Nursing interventions to minimize cetuximab-induced dermatologic toxicity

Abstract

Objective: This study investigated early nursing interventions with the purpose to minimize cetuximab-induced acneiform eruption. The most important side-effect of cetuximab is dermatologic toxicity, up to 90%. Dose-reduction or interruption of cetuximab reduces severity of dermatologic toxicity, probably at the cost of reduced efficacy of the cancer therapy. Thus, prevention or effective supportive care during treatment is important. The study evaluated if patient education could ensure compliance of cancer treatment and effect of oral tetracycline on acneiform eruption, with the purpose to minimize severity of dermatologic toxicity and reduce the use of tetracycline.
Methods: The design was a single group prospective interventional study. Gastro-intestinal (GI) cancer patients treated with cetuximab between April 2009 and June 2011 were educated to start treatment with tetracycline 500 mg twice daily when acneiform eruption occurred. Patient’s dermatologic toxicity were graded (by CTCAE) and registered by nurses.
Results: Sixty-three patients were evaluable. Patients started tetracycline when acneiform eruption occurred. It reduced severity but not incidence of acneiform eruption, 10% of the patients never developed acneiform eruption and therefore never received tetracycline.
Conclusions: Patient-education by a trained oncology nurse in the handling of cetuximab induced acneiform eruption is manageable and effective and ensures a high number of patients carrying through treatment with a full dose of cetuximab.