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Management of the extravasation of anti-neoplastic agents

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Abstract

Background

Extravasation is a potentially severe complication that can occur during the administration of chemotherapy. The scarcity of evidence available makes it difficult to develop an optimal management scheme. The purpose of this guideline is to review the relevant scientific literature on the prevention, management, and treatment of extravasation occurring during the administration of chemotherapy to cancer patients.

Method

A scientific literature review was conducted using the PubMed search tool. The period covered was from database inception to April 2014, inclusively. Since the literature on extravasation treatment is often empirical, anecdotal, and controversial, the review also identified clinical practice guidelines and expert consensuses published by relevant international organizations and cancer agencies.

Results

Identification of potential risk factors and preventive measures can reduce the risk of extravasation. Recognition and management of symptoms are crucial in patients with this complication. Provision of adequate instruction to personnel responsible for administering chemotherapy and to patients on recognizing symptoms, preventing, and managing extravasation is essential. Extravasation can be treated with dry warm or cold compresses and various antidotes such as dimethyl sulfoxide, dexrazoxane, hyaluronidase, or sodium thiosulfate, depending on the agent that has caused extravasation. Patient monitoring to assess the progression or regression of symptoms and to thus take the appropriate measures is necessary.

Conclusion

Several strategies must be established to ensure that extravasation is recognized and properly managed. Given the evidence available at this time, the Comité de l’évolution des pratiques en oncologie (CEPO) has made recommendations for clinical practice in Quebec.

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Acknowledgments

The CEPO is a group of oncology specialists that reports to the Institut national d’excellence en santé et en services sociaux (INESSS). INESSS and the Direction québécoise de cancérologie provided funding for the work reported in this article, which is an adaptation of the CEPO’s original clinical practice guidelines published in June 2014, available in French at http://www.inesss.qc.ca/publications/publications/publication/prise-en-charge-de-lextravasation-associee-aux-traitements-antineoplasiques.html. The CEPO would like to thank Luisa Luciani Castiglia, Montreal General Hospital (MUHC); Isabelle Côté, Hôpital du Saint-Sacrement (CHU de Québec); Lucie Laporte, Hôpital Charles-Le Moyne (CSSS Champlain—Charles-Le Moyne); France Paquet, MUHC; and Geneviève Faucher, Hôpital regional de Saint-Jérôme (CSSS de Saint-Jérôme) for their contribution as external reviewers of the original clinical practice guideline.

Conflict of interest

The authors have no financial conflicts of interest to declare.

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Authors and Affiliations

  1. Institut national d’excellence en santé et en services sociaux, 2535 Laurier Boulevard, 5th floor, Quebec City, Quebec, G1V 4 M3, Canada

    J. Boulanger

  2. Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Boulevard West, Montreal, Quebec, H4J 1C5, Canada

    A. Ducharme

  3. Hôpital Charles-Le Moyne (CSSS Champlain—Charles-Le Moyne), 3120 Taschereau Boulevard, Greenfield Park, Quebec, J4V 2H1, Canada

    A. Dufour

  4. Hôpital Royal Victoria (MUHC), 687 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada

    S. Fortier

  5. Hôpital de la Cité-de-la-Santé (CSSS de Laval), 1755 René Laennec Boulevard, Laval, Quebec, H7M 3L9, Canada

    K. Almanric

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  1. J. Boulanger
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  2. A. Ducharme
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  3. A. Dufour
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  4. S. Fortier
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Consortia

in cooperation with the Comité de l’évolution de la pratique des soins pharmaceutiques (CEPSP) and the Comité de l’évolution des pratiques en oncologie (CEPO)

Corresponding author

Correspondence to K. Almanric.

Additional information

The members of the CEPSP guideline and advice subcommittee are Karine Almanric, BPharm/MSc/BCOP, Hôpital de la Cité-de-la-Santé (CSSS de Laval); Philippe Bouchard, BPharm/MSc/BCOP, Hôpital Maisonneuve-Rosemont; Amélie Chartier, BPharm/MSc/BCOP, Montreal General Hospital (MUHC); Andrée Ducharme, BPharm/MSc/BCOP, Hôpital du Sacré-Cœur de Montréal; Annick Dufour, BPharm/MSc, Hôpital Charles-Le Moyne (CSSS Champlain—Charles-Le Moyne); Sophie Fortier, BPharm/MSc, Royal Victoria Hospital (MUHC); Marie-Élaine Genest, BPharm/MSc, Hôpital Brome-Missisquoi-Perkins (CSSS La Pommeraie); Dominique Goulet, BPharm/MSc/BCOP, Hôpital de l’Enfant-Jésus (CHU de Québec); Nathalie Letarte, BPharm/MSc/DESG/BCOP, Hôpital Notre-Dame (CHUM); Mélanie Masse, BPharm/MSc, Centre hospitalier affilié universitaire régional (CSSS de Trois-Rivières); and Mélanie Simard, BPharm/MSc/BCOP, Hôtel-Dieu de Québec (CHU de Québec).The members of the CEPO are Karine Almanric, BPharm/MSc/BCOP, Hôpital de la Cité-de-la-Santé (CSSS de Laval); Jean-Sébastien Aucoin, MD, Centre hospitalier affilié universitaire régional (CSSS de Trois-Rivières); Gino Boily, INESSS; Philippe Bouchard, BPharm/MSc/BCOP, Hôpital Maisonneuve-Rosemont; Jim Boulanger, PhD, INESSS; Alexis Bujold, MD, Hôpital Maisonneuve-Rosemont; Ghislain Cournoyer, MD, Hôpital régional de Saint-Jérôme (CSSS de Saint-Jérôme); Félix Couture, MD, Hôtel-Dieu de Québec (CHU de Québec); Normand Gervais, MD, Centre hospitalier régional du Grand-Portage (CSSS de Rivière-du-Loup); Stéphanie Goulet, PhD, INESSS; Marie-Pascale Guay, BPharm/MSc/BCOP, Jewish General Hospital; Bernard Lespérance, MD, Hôpital du Sacré-Cœur de Montréal, Groupe d’étude en oncologie du Québec; Nathalie Letarte, BPharm/MSc/DESG/BCOP, Hôpital Notre-Dame (CHUM), Programme de gestion thérapeutique des médicaments; Jean-François Ouellet, MD, Hôtel-Dieu de Québec (CHU de Québec); Marie-Christine Paquin, PhD, INESSS; Gilles Pineau, MD, INESSS; Raghu Rajan, MD, Montreal General Hospital (MUHC); Benoît Samson, MD, Hôpital Charles-Le Moyne (CSSS Champlain—Charles-Le Moyne); and François Vincent, MD, Centre hospitalier affilié universitaire régional (CSSS de Trois-Rivières).

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Boulanger, J., Ducharme, A., Dufour, A. et al. Management of the extravasation of anti-neoplastic agents. Support Care Cancer 23, 1459–1471 (2015). https://doi.org/10.1007/s00520-015-2635-7

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