Clinical utility of nurses’ telephone follow-up program (Tsukiji Call) for resectable locally advanced esophageal squamous cell carcinoma patients received neoadjuvant DCF therapy.

Abstract

384 Background: The standard neoadjuvant treatment in Japan for resectable locally advanced esophageal squamous cell carcinoma (ESCC) is docetaxel (DTX) + cisplatin (CDDP) + 5-fluorouracil (5-FU) (DCF) based on the results of the JCOG1109 study. Neoadjuvant DCF therapy is administrated triweekly; in the first week in a hospital, and the remaining two weeks at hom. After the administration of neoadjuvant DCF therapy, patients might suffer from febrile neutropenia or gastrointestinal symptoms such as nausea, vomiting, constipation, diarrhea, and stomatitis even during remaining two weeks at home. Therefore, nurses in our hospital teach self-care at home for these patients who received neoadjuvant DCF therapy. However, some patients experienced emergency admission due to worsening adverse events. To prevent these events, nurses in our hospital conducted a telephone follow-up program (Tsukiji Call) for patients at home. Methods: This retrospective analysis included locally advanced ESCC patients who received neoadjuvant DCF therapy in our hospital between Feb 2023 and Jul 2024. Three courses of DCF (DTX [day 1]: 70 mg/m2, CDDP [day 1]: 70 mg/m2, 5-FU [continuous infusion on days 1-5]: 750 mg/m2, every three weeks) were planned as neoadjuvant treatment. On days 8-14 of the first course of neoadjuvant DCF therapy, Tsukiji Call was conducted by nurses in our hospital to check fever and nausea, vomiting, constipation, diarrhea, and stomatitis based on the CTCAE ver. 5.0 for patients at home before the first outpatient clinic. Eligible patients were divided into the Tsukiji Call and non-Tsukiji Call groups. We used Fisher's exact test to evaluate the frequency of grade 2 (Gr.2) or more adverse events (AEs) between two groups at the first outpatient clinic. Results: This study identified 90 patients (Tsukiji Call: 20, non-Tsukiji Call: 70). The median age (range) and gender male/female, PS 0/1/2, cStage I/II/III/IVA/IVB were 66.5 years (45-76 years) and 15 (75%)/5(25%), 19(95%)/1(5%)/0, 1(5%)/4(20%)/11(55%)/1(5%)/3(15%) in Tsukiji Call group, and were 64 years (46-79 years) and 49(70%)/21(30%), 67(95%)/2(2%)/1(1%), 1(1%)/13(18%)/50(71%)/0/6(8%) in non-Tsukiji Call group, respectively. In the first outpatient clinic, the frequency of Gr.2 or more AEs on fever, nausea, vomiting, constipation, diarrhea, stomatitis and any events between in Tsukiji Call and non-Tsukiji Call groups were 0/0(p = 1), 2(10%)/1(1%) (p = 0.123), 0/0 (p = 1), 0/0 (p = 1), 0/4(5%) (p = 0.572), and 0/10(14%) (p = 0.109), 2(10%)/15(21%) (p = 0.342), respectively. One patient in each group was emergently admitted within 7 days after discharge. Conclusions: Non-hematologic toxicities during DCF therapy may be reduced by Tsukiji Call by nurses in the hospital, which seemed to be in preventing the worsening of adverse events.