Document Detail


An audit to determine the time taken to administer intravenous bisphosphonate infusions in patients diagnosed with metastatic breast cancer to bone in a hospital setting.
MedLine Citation:
PMID:  17559749     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Bone metastases can occur in many forms of cancer. More than two-thirds of women with metastatic breast cancer may be affected by bone metastasis during the course of their disease. Bisphosphonates, which inhibit osteoclast-mediated bone resorption, are an established standard of care for patients with bone metastases. For patients with cancer and bone metastases, bisphosphonates are associated with a significant reduction in skeletal-related events such as vertebral fractures, non-vertebral fractures as well as increasing the time to skeletal event. The purpose of this study was to quantify the current time involved in the administration of i.v. bisphosphonates and how this might impact on patient experience and cancer unit capacity. RESEARCH DESIGN AND METHODS: A pilot audit was initially conducted at the Royal Marsden Hospital (RMH), London (both Chelsea and Sutton sites), and was followed by audits at a further two UK hospital sites: Velindre Hospital, Cardiff and the Royal Surrey County Hospital, Guildford. The study was conducted between December 2005 and September 2006. RESULTS: Overall, 151 forms were completed. Of the total patients audited, approximately 71% had a diagnosis of breast cancer. Where data on the reason for attendance were collected (Velindre and the Royal Surrey County Hospital), over 77% of patients attended hospital for the sole reason of having an i.v. bisphosphonate administered. The majority of patients (94%) required cannulation prior to infusion and, at the sites where this information was recorded (Royal Surrey County Hospital and Velindre Hospital), almost one-third of patients required two or more attempts before they were successfully cannulated. The time that the patients spent on the unit where the i.v. bisphosphonates were administered was greater for patients receiving pamidronate compared to those receiving zoledronic acid (2 h 36 min and 1 h 38 min, respectively). The magnitude of the difference was not as great as would be expected considering zoledronic acid should take one-sixth of the time to administer (Royal Marsden Hospital, pamidronate 1 h 29 min, zoledronic acid 18 min: Royal Surrey County Hospital, zoledronic acid 21 min: Velindre Hospital, pamidronate 1 h 42 min, zoledronic acid 17 min). CONCLUSIONS: I.v. bisphosphonates are accepted as standard clinical practice for the management of metastatic bone disease. They are often prescribed for long periods of time, so tolerability and patient acceptability are important factors in therapy. The administration of i.v. bisphosphonates contributes a substantial time burden for patients travelling to the hospital, considering that in most cases the purpose is for this treatment only. It also places a significant burden on hospital resources, creating capacity planning challenges. Receiving an i.v. bisphosphonate also has other disadvantages associated with it, such as the need for patients to undergo repeated cannulation. Service redesign, such as home administration of i.v. bisphosphonates, could help to overcome issues highlighted in this audit. The use of oral alternatives to pamidronate and zoledronic acid which may be more convenient for patients, and perhaps also cost-effective, should also be of ongoing interest.
Authors:
Peter Barrett-Lee; Danny Bloomfield; Lisa Dougherty; Martyn Harries; Robert Laing; Hetal Patel; Mel Walker
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Current medical research and opinion     Volume:  23     ISSN:  1473-4877     ISO Abbreviation:  Curr Med Res Opin     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-07-19     Completed Date:  2007-09-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0351014     Medline TA:  Curr Med Res Opin     Country:  England    
Other Details:
Languages:  eng     Pagination:  1575-82     Citation Subset:  IM    
Affiliation:
Velindre Hospital, Whitchurch, Cardiff, UK. Peter.Barrett-Lee@Velindre-tr.wales.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Bone Density Conservation Agents / administration & dosage*
Bone Neoplasms / drug therapy*,  secondary
Breast Neoplasms / pathology*
Diphosphonates / administration & dosage*
Drug Administration Schedule
Female
Great Britain
Hospitals
Humans
Imidazoles / administration & dosage
Infusions, Intravenous
Medical Audit*
Time Factors
Chemical
Reg. No./Substance:
0/Bone Density Conservation Agents; 0/Diphosphonates; 0/Imidazoles; 118072-93-8/zoledronic acid; 40391-99-9/pamidronate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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