printemailclick to share buttonfacebooktwitterlinkedin
About our Documents
 
Drug Monographs | Chemotherapy Regimens | Symptom Management Information | Information Sheets for Patients | Appendices  | Also see: Regimen Taxonomy

Drug Monographs

Purpose: To provide information to healthcare professionals on the use and administration of systemic cancer therapies and related supportive therapies. The monographs are designed as general references for the use and dosing of systemic cancer therapies. They are not intended to replace the prescribing information or physician recommendations.

Monographs contain these sections:

  • Drug name
  • Mechanism of action and pharmacokinetics
  • Indications and status
  • Adverse effects
  • Dosing
  • Administration guidelines (special precautions, interactions, recommended and suggested clinical monitoring)

Section Information included
Drug Name 
  • Full drug name, synonyms and abbreviations (always use full drug name for writing prescriptions)
  • Trade names and the associated manufacturers
Mechanism of Action and Pharmacokinetics
Indications and Status
  • Indications approved or conditionally approved by Health Canada
  • "Other uses" reported in the literature 
Inclusion of a cancer type in this section does not imply endorsement as a CCO Formulary regimen.
Adverse Effects
  • These are presented in a table format
  • Incidences are described (when known)
  • Coded for onset (immediate, early, delayed or late)
  • Dose-limiting effects (i.e., requiring modification to keep toxicity within acceptable limits) are noted
  • Management of adverse effects (when known)
  • Further information can be obtained from the corresponding symptom management tools or information.
Dosing
  • Commonly seen dosage ranges
  • Dose modifications for toxicity, renal and hepatic impairment
Dosing is related to the regimen. Due to the variation in normal lab values, particularly for renal or hepatic function tests, the terminology "Upper Limit of Normal" (ULN) is used occasionally as a reference base for dosage modification.
Administration Guidelines 
Special Precautions Considerations for patient selection, e.g., contraindications, warnings/precautions, pregnancy and lactation, and other drug properties. 
Interactions Lists the agent involved, effect, mechanism and management.
Recommended and Suggested Clinical Monitoring Standard monitoring procedures which are part of clinical practice such as Complete Blood Counts (for myelosuppressive drugs) are not reiterated in each monograph. Recommended and suggested clinical monitoring are based on evidence, common practice, likelihood of toxicity and magnitude of patient risk. Recommended monitoring should be done, while suggested monitoring could be followed.

Revisions and updates

We add new monographs to the Formulary after a Health Canada Notice of Compliance and drug availability in Canada, or, in certain circumstances, when drugs become available under the Special Access Program.

The Formulary Team revises and updates existing monographs on an ongoing basis. Although we strive to ensure that the information is as accurate and up-to-date as possible, you should always refer to the product monograph, and to other resources such as the Health Canada or manufacturers’ websites for the latest drug monograph information as well as health advisories/warnings.

Chemotherapy Regimens

Chemotherapy Regimens are categorized according to the recommendations of the respective CCO Disease Site Group. Specific eligibility criteria for use of a particular regimen may be applied in some centres, but have not been included here -- with the exception of regimens with supplementary public funding.

After the initial review by the CCO Disease Site Groups and the Formulary Team, regimens will be reviewed and updated at least once in an every 3-year cycle.

Regimen categories

Standard: Standard therapy endorsed by the Disease Site Group or a regimen widely used by most regional cancer centres in this disease site.The category is unrelated to the source or availability of funding.
Local: A regimen not widely used by regional cancer centres in this disease site.
Emergent: A regimen which has not yet been accepted as a Standard Regimen but may become so based upon emergent Phase II and Phase III clinical trial data. This is published on this website for your information, but does not imply endorsement by the CCO Disease Site Group
 Excluded/Archived: No longer in use and listed for reference purposes only, although the use of such a regimen may be appropriate in a situation where a Standard Regimen cannot be used for clinical reasons.

Note: The Disease Site Group considers this regimen archived. It is listed for historical reference only and is no longer updated.

Regimen Taxonomy

A regimen taxonomy is in use for regimens in the Standard, Local and Emergent categories.

Supplementary public funding

Supplementary public funding, if available, is described in section A of the regimen monograph under the heading, “Supplementary Public Funding”. Reimbursement is for the drug costs of those patients who meet the eligibility criteria for the specific approved drugs.

Public funding status is based on publicly available information from the New Drug Funding Program or Ontario Public Drug Programs websites.

Pharmacy and nursing workload information

The workload information was determined in collaboration with nursing and pharmacy groups respectively. Each workload value is presented as an average time per visit (in minutes). 

Pharmacy Workload considers pharmacy staff’s time involved in: Nursing Workload considers nursing staff’s time involved in:
  • Reviewing and verifying order
  • Order entry and/or documentation into pharmacy computer system and/or generating and checking labels
  • Gathering drugs, equipment, and supplies for preparation
  • Hood cleaning
  • Drug reconstitution and preparation
  • Preparation of supportive care drugs
  • Labelling and packaging of the prepared drugs
  • Checking the final product
  • VAD access/IV start and disconnect
  • Preparation time
  • Patient education (in treatment unit)
  • Documentation
  • Toxicity assessment and symptom management
  • Antiemetics, [remedications or additional medications
  • Nursing time required for regimen delivery
  • Hydration
  • Observation post-treatment
  • Average reaction
  • Bring-in and turnaround
  • Infection control practices
  • Multitask adjuster

Use of generic drug names

All drugs are referred to by their generic names. Trade names and manufacturers are noted where applicable. For ease of use and consistency, we have used some common acronyms for multi-drug regimens, even though an acronym may refer to the trade name of one or more drugs.

e.g.,  CAF refers to Cyclophosphamide, ADRIAMYCIN® (Doxorubicin), Fluorouracil

In these cases, we list the drug's generic name (instead of the trade name) next to the acronym.

e.g., CAF : cyclophosphamide, doxorubicin, fluorouracil

Use of trade names does not constitute endorsement by the Formulary of any particular brand of drug in circumstance where multiple generic equivalents are available.

Revisions and updates

After the initial review by the CCO Disease Site Groups and the Formulary Team, regimens will be reviewed and updated at least once in an every 3-year cycle.

Appendices

Purpose: The appendices provide additional information to help doctors and pharmacists to better interpret and use cancer drug and regimen information.

  • Abbreviations (Appendix 1)
  • Administration Guidelines (Appendix 3)
  • Administration Guidelines for Chemotherapy Drugs (Appendix 3a)
  • Administraton Guidelines for Selected Supportive Care Drugs (Appendix 3b)
  • Calculation of Body Surface Area (Appendix 4)
  • Calculation of Estimated Creatinine Clearance (Appendix 5)
  • Dose Modification for Hematologic and Non-Hematologic Toxicities (Appendix 6)
  • Pediatric Considerations (Appendix 7)
  • Management of Angiogenesis Inhibitor (AI)-Induced Hypertension (Appendix 8)

Symptom Management Information

Supportive care is intended to meet patients' physical, informational, emotional, psychological, social, spiritual, and practical needs. But, while the term 'supportive care' encompasses more than drug therapy, the regimens posted in the Drug Formulary are only those involving drug therapy.

Purpose: Used to relieve or minimize the symptoms caused by cancer drug therapy, radiation therapy and the cancer itself.

Sources: Many of these regimens, or protocols, have been developed over time and modified by practitioners according to local needs. Here, we provide a compilation and summary of protocols from many institutions.

This information can be used as a reference source and starting point for the management of these common problems.

Information Sheets for Patients

CCO provides medication, symptom management and chemotherapy regimen information sheets for patients and their families, to help them become informed and active participants in their own care.

Purpose: To provide information about systemic cancer therapies, their use, and symptom control to patients and their families.

Info sheets supplement the doctor's advice

The patient information sheets are intended as supplemental material, and are not to be used in place of advice from physicians and other healthcare providers. They should be accompanied by verbal instructions from a healthcare professional. Some of the information in the sheets may not apply to a specific patient under certain circumstances since cancer treatments are often very individualized.

Drug Information Sheets The drug information sheets provide information about systemic cancer therapies, their usage, side effects and symptom management.
Chemotherapy Regimen Information Sheets Chemotherapy regimen information sheets describe specific chemotherapy regimens, such as schedules, the drugs involved, side effects and their management.  Selected lung and breast Chemotherapy Regimen Information Sheets are available.
Symptom Control Information Sheets Patients taking certain chemotherapy treatments may experience side effects. Symptom management information sheets outline steps to prevent and reduce these side effects in patients undergoing certain treatments. Some information sheets related to treatment administration are also available

Disclaimer

The information contained herein is intended to be for informational purposes only. It is not intended to constitute medical advice and should not be relied upon in any such regard. CCO does not recommend or endorse the use of any drug or treatment method described in any of the documents. Anyone using the information does so at his or her risk. Any use of the information is subject, at all times, to CCO’s Terms and Conditions .

Last modified: Thu, Oct 25, 2012
cancer care ontario | action cancer ontario   620 University Avenue Toronto Ontario, Canada M5G 2L7   Phone: 416.971.9800 Fax: 416.971.6888

Please help improve the quality of our website by answering 10 brief questions in our online survey. Would you like to participate?

YesNo