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CSC GI Concurrent XRT Capecitabine(35D:1-5) VER 8-15-17 (HL 524)

CSC GI Concurrent XRT Capecitabine(35D:1-5) VER 8-15-17 (HL 524) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, GI


CSC GI CONCURRENT XRT CAPECITABINE (35D:1-5) VER: 8-15-17 –  Properties
Pre-Cycle –  8/1/2017 through 8/7/2017 (7 days), Planned
Day 1, Pre-Cycle –  Planned for 8/1/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastric (Adjuvant/Advanced), Pancreatic (Adjuvant/Advanced), Esophageal (Adjuvant/Advanced), Rectal
(Adjuvant/Advanced), Anal (Adjuvant/Advanced), Cholangiocarcinoma (Advanced), Gall Bladder (Adjuvant/Advanced);
THERAPY: capecitabine 825 mg/m2 by mouth twice daily for 5 days/week, concurrent with radiotherapy; COURSE: for
duration of radiotherapy.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S Approximate, Expires: S+365, Routine
BUN
Expected: S Approximate, Expires: S+365, Routine
CREATININE
Expected: S Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S Approximate, Expires: S+365, Routine
Take Home Medications
ondansetron (ZOFRAN) 8 MG tab
Take 1 tab by mouth every 8 hours as needed for nausea/vomiting., 8 mg, Disp-30 tab, R-5, EVERY 8 HOURS PRN
starting S, Local Printer
Cycle 1 –  8/8/2017 through 9/11/2017 (35 days), Planned
Day 1, Cycle 1 –  Planned for 8/8/2017
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Zztestonc,Jeff J [2507481]
8/8/2017 2:44:25 PM Page 1 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Treatment Plan Information
Reference Information (1)
GASTRIC, PANCREATIC, ESOPHAGEAL, CHOLANGIOCARCINOMA, GALL BLADDER, RECTAL AND ANAL CANCER: Saif M,
et al. J Clin Oncol 2005;23:8679-87.
Reference Information (2)
GASTRIC, PANCREATIC, ESOPHAGEAL, CHOLANGIOCARCINOMA, GALL BLADDER, RECTAL AND ANAL CANCER: Rich TA,
et al. J Clin Oncol 2004;22:2214-32.
Reference Information (3)
GASTRIC, PANCREATIC, ESOPHAGEAL, CHOLANGIOCARCINOMA, GALL BLADDER, RECTAL AND ANAL CANCER:
Hofheinz RD, et al. Lancet Oncol 2012;13(6):579-88.
Treatment Plan Summary
DISEASE: Gastric (Adjuvant/Advanced), Pancreatic (Adjuvant/Advanced), Esophageal (Adjuvant/Advanced), Rectal
(Adjuvant/Advanced), Anal (Adjuvant/Advanced), Cholangiocarcinoma (Advanced), Gall Bladder (Adjuvant/Advanced);
THERAPY: capecitabine 825 mg/m2 by mouth twice daily for 5 days/week, concurrent with radiotherapy; COURSE: for
duration of radiotherapy.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL
or Creatinine greater than ULN.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil
infusion and to call with concerns.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): capecitabine (Dispensed Day 1 of
each cycle).
Take Home Medications
capecitabine (XELODA) 500 MG tab
Take 3 tabs by mouth 2 times daily. Take on Monday through Friday during radiotherapy for up to 56 doses., 1,500
mg (rounded from 1,617 mg = 825 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), R-0, 2 X DAILY
starting S
Round doses to available tablet sizes of 500mg and 150mg.
capecitabine (XELODA) 150 MG tab
This medication will not be e-prescribed. If patient is present, script will go to printer. Otherwise,
script will go to nursing or tech pool.   Invalid items: Pharmacy   Details...
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Zztestonc,Jeff J [2507481]
8/8/2017 2:44:25 PM Page 2 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Take 11 tabs by mouth 2 times daily. Take on Monday through Friday during radiotherapy for up to
56 doses., 1,650 mg (rounded from 1,617 mg = 825 mg/m2 × 1.96 m2 Treatment plan BSA from
recorded weight), R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg.
Follow-Up
VERIFY APPOINTMENTS
Verify post-chemotheraphy radiation appointment with provider;
LABS: CBC,ANC (Diff if  Done locally), Electrolytes, Glucose, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline
Phosphatase.
This medication will not be e-prescribed. If patient is present, script will go to printer.
Otherwise, script will go to nursing or tech pool.   Invalid items: Pharmacy   
Details...
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Zztestonc,Jeff J [2507481]
8/8/2017 2:44:25 PM Page 3 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org