Authors (including presenting author) :
Lam KM(1), Chan SY(1), Wong CK(2), Luk MY(1), Yuen KK(1)
Affiliation :
(1) Department of Clinical Oncology, Queen Mary Hospital (QMH)
(2) Department of Pathology, QMH
Introduction :
5-Fluorouracil (5FU), capecitabine (Xeloda) and TS-1 are cornerstone anticancer agents particularly in managing colorectal cancers, the third commonest cancer in Hong Kong. Despite the likely low but unestablished prevalence of dihydropyrimidine dehydrogenase (DPYD) deficiency in Asian population, patients with DPYD deficiency faced significantly higher risk of severe toxicities and potentially life-threatening toxicities when treated with these agents. Plasma uracil testing helps to identify DPYD deficiency, which the abnormal level might warrant dose reduction or avoidance of 5FU, capecitabine or TS-1, as well as close monitoring.
In Hong Kong West Cluster, the laboratory service for DPYD phenotyping (by the measurement of plasma uracil concentration) was launched by QMH Chemical Pathology in HKWC since 20 February 2024.
Objectives :
The objective of this project is to evaluate the compliance with plasma uracil testing before initiating 5FU, capecitabine or TS-1 based systemic treatment in patients treated at department of clinical oncology, Queen Mary Hospital.
Methodology :
This study has evaluated the compliance of DPYD test service over 6 months during Aug24 to Jan 25 following implementation of a comprehensive, multifaceted intervention strategy with the following components: (1) Educational material for healthcare providers to raise awareness of the importance of plasma uracil testing (2) Integration of plasma uracil on chemotherapy protocol in paper format and chemotherapy module system which prompt oncologist to order the test and proper documentation of result before initiating chemotherapy, then crosschecking by specialists, pharmacists and nurses upon prescription, dispensing and administration of chemotherapy.
Result & Outcome :
56 and 26 patients were newly started on 5FU based chemotherapy before and after launching the interval intervention respectively. Compliance rate improved from 60.7% to 100% after implementation of intervention strategy. 105 and 138 patients were newly started on capecitabine based chemotherapy before and after launching the interval intervention respectively. The overall compliance rate improved from 86.7% to 97.8% after the implementing the intervention.
15 and 18 patients were newly started on TS-1 based chemotherapy before and after launching the interval intervention respectively. The overall compliance rate improved from 60% to 100% after the implementing the intervention.
The implementation of the intervention strategy significantly improved compliance with standardized plasma uracil testing in patients undergoing 5FU, capecitabine or TS-1 chemotherapy in our department, which is expected to enhance patient safety by reducing the risk of severe toxicities associated with DPD deficiency. Ongoing efforts to maintain and further enhance compliance are essential, including continuous education for healthcare providers and future research should explore the long-term clinical impact of plasma uracil testing on patient outcomes.
