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MOH KS management guidelines

This document outlines the management guidelines for Kaposi's Sarcoma (KS) at Tiyanjane Clinic, Queen Elizabeth Central Hospital (QECH), emphasizing the criteria for administering vincristine in patients with advanced or progressive KS who are HIV positive and on ARVs for at least three months. Key considerations include patient assessment, treatment evaluation, pain management, and the importance of realistic expectations. This protocol emphasizes the need for constant review and adjustment of therapy to improve the quality of life for patients.

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MOH KS management guidelines

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  1. MOH KS management guidelines Jane Bates Tiyanjane Clinic, QECH October 2009

  2. Criteria for vincristine Clinical diagnosis of KS Testedfor HIV On ARVs for at least 3 months advanced and / or progressive disease (check FBC) - consider vincristine improving and / or stable disease - hold vincristine • High priorityMedium Priority consider continue ARVS • may start before unilat or biilat. leg if exclusions • 3 months ARVs completed KS limiting function apply •  confirmed or suspected  oral lesions • Pulmonary KS •  rapidly progressivemaintain pain and • disease Involving facesymptom control

  3. Exclusions Absolute • severe peripheral neuropathy • unable to travel – financial or physical constraints • Hb < 8, platelet < 150 • severe liver disturbance/disease Relative • near to another hospital site delivering chemotherapy • minimal disease

  4. 2mg × six doses weekly Six week review If ‘no effect’, side effects and /or limited stable disease - discontinue If ‘good effect’, minimal side effects and residual disease – continue 2mg × six doses fortnightly Review (as for six week review) 2mg × six doses monthly Review at end of schedule + Review 3 months post treatment Initial assessment visit

  5. Pain and symptom control • Assess and treat pain according to WHO analgesic ladder • Salicylic acid cream/antihistamines for itching • Crushed metronidazole to reduce smell • potassium permanganate soaks to dry excess oozing • Wound care, nutrition assessment and advice

  6. WHO 3-stepLadder 3 severe Morphine ± step 1 and/or Adjuvants 2 moderate A/Codeine A/Dihydrocodeine Tramadol ± step 1 and/or Adjuvants 1 mild Aspirin Paracetemol NSAIDs ± Adjuvants

  7. Other issues to consider • This treatment regime is not curative • Patients/guardians need counselling about nature of disease to assist with having realistic expectations • A major part of management is managing expectations of patients, so information needs to be clear, consistent and honest • At Tiyanjane we use a Chichewa information sheet for literate patients (double side A4) which you can have a copy of. If its of use photocopy and give out. • If vincristine is not helping don’t continue it, aim for patient comfort and quality of life

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