Effectiveness of medical supportive team for outpatients treated with sorafenib: a retrospective study

Patient characteristics

In this study, 72 outpatients were screened. Two patients were excluded from the analysis;
one had not undergone an intervention by the medical supportive team and the other
was only administered sorafenib for one day because of adverse drug reactions. Therefore,
70 outpatients were classified into two groups: an intervention group and a non-intervention
group, according to interventions by the medical supportive team. No significant differences
were observed in the baseline characteristics between the two groups, except for diagnosis
(Table 1).

Table 1. Patient characteristics

Duration of the sorafenib treatment

The duration of the sorafenib treatment was significantly longer in the intervention
group than in the non-intervention group (P?=?0.008) (Figure 2). In the non-intervention group, 7 patients stopped using sorafenib due to adverse
drug reactions that were potentially tolerable. Table 2 shows the reasons for the discontinuation of sorafenib in the non-intervention group.
The dosage of sorafenib was not decreased from 800 mg/day in three cases. However,
sorafenib treatment was interrupted in 3 outpatients to maintain a dose of 800 mg.
Furthermore, one outpatient refused to continue the sorafenib treatment due to anorexia.
The dose of sorafenib was decreased to 600 mg/day in a patient with hypothyroidism;
however, inn this case, sorafenib treatment was discontinued without endocrine therapy
such as thyroid gland auxiliary therapy.

Figure 2. Effect of interventions by the medical supportive team on the duration of sorafenib
treatment in outpatients.

Table 2. Discontinuation of sorafenib in the non-intervention group (n?=?7)

Activities of the medical supportive team for outpatients

Mean daily doses of sorafenib were lower in the intervention group (486.5?±?198.6 mg
(median, 480.8 mg)) than in the non-intervention group (581.8?±?196.0 mg (median,
600 mg)) (P?=?0.048). Furthermore, no significant differences were observed in the
mean initial doses of sorafenib between the intervention group (709.7?±?170.0 mg (median,
800 mg)) and the non-intervention group (702.6?±?170.9 mg (median, 800 mg)). The medical
supportive team spent an average of 37.1?±?11.1 min per outpatient (median, 40 min),
and the total number of interventions was 146. A total of 61 interventions in the
intervention group concerned suggestions on medication to physicians and outpatients.
Table 3 shows the medical supportive team’s suggestions to physicians and patients. The incidences
of adverse drug reactions, apart from those of grades 3–4, such as hand-foot skin
reaction, diarrhea, anorexia, hair loss, thrombocytopenia, hoarseness, increased serum
amylase, fatigue, and stomatitis, were higher in the intervention group than in the
non-intervention group (Table 4).

Table 3. Details of supportive care or suggestions by the medical supportive team

Table 4. Incidence of adverse drug reactions