Implementation of a nurse-driven educational program improves management of sorafenib's toxicities in hepatocellular carcinoma

Background > Sorafenib is the standard treatment for advanced hepatocellular carcinoma (HCC). Due to its peculiar toxicities, improving patient's tolerance may need close follow-up. Nurses can play a crucial role, by driving a patient education program (EP). We aimed to prove that adding EP to usual care (UC) improves patient's care. Methods > Since 2011, oncologists referred patients treated by sorafenib to the EP, driven by clinical nurses. It consisted in a visit before first administration, weekly telephone calls and a visit before each oncologist consultation. We retrospectively compared patients followed by the EP to those followed by oncologist in usual care (UC) and patients included in a clinical trial (CT). Results > Since 2005, 129 patients were treated with sorafenib for HCC, 31 (24%) in the EP, 22 (17%) in CT and 76 (59%) with UC. Seventy-one percent of patients in the EP had toxicities identified during a telephone call, which prompted symptomatic measures in 65% of patients, leading to treatment modification before the planned on-site visit in 29% of patients. EP patients required less dose reductions (39% vs. 61% for UC, P = 0.04), and median time to first dose reduction was shorter with EP than with UC (25 days vs. 45 days, P = 0.036). Conclusion > This study suggests a clinical benefit of EP, with a better toxicity's management of sorafenib, leading to less dose reduction. Different types of EP should be compared prospectively, focusing on quality of life.