Authors (including presenting author) :
Tse PL(1), Chu LM(1), Young WM(1), Wong CS(2), Chan PC(2), Cheung KW(2)
Affiliation :
(1)Department of Pharmacy (2)Department of Clinical Oncology, Tuen Mun Hospital
Introduction :
Nephrotoxicity is the dose-limiting toxicity for patients receiving high-dose cisplatin. Literature reported overall prevalence of cisplatin-induced nephrotoxicity was up to 22%-33% and adequate hydration is important to prevent nephrotoxicity. Conventional hydration with 7200mL fluid over 43.5 hours requires 3 days of in-patient hospitalization in TMH. Emerging evidence in overseas showed that shorter duration and lower volume hydration regimen is also effective to prevent nephrotoxicity.
Objectives :
(1)To reduce the length of hospitalization through developing a short hydration regimen (2)To evaluate the effectiveness of short hydration regimen to prevent nephrotoxicity.
Methodology :
Literature review was performed by oncologists and clinical pharmacists to tailor-made a short hydration regimen consisting of 5000mL fluid over 23 hours for high-dose cisplatin (100mg/m2) protocols. Medication Administration Record was modified so that administration of cisplatin and hydration can be completed within 2 days. During Oct 2018-Oct 2019, 22 patients who received totally 52 cycles of high-dose cisplatin chemo-radiation for head and neck or nasopharyngeal cancer have been selected for short hydration regimen as pilot study. Length of hospitalization and cisplatin-related nephrotoxicity were evaluated.
Result & Outcome :
Length of planned hospitalization reduced from 3 days to 2 days in 44 out of 52(85%) cisplatin cycles, i.e. total reduction of 28% bed-days in 52 admissions. In 2018, totally 247 cycles of chemotherapy containing high-dose cisplatin which involved 108 patients were administered in TMH. This may result in cost reduction of around $836,000 per year if they were changed to short hydration regimen based on the study result. Among all cisplatin cycles, 98%(n=51) cycles were completed without any nephrotoxicity according to CTCAE definition. Only one patient had Grade 2 creatinine elevation in one cycle and the creatinine clearance returned to baseline after rehydration. There were no dose reduction or suspension due to nephrotoxicity for all cases. Short hydration was clinically effective to prevent cisplatin-induced nephrotoxicity in 98% cases while reducing the length of planned hospitalization by 28%. Collaboration between oncologists and pharmacists to review cisplatin hydration regimen reduces the burden of public resources and eases the workload of in-patient service by shortening hospital stay. Further collaboration is advocated to extend the use of short hydration regimen in more patient types.
