specify
12. In your experience, which dose do patients most often forget to take?
a. 24 hours prior to chemotherapy
b. 12 hours prior to chemotherapy
c. 6 hours prior to chemotherapy
d. 3 hours prior to chemotherapy
e. The morning of chemotherapy
f. Other – please specify
13. If a patient has not taken their steroid premedication for docetaxel containing chemotherapy,
does your institution have guidelines / protocol for management?
a. Yes
b. No
c. Unsure
14. If a patient has not taken their steroid premedication prior to docetaxel containing
chemotherapy, what do you usually do? Tick all that apply
a. Follow institution guidelines / protocols
b. Administer / recommend a dose of steroid – please specify steroid used, dose and route
c. Contact prescribing doctor for advice
d. Contact pharmacist for advice
e. Contact nursing lead / nursing advisor for advice
f. Proceed with chemotherapy
g. Cancel chemotherapy and reschedule with further instruction to patient to take steroid
premedication as prescribed
h. Other? Please state:
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15. In your personal experience, if a patient forgot to take her dexamethasone on the morning just
before chemotherapy do you usually administer an additional dose of steroid BEFORE
administering chemotherapy?
a. No I do not usually give an additional dose of steroids
b. Yes – if yes
i. What steroid do you usually give?
ii. What dose?
iii. What route – IV or PO?
iv. How long will you usually wait after this dose to give docetaxel?
16. What do you think are the benefits of giving a steroid pre-medication prior to docetaxel
containing chemotherapy? Tick as many as you think apply;
a. Reduced risk of nausea and vomiting
b. Reduced risk of allergic / hypersensitivity reactions
c. Reduced risk of peripheral neuropathy
d. Reduced risk of skin toxicity (hand foot syndrome)
e. Reduced risk of fluid retention
f. Enhance patient well being
g. None of the above
h. Other – please state
17. Do you think that omission of pre-medication with steroid prior to docetaxel containing
chemotherapy is an important clinical issue?
a. Yes – very important
b. Yes – somewhat important
c. Neutral
d. No – not very important
e. No – completely irrelevant
f. I do not know
Thank you for completing the survey
If you would like to receive a Starbucks voucher, please provide your email address here:
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Survey for patients
You are being asked to participate in this survey because you are receiving a chemotherapy drug
called docetaxel (Taxotere) as part of your chemotherapy. Taxotere may cause side effects and is
often given with extra medicine to help prevent some of these side effects. This survey has been
designed to explore your understanding of the medicines given around the time of your Taxotere
chemotherapy.
Please note that many medicines have two or more names. Usually the drug name, called the
generic name and a brand name, given by pharmaceutical companies to the version of the drug
they market. The table below lists common generic names and brand names relevant to this
survey. These names can be used interchangeably.
Table 1.
Generic Name
Dexamethasone
Ondansetron
Aprepitant
Lorazepam
Acetaminophen
Brand Name
Decadron
Zofran
Emend
Ativan
Tylenol
Thank you for participating – please remember these questions are all focused on the Taxotere part
of your chemotherapy
1. Do you remember which chemotherapy regimen you are receiving?
a. FEC-D (3 cycles of FEC then 3 cycles of Taxotere)
b. TC (4 cycles of Taxotere with cyclophosphamide)
c. AC-D (4 cycles of AC followed by 4 cycles of Taxotere)
d. TCH (6 cycles of Taxotere, carboplatin and Herceptin)
e. Other
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2. Did your oncologist prescribe other medicines for you to take before your Taxotere
chemotherapy?
a. Yes
b. No
c. Unsure
3. What is this medicine called? Choose as many as are applicable
a. Ondansetron (Zofran)
b. Dexamethasone (Decadron)
c. Aprepitant (Emend)
d. Lorazepam (Ativan)
e. Acetaminophen (Tylenol)
f. Other
g. Yes, but I am unsure of the name of the medicine
h. No
4. If your oncologist prescribed a medicine called dexamethasone (Decadron) to take before your
chemotherapy, did you take it as prescribed?
a. Yes
b. No
c. Unsure
5. If you didn’t take your dexamethasone (Decadron) as prescribed, do you recall why you didn’t
take it?
a. I forgot
b. I never received the prescription
c. I didn’t understand when to take the Decadron
d. I didn’t want to take additional medicine
e. I am not sure why I didn’t take the Decadron
6. If you took dexamethasone (Decadron) before your chemotherapy, how much did you take?
a. Two tablets (8mg) twice a day starting the day (i.e. 24 hours) before the chemotherapy and
then the morning before chemotherapy
b. Two tablets starting the night before chemotherapy and then the morning before
chemotherapy
c. Two tablets twice a day starting the morning of chemotherapy
d. I am unsure if I took any dexamethasone (Decadron)
e. I did not take any dexamethasone (Decardon) before chemotherapy
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f. Other. Please specify
7. If you took dexamethasone (Decadron) after your chemotherapy was given, how much
did you take?
a. Two tablets twice a day for 3 doses (i.e. finished the day after chemotherapy)
b. Two tablets twice a day for 4 doses (i.e. finished two days after chemotherapy)
c. I took dexamethasone (Decadron) but in a different dose than above
d. I am unsure if I took any dexamethasone (Decadron)
e. I did not take any dexamethasone (Decadron) after chemotherapy
f. Other, please specify
8. If you took dexamethasone (Decadron), do you think it caused any side effects? Choose as
many options as you wish
a. Yes – it caused difficulty sleeping
b. Yes – it caused nausea and or vomiting
c. Yes – it caused flushing / skin rash
d. Yes – it caused other side effects – please name the side effects it caused
e. No – I did not notice any side effects from dexamethasone (Decadron)
f. Unsure
9. If you took dexamethasone (Decadron), do you know why it was prescribed? Choose as many
options as you wish
a. To prevent side effects from the chemotherapy
b. To help chemotherapy work better
c. To prevent allergic reactions to chemotherapy
d. To help reduce swollen ankles
e. I do not know why it was prescribed
10. Do you think that your chemotherapy and the medicines prescribed to take with
chemotherapy were explained clearly?
a. Yes
b. No
11. Is there anything you would suggest to make it easier for you to take your medicines as
prescribed?
Thank you for completing the survey.
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Version 1: 6 January 2014