Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For cancer patients, what is the comparative effectiveness of different strategies to manage the symptoms of chemotherapy for improving net health outcome?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Different strategies compared to placebo (or standard regimens where available) to manage side-effects of chemotherapy. Symptoms of focus include:

1. Neuropathy (e.g., serotonin noradrenalin reuptake inhibitors vs. placebo and/or gabapentin)
2. Skin toxicity associated with epidermal growth factor receptor (EGFR) inhibitors (e.g., use of topical antibiotics with topical hydrocortisone vs. topical antibiotics alone)

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Adult cancer patients undergoing certain types of chemotherapy.

• For peripheral neuropathy, chemotherapeutic agents include platinum compounds, vincristine, taxanes, epothilones, bortezomib, thalidomide, and lenalidomide, which may be used for breast and colon cancer, among others.
• For EGFR inhibitor–related skin toxicity, cancers may include colorectal cancer and lung cancer.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Subgroups might include patients treated with specific chemotherapy drug or regimen.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Reduction in patient symptoms from adverse effects of chemotherapy and improved quality of life; potential increase in survival if reduction in symptoms permits skipping fewer treatments or completing treatment regimen that would otherwise be truncated.

Describe any health-related risks, side effects, or harms that you are concerned about.

Side effects of symptom reduction therapies, such as antidepressants, antibiotics,

gabapentin.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cancer

AHRQ Priority Populations

• Women
• Elderly

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Symptoms related to chemotherapy are prominent in many cancer patients. In addition to reducing quality of life, symptoms may be severe enough to delay or inhibit continued treatment, with potential adverse effects on progression-free or overall survival. Treating or preventing peripheral neuropathy effectively has been difficult to achieve, and the side effects/symptoms of treatment with EGFR inhibitors have only recently become evident. Identifying more effective treatments can improve quality of life and possibly improve long-term outcomes if chemotherapy regimens can be administered as planned.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic was given the second-highest priority by a multi-disciplinary stakeholder panel (including patient advocates/representatives) convened to identify and select research questions of importance for systematic review.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

The stakeholder panel noted the uncertainty surrounding effective treatments for

peripheral neuropathy. EGFR inhibitors are a relatively recent addition to the pool of

chemotherapy drugs used to treat cancer, and uncertainty remains on how to treat it

most effectively.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

A report would inform clinical decision-making for patients, payers and providers.

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Symptoms from chemotherapy will be particularly difficult to tolerate for those who are frail and may have additional comorbidities.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

A report would inform clinical decision-making for patients, payers and providers.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

The BlueCross BlueShield Association Technology Evaluation Center is an Evidence-based Practice Center of AHRQ.