Drug Therapy

Check the appropriate box whether the patient participated on a clinical trial during initial course of chemotherapy.

Check if the patient received chemotherapy administered during their initial treatment course.

For GYN cases only. Indicate if the patient received neoadjuvant chemotherapy. If the patient received chemotherapy but did not have surgery, answer “yes” to this question.

Check the box in which the route of neoadjuvant chemotherapy was given. Check all that apply.

For GYN cases only. Indicate if the patient was prescribed any of the anticoagulation medications listed in the help text within 30 days of starting neoadjuvant chemotherapy. Anticoagulation medications include LMWH/low molecular weight heparin,Warfarin/Coumadin, Apixaban/Eliquis, Rivaroxaban/Xarelto, Fondaparinux/Arixtra,Dabigatran/Pradaxa, and Edoxaban/Savaysa. “Concurrently” is defined as +/-30 days from neoadjuvant therapy start date

If you answer "Yes" to the patient given anticoagulation medications concurrently with neoadjuvant chemotherapy, then indicate what anticoagulation medications were given to the patient within 30 days of starting.

For GYN cases only. Indicate if the patient received adjuvant chemotherapy after their surgery. If the patient did not have surgery, answer “No” to this question.

Check the box in which the route of adjuvant chemotherapy was given. Check all that apply.

If you answered yes to patient received neoadjuvant, enter the start date for any/all neoadjuvant chemotherapy routes selected.

If you answered yes to patient received adjuvant, enter the start date for any/all adjuvant chemotherapy routes selected.

If you answered yes to patient received anticoagulation medication, enter the start date and dosage of any/all anticoagulation medications given to the patient within 30 days of starting neoadjuvant chemotherapy.

For the following pre-chemotherapy lab result questions, use the Complete Blood Count (CBC) completed just prior to or on Cycle 1, Day 1 of chemotherapy. If a patient has both neoadjuvant and adjuvant chemotherapy, use the lab work prior to neoadjuvant start date. If a patient only has adjuvant chemotherapy, use lab results prior to adjuvant chemotherapy start date. Use the CBC closest, but prior, to the first day of chemotherapy. ➢ Indicate if the pre-chemotherapy platelet count ≥350 x 10⁹/L. ➢ Indicate if the Hemoglobin level <10 g/dL or using RBC growth factors ➢ Indicate if the pre-chemotherapy leukocyte count >11x10⁹/L

For GYN only. Indicate if the pre-chemotherapy platelet count is ≥350x10⁹/L.

For Gyn Only. Indicate if the pre-chemotherapy Hemoglobin level is <10 g/dL or using if the patient is receiving Red Blood Cell growth factors such as Epoetin alfa (Epogen/Procrit) or Darbepoetin alfa (Aranesp).

For Gyn only. Indicate if the pre-chemotherapy leukocyte (WBC) count is >11x10⁹/L.

Provide the start date for the IV chemotherapy during Cycle 1 of initial anticancer therapy treatment. If patient received both neoadjuvant & adjuvant chemotherapy, use start date of neoadjuvant chemotherapy.

Indicate whether or not the patient received Cisplatin at any point during the initial regimen, not just Cycle 1.

Indicate whether or not the patient received Carboplatin at any point during the initial regimen, not just Cycle 1.

If the patient received Carboplatin, enter the Carboplatin AUC.

Indicate whether or not the patient received Taxane at any point during the initial regimen, not just Cycle 1.

Indicate whether or not the patient received Doxorubicin & Cyclophosphamide at any point during the initial regimen, not just Cycle 1.

Indicate the emetic risk of the patients chemotherapy regimen given for Cycle 1, day 1 of initial IV chemotherapy. Review the chemotherapy flowsheet. Respond based on the highest Emetic risk agent administered, if more than one chemotherapy drug administered.

Indicate if the patient is on an antiemetic clinical trial.

Indicate date of Serotonin Antagonist administered for Cycle 1 initial IV chemotherapy.

Indicate date of Corticosteroid administered for Cycle 1 initial IV chemotherapy.

If more than one high emetic risk drug was administered, reference the first administration when checking for aprepitant (Emend) OR netupitant (AKYNZEO®) or rolapitant.

Provide start date for the NK1 Antagonist Administered for Cycle 1 IV Chemotherapy.

During Cycle 1 of initial IV chemotherapy, indicate if olanzapine was prescribed.

Indicate whether there is documentation/acknowledgement of intent for the initial treatment course, by a practitioner in the practice. • Palliation may be to prolong life (without goal of cure) or to control symptoms.

Only populates if you choose Non-curative intent. Indicate whether GCSF was administered with chemotherapy treatment to patients with non-curative intent during first course/regimen (not just first cycle) of non-curative chemotherapy treatment.

Documentation may be found under the oncology treatment or medication section in the EMR, as they are usually given as tablets or capsules. Enter whether the PARP-Inhibitor was prescribed (yes or no), which one was prescribed (from the 3 choices) and the date that the PARP-Inhibitor was prescribed. If the prescribed date cannot be determined, choose the unknown box for the date.

Choose between Olaparib, Rucaparib, Niraparib or unknown.