Articles

Case-based illustrations of clinical flow and practical aspects of DPD-deficiency screening in Belgium

BJMO - volume 16, issue 3, may 2022

L. Crapé MD, K.P. Geboes MD, PhD, V. Casneuf MD, A.G. Verstraete MD, PhD, K.B.M. Claes PhD, M. van den Eynde MD, PhD, I. Borbath MD, PhD, Y. Verheezen MD, W. Demey MD, J. Van der Meulen MD, V. Haufroid PhD

SUMMARY

Fluoropyrimidines are frequently used as anti-cancer treatment for gastro-intestinal malignancies, breast, head and neck cancer and others. The enzyme dihydropyrimidine dehydrogenase (DPD) is crucial in the first and rate limiting enzyme step of 5-fluorouracil (5-FU) catabolism. Reduced or complete deficiency leads to severe and even fatal toxicity. The Belgian Group of Digestive Oncology (BGDO) has agreed upon a recommendation on screening for DPD deficiency before starting treatment, which was endorsed by the Belgian Society of Medical Oncology (BSMO), the College of Genetics (CG), and the Toxicological Society of Belgium and Luxembourg (BLT). This article focuses on the clinical flows and practical recommendations. Both targeted germline genotype testing and phenotyping are supported. It was suggested to use a stepwise approach, with a phenotype testing upfront because of higher sensitivity and lower societal cost. In patients with uracil levels above 14 ng/ mL, targeted germline genotype screening should follow. Fluoropyrimidines are contra-indicated in patients with complete DPD deficiency and starting dose recommendations have been validated for patients with partial deficiency.

(BELG J MED ONCOL 2022;16(3):119–24)

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A digital automated health monitoring system for oncology patients during the COVID-19 pandemic: practical issues and lessons for the future

BJMO - volume 15, issue 6, october 2021

J. Robijns PhD, J. Lodewijckx MSc, K. Wijnen PhD, S. Snoekx MSc, R. Hilkens RN , S. Bortels RN , H. Lenders RN , W. Nassen RN , E. Dewaele MD, D. Luyten MD, E. Joosens MD, A. Requilé MD, Y. Verheezen MD, T. Wessels MD, P. Bulens MD, J. Mebis MD

SUMMARY

During the COVID-19 pandemic, patients with cancer are subject to multiple risks (e.g., frequent hospital visits, increased infection risk, more severe clinical course, discontinued cancer treatment). Patients undergoing cancer therapy can face quality of life (QoL) – impairing side effects. Both for COVID-19 positive and negative patients who will continue or discontinue cancer treatment throughout the pandemic, providing supportive care is more important than ever. Digitally monitoring patient-reported outcome measures (PROMs) could offer a solution to improve the supportive care during cancer treatment, and certainly in times of COVID–19.

A prospective cohort trial was performed between August 2020 and February 2021 at the Jessa Hospital (Hasselt, Belgium), evaluating the feasibility and usability of a digital patient monitoring (DPM) system to collect PROMs of oncology patients undergoing chemotherapy during the COVID-19 pandemic. Based on available evidence from our trial, digitalised PROMs could significantly contribute to improved communication, patient satisfaction, supportive care, monitoring cancer treatment, and detecting problems. However, the DPM system needs fine-tuning to lead to a patient and healthcare worker-friendly system, fully incorporated in the electronic health records without losing the personal contact between patient and healthcare team.

(BELG J MED ONCOL 2021;15(6):292-303)

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