Proactive nursing interventions on side effects during the treatment of acute promyelocytic leukemia with arsenic trioxide: A mixed-methods study in Piacenza
Keywords:
APL, nurse, arsenic trioxide, proactive interventions, mixed methods, side effectsAbstract
Background and aim: Acute promyelocytic leukaemia (APL) accounts for about 10% of acute myeloblastic leukaemias in adults and has become the most potentially curable subtype.
Randomised trials have demonstrated the efficacy and safety of the arsenic trioxide and all-trans retinoic acid (ATO/ATRA) protocol without chemotherapy as first-line therapies in patients with low-risk APL. Despite the progress achieved in the treatment of APL, complications often occur therefore rapid intervention is required.
No articles can be found in the literature on the centrality of the nurse in the management of patients in treatment with ATO, but daily experience shows that nursing care also plays a key role in the success of therapy by preventing adverse events. The aim of the study is to find out whether and which proactive nursing interventions can reduce the consequences of major drug side effects on the patient, improve compliance and the patient's course of treatment.
Methods: This study was carried out through a retrospective survey of medical records combined with qualitative 14 semi-structured interviews with operators and patients at the U.O. Haematology in-patient unit.
Results: Considering that the patients in this study were hospitalized for an average of 39 days, out of a total of a mean number of 542 interventions carried out during a single 39-day hospitalization, the frequency of autonomous interventions was 395 (73%) compared to 147 (27%) of collaborative interventions.
Conclusions: Although the results obtained underline the centrality of the nurse and the proactive interventions, the narrowness of the sample makes it necessary to undertake further investigations.
References
1. Warrell RP, de The H, Wang ZY, Degos L. Acute promyelocytic leukemia. N Engl J Med. 1993;329(3):177-89. doi: 10.1056/NEJM199307153290307.
2. Kayser S, Schlenk RF, Platzbecker U. Management of patients with acute promyelocytic leukemia. Leukemia. 2018;32(6):1277-94. doi: 10.1038/s41375-018-0139-4.
3. Abedin S, Altman JK. Acute promyelocytic leukemia: preventing early complications and late toxicities. Hematology. 2016;2016(1):10-5. doi: 10.1182/asheducation-2016.1.10.
4. Walker DK, Held-Warmkessel J. Acute promyelocytic leukemia: an overview with implications for oncology nurses. Clin J Oncol Nurs. 2010;14(6):747-59. doi: 10.1188/10.CJON.747-759.
5. Impiego del Triossido di Arsenico nella Leucemia acuta promielocitica in recidiva molecolare [Internet] [Dottorato]. Università degli studi di Roma Tor Vergata; 2009. Available from: https://docplayer.it/5249901-Impiego-del-triossido-di-arsenico-nella-leucemia-acuta-promielocitica-in-recidiva-molecolare.html
6. Autore F, Chiusolo P, Sorà F, et al. Efficacy and tolerability of first line arsenic trioxide in combination with all-trans retinoic acid in patients with acute promyelocytic leukemia: real life experience. Front Oncol. 2021;11:2746. doi: 10.3389/fonc.2021.614721.
7. Platzbecker U, Avvisati G, Cicconi L, et al. Improved outcomes with retinoic acid and arsenic trioxide compared with retinoic acid and chemotherapy in non–high-risk acute promyelocytic leukemia: final results of the randomized Italian-German APL0406 trial. J Clin Oncol. 2016;35(6):605-12. doi: 10.1200/JCO.2016.67.1982.
8. Lo-Coco F, Avvisati G, Vignetti M, et al. Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med. 2013;369(2):111-21. doi: 10.1056/NEJMoa1300874.
9. Avvisati G, Lo-Coco F, Paoloni FP, et al. AIDA 0493 protocol for newly diagnosed acute promyelocytic leukemia: very long-term results and role of maintenance. Blood. 2011;117(18):10. doi: 10.1182/blood-2010-08-302950.
10. European Medicines Agency. Trisenox, INN-arsenic trioxide, caratteristiche del prodotto. 2022.
11. Agenzia Italiana del Farmaco. Trisenox: riassunto delle caratteristiche del prodotto. 2020.
12. Mangiacavalli B, Pulimeno AML, Mazzoleni B, Cicolini G, Cosimo C. Codice deontologico delle professioni infermieristiche, a cura del comitato centrale FNOPI [Internet]. 2019.
13. Gordon DB. Acute pain assessment tools: let us move beyond simple pain ratings. Curr Opin Anaesthesiol. 2015;28(5):565-9. doi: 10.1097/ACO.0000000000000225.
14. Wagner EH. The role of patient care teams in chronic disease management. BMJ. 2000;320(7234):569-72. doi: 10.1136/bmj.320.7234.569.
15. Gabbay RA, Bailit MH, Mauger DT, Wagner EH, Siminerio L. Multipayer patient-centered medical home implementation guided by the chronic care model. Jt Comm J Qual Patient Saf. 2011;37(6):265-73. doi: 10.1016/s1553-7250(11)37034-1.
16. Yarbro CH. Cancer nursing: principles and practice. 7th ed. Sudbury (MA): Jones & Bartlett; 2011.
17. Tay LH, Hegney D, Ang E. Factors affecting effective communication between registered nurses and adult cancer patients in an inpatient setting: a systematic review. JBI Evid Implement. 2011;9(2):151-64. doi: 10.1111/j.1744-1609.2011.00212.x.
18. Buja A, Solinas G, Visca M, Bruno F, Gini R, Baldo V. Prevalence of heart failure and adherence to process indicators: which socio-demographic determinants are involved? Int J Environ Res Public Health. 2016;13(2):238. doi: 10.3390/ijerph13020238.
19. National Cancer Institute. Common Terminology Criteria for Adverse Events v3.0 (CTCAE). 2006. Available from: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcaev3.pdf
20. Pawson R. Evidence-based policy: a realist perspective. Can J Program Eval. 2006;23.
21. MacDonald M, Pauly B, Wong G, et al. Supporting successful implementation of public health interventions: protocol for a realist synthesis. Syst Rev. 2016;5(1):54. doi: 10.1186/s13643-016-0229-1.
22. Jagosh J. Realist synthesis for public health: building an ontologically deep understanding of how programs work, for whom, and in which contexts. Annu Rev Public Health. 2019;40:361-72. doi: 10.1146/annurev-publhealth-031816-044451.
23. Coles E, Anderson J, Maxwell M, et al. The influence of contextual factors on healthcare quality improvement initiatives: a realist review. Syst Rev. 2020;9(1):94. doi: 10.1186/s13643-020-01344-3.
24. Astbury B, Leeuw FL. Unpacking black boxes: mechanisms and theory building in evaluation. Am J Eval. 2010;31(3):363-81. doi: 10.1177/1098214010371972.
25. Pfadenhauer LM, Mozygemba K, Gerhardus A, et al. Context and implementation: a concept analysis towards conceptual maturity. Z Evid Fortbild Qual Gesundhwes. 2015;109(2):103-14. doi: 10.1016/j.zefq.2015.01.004.
26. Koch T. Establishing rigour in qualitative research: the decision trail. J Adv Nurs. 1994;19(5):976-86. doi: 10.1111/j.1365-2648.1994.tb01177.x.
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