Running head: EVIDENCE-BASED PRACTICE GUIDELINE FOR ADMINISTRATION OF
CHEMOTHERAPY FOR TYPES II - IV OVARIAN CANCER
Evidence-Based Practice Guideline for Administration of Chemotherapy for Types II - IV Ovarian Cancer
Ovarian cancer is the seventh most common form of cancer in women today with some 140,000 new cases reported every year (AOCTG, 1999). Since the introduction of the antineoplastic platinum agent cisplatin in the 1970’s (CC, 2001), chemotherapy was generally accepted as the first-line treatment method for advanced carcinomas (Fung Kee Fung et al., 2002). However, several other chemotherapy drugs, such as carboplatin, doxorubicin and more recently paclitaxel, have been developed to combat ovarian cancer. From 1980 to the present, several randomized control trails (RCT) have tested the effects of the antineoplastic agents against varied control arms. In an effort to consolidate the information, the Advanced Ovarian Cancer Trialists Group (AOCTG) performed a major meta-analysis in 1991 (updated 1998) of all advanced ovarian cancer chemotherapy RCTs. It was not until July 2002 when the Cancer Care Ontario Practice Guidelines Initiative (CCOPGI) publish
Nurses who administer platinum should be aware that carboplatin can have grade 3-4 hematologic side effects including leukopenia and thrombocytopenia while cisplatin"tms side effects may include grade 3-4 neurotoxicity (Fung Kee Fung et al. ed the first guideline with recommendations for first-line chemotherapy treatment of advanced ovarian cancer. Davis"tms Drug Guide for Nurses (7th ed. It is a point of curiously, however, why the SCOSGI trial differed so drastically. They could either be tested alone versus another antineoplastic agent such as cyclophosphamide or doxorubicin, or added to a regimen versus a control arm that did not contain platinum. and the Gynecology Disease Site Group. Most trials used 75 mgm2 of cisplatin or AUC 5 or 6 of carboplatin as a baseline, and subsequently the CCOPGI recommends this amount. Certainly to minimize toxic effects from platinum while still achieving the maximum desired effect, a RCT to determine the best concentration of platinum is still needed. However, the lowered HR may only be a function of multiple antineoplastic agents working in tandem as controlled against a single drug. The AOCTG reviewed studies of single-agent versus multi-agent therapy both with and without platinum involved. The main topics the guideline addresses include: 1) whether the addition of platinum is beneficial, 2) what advantages exist for paclitaxel, 3) whether multi-agent therapy works better than single-agent therapy and 4) if there exists any differences between the main platinum drugs cisplatin and carboplatin. Should signs of bone marrow depression, anaphylaxis, hypotension or tachycardia appear, immediately discontinue medication (Deglin Vallerand, 1999).