3W 1H: PROTOCOL FOR PREVENTION OF LATE SKIN TOXICITY RELATED TO INTRAVENOUS DOCETAXEL ADMINISTRATION IN BREAST CANCER WOMEN

Keywords:

Antineoplastic Agents - Drug-Related Side Effects and Adverse Reactions - Protocols

Introduction: Chemotherapy is the main resourse in systemic breast cancer treatment setting. It includes the use of several drugs, among which taxanes stands out. Intravenous administration of docetaxel has the potential to cause skin damage in case of extravasation, therefore it's classified as a vesicant agent. However, in some rare cases, late tissue toxicity may occur (around the 7th day after administration), which may progress with severity. Objective: To develop a protocol for prevention of late skin toxicity related to intravenous docetaxel administration. Methods: Implementation of 3 W 1 H tool (Who; Why What, How) in the development of skin toxicity prevention protocol. Protocol's design and execution took place through tree meetings with oncological nurses from ta cancer center with the following stages: 1) Diagnosis on occurrence and probable causes related to late skin toxicity secondary to docetaxel intravenous administration (Who) , 2) Database search on skin toxicity prevention (Why), 3) Outlining strategies (What) and feasibility and applicability within the prevention protocol (How). Results: Late toxicity predominantly affected (Who) women who received 100mg/m2 docetaxel in veins on the back of the hand. The prevention factors (Why) were defined as punctures in forearm veins and an increase volume of 0.9% saline solution after drug administration in order to decrease drug contact with venous wall, both directed to prevent acute injuries. An education approach for photoprotection was proposed to prevent pro-melanocytic substances leak into the subcutaneous tissue caused by the increase in capillary permeability , a mechanism responsible for late lesions. A protocol was designed consisting on:_ Preference for forearm veins instead of the back of the hand for drug administration, _ Implementation of venous "washing" with saline solution in a minimum volume of 200ml - Educational approach on photoprotection relevance through emphasis on use of sunscreen and protective gloves when handling high temperature objects. This protocol was applied to all patients receiving docetaxel 100mg/m2 for breast cancer treatment through peripheral veins in a cancer center and the results on feasibility and applicability (How) were reviewed 1 month after its implementation. Conclusion: The option for forearm veins was challenging, especially in post-mastectomy patients. Vein washing had the greatest feasibility and education for photoprotection was described as adequate.

 

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Publikationsverlauf

Artikel online veröffentlicht:
17. November 2021