Extravasation associated with cancer drug therapy: multidisciplinary guideline of the Japanese Society of Cancer Nursing, Japanese Society of Medical Oncology, and Japanese Society of Pharmaceutical Oncology

• Published in: ESMO open 2024-10, Vol.9 (10), p.103932, Article 103932
• Main Authors: Matsumoto, K., Ryushima, Y., Sato, J., Aizawa, Y., Aoyama, T., Akaishi, Y., Okamoto, R., Sato, Y., Sugano, K., Tazumi, K., Tsuji, M., Fujikawa, N., Bun, S., Yagasaki, K.
• Format: Article
• Language: English
• Subjects: adverse events; chemotherapy; clinical practice guideline; extravasation; injection-site reaction; Original Research
• ISSN: 2059-7029; 2059-7029
• DOI: 10.1016/j.esmoop.2024.103932

Extravasation (EV), or the leakage of anticancer drugs into perivascular and subcutaneous tissues during intravenous administration, can cause serious conditions that may require surgical intervention. Therefore, updated guidelines for EV based on systematic review are needed. Additionally, classifications for anticancer drugs that cause EV are not standardized across the current guidelines, and some novel drugs have not been classified. Therefore, this study aimed to formulate guidelines using evidence-based information for shared decision making on prevention, early detection, treatment, and care for EV in Japan and provide additional classification for tissue injury based on systematic review. The members of the Japanese Society of Cancer Nursing (JSCN), Japanese Society of Medical Oncology (JSMO), and Japanese Society of Pharmaceutical Oncology (JASPO) were surveyed about significant clinical challenges related to EV, and 17 clinical questions (CQs) were formulated. PubMed and ICHUSHI Web were searched using the Patient, Intervention, Comparison, and Outcomes terms listed in each CQ as key words. For the classification of new drugs, articles published through February 2021 were selected using the search terms ‘extravasation’, ‘injection-site reaction’, ‘adverse events’, and the names of individual drugs as key words. Recommendations based on the results of randomized controlled trials (RCTs) were made with regard to the selection of central venous (CV) devices (CQ2, CQ3a, CQ3b, and CQ3c), regular replacement of peripheral venous catheters (CQ5), and use of fosaprepitant (CQ7). These CQs are novel and were not mentioned in previous guidelines. Warm compression monotherapy (CQ10b) and local injection of steroids (CQ12) are discouraged for the management of EV. Ten new drugs were classified for EV tissue injury. This study provides updated guidelines for the prevention and treatment of EV, which can be used to help health care providers and patients and their families practice better EV management. •This JSCN/JSMO/JASPO EV guideline addressed 17 CQs related to the prevention, early detection, treatment, and care of EV.•This guideline is based on a systematic review and meta-analysis conforming to GRADE/MINDS 2020.•Based on RCTs, we recommended to use CV devices rather than peripheral veins, especially CV port for pts with solid tumor.•We conducted a systematic review on 31 drugs and a classification with 10 additional drugs was proposed.•Warm compression