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Evaluation of Adherence to Chemotherapy-Induced Nausea and Vomiting Guidelines. An Observational Study

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DOI: 10.4236/jct.2012.35078    4,014 Downloads   6,644 Views   Citations

ABSTRACT

Objective: To describe the prescribing trends of antiemetics in chemotherapy-induced nausea and vomiting (CINV), assess adherence to American Society of Clinical Oncology (ASCO) guidelines, and evaluate the effectiveness of prescribed antiemetics. Additionally, we also sought to explore barriers that hinder clinical practice guideline (CPG) implementation. Methods: One hundred fifty-five patients between the ages of 18 and 60 who were admitted to the haematology/oncology department/clinic to receive intravenous chemotherapy, either as in-patients or outpatients, were enrolled in a prospective observational study. Relevant patient demographic data, chemotherapy protocols and antiemetics were collected. Chemotherapies were classified according to their emetogenic potential. This information was used to assess whether the antiemetic prescribed matched the emetogenic risk of treatment. The analysis of outcomes was performed using the MASCC antiemetic assessment tool. Key Findings: The results showed that 95% of antiemetic prescription pre-chemotherapy regimens did not adhere to the guidelines. The findings were use of twice the recommended dose of granisetron (87.7%), overuse granisetron (16%) and metoclopramide (62.6%), and underuse dexamethasone (27%) and corticosteroid duplication (7.7%). With respect to post-chemotherapy antiemetic prescriptions, 91% of prescriptions were not adherent to guidelines, with overuse of granisetron (81.9%) and metoclpramide (34.2%) and underuse of dexamethasone (66.5%) being the most frequently reported trends. Conclusion: This study shows a lack of conformity to antiemetic guidelines, resulting mainly in overtreatment. Although vomiting was well-managed, nausea remains under controlled and requires additional medical attention. The lack of knowledge and motivation are considered barriers to CPG implementation.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

S. Almazrou and L. Alnaim, "Evaluation of Adherence to Chemotherapy-Induced Nausea and Vomiting Guidelines. An Observational Study," Journal of Cancer Therapy, Vol. 3 No. 5, 2012, pp. 613-620. doi: 10.4236/jct.2012.35078.

References

[1] D. J. Stewart, “Cancer Therapy, Vomiting, and Antiemetics,” Canadian Journal of Physiology and Pharmacology, Vol. 68, No. 2, 1990, pp. 304-313.doi:10.1139/y90-045
[2] P. L. Andrews and C. J. Davis, “The Mechanism of Emesis Induced by Anticancer Therapies,” In: P. L. Andrews, Ed., Emesis in Anti-Cancer Therapy, Chapman and Hall, London, 1993, pp. 113-161.
[3] S. M. Grunberg, et al., “Incidence of Chemotherapy-Induced Nausea and Emesis after Modern Antiemetics,” Cancer, Vol. 100, No. 10, 2004, pp. 2261-2268. doi:10.1002/cncr.20230
[4] The Italian Group for Antiemetic Research, “Transferability to Clinical Practice of the Results of Controlled Clinical Trials: The Case of Antiemetic Prophylactic Treatment for Cancer Chemotherapy-Induced Nausea and Vomiting," Annals of Oncology, Vol. 9, No. 7, 1998, pp. 759-765. doi:10.1023/A:1017132123411
[5] A. Fabi, et al., “Is Delayed Chemotherapy Induced Emesis Well Managed in Oncological Clinical Practice? An Observational Study,” Supportive Care in Cancer, Vol. 11, No. 3, 2003, pp. 156-161.
[6] A. Molassiotis, et al., “A Prospective Observational Study of Chemotherapy-Related Nausea and Vomiting in Routine Practice in a UK Cancer Center,” Supportive Care in Cancer, Vol. 16, No. 2, 2008, pp. 201-208.
[7] J. López-Jiménez, et al., “Chemotherapy-Induced Nausea and Vomiting in Acute Leukemia and Stem Cell Transplant Patients: Results of a Multicenter, Observational Study,” Haematologica, Vol. 91, No. 1, 2006, pp. 84-91.
[8] M. G. Kris, et al., “American Society of Clinical Oncology Guideline for Antiemetics in Oncology: Update 2006,” Journal of Clinical Oncology, Vol. 24, No. 35, 2006, pp. 2932-2947.doi:10.1200/JCO.2006.06.9591
[9] The Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC), “Prevention of Chemotherapy-and Radiotherapy-Induced Emesis: Results of the 2004 Perugia International Antiemetic Consensus Conference,” Annals of Oncology, Vol. 17, No. 1, 2006, pp. 20-28.
[10] A. Molassiotis, et al., “Validation and Psychometric Assessment of a Short Clinical Scale to Measure Chemotherapy-Induced Nausea and Vomiting: The MASCC Antiemesis Tool,” Journal of Pain and Symptom Management, Vol. 34, No. , 2007, pp. 148-159.doi:10.1016/j.jpainsymman.2006.10.018
[11] M. A. J. Peters, et al., “Room for Improvement? Barriers to and Facilitators for Improvement of Patient Care,” Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, 2002.
[12] M. Yonemura, et al., “Randomized Controlled Study Comparing Two Doses of Intravenous Granisetron (1 and 3 mg) for Acute Chemotherapy-Induced Nausea and Vomiting in Cancer Patients: A Non-Inferiority Trial,” Japanese Journal of Clinical Oncology, Vol. 39, No. 7, 2009, pp. 443-448. doi:10.1093/jjco/hyp036
[13] S. M. Bosnjak, et al., “High Efficacy of a Single Oral Dose of Ondansetron 8 mg versus a Metoclopramide Regimen in the Prevention of Acute Emesis Induced by Fluorouracil, Doxorubicin and Cyclophosphamide (FAC) Chemotherapy for Breast Cancer,” Journal of Chemotherapy, Vol. 12, No. 5, 2000, pp. 446-453.
[14] J. Bonneterre, et al., “A Randomized Double-Blind Comparison of Ondansetron and Metoclopramide in the Prophylaxis of Emesis Induced by Cyclophosphamide, Fluorouracil, and Doxorubicin or Epirubicin Chemotherapy,” Journal of Clinical Oncolory, Vol. 8, No. 6, 1990, pp. 1063-1069.
[15] H. Tsurumi, “Steroid Therapy in Oncology,” Nihon Rinsho, Vol. 66, No. 1, 2008, pp. 143-147.
[16] M. S. Aapro, et al., “A Randomized Double-Blind Trial to Compare the Clinical Efficacy of Granisetron with Metoclopramide, both Combined with Dexamethasone in the Prophylaxis of Chemotherapy-Induced Delayed Emesis,” Annals of Oncology, Vol. 14, No. 2, 2003, pp. 291-297. doi:10.1093/annonc/mdg075
[17] O. Geling and H. G. Eichler, “Should 5-Hydroxytryptamine-3 Receptor Antagonists be Administered beyond 24 Hours after Chemotherapy to Prevent Delayed Emesis? Systematic Re-Evaluation of Clinical Evidence and Drug Cost Implications,” Journal of Clinical Oncology, Vol. 23, No. 6, 2005, pp. 1289-1294.doi:10.1200/JCO.2005.04.022
[18] E. M. Ibrahim, et al., “Antiemetic Efficacy of High-Dose Dexamethasone: Randomized, Double-Blind, Crossover Study with High-Dose Metoclopramide in Patients Receiving Cancer Chemotherapy,” European Journal of Cancer & Clinical Oncology, Vol. 22, No. 3, 1986, pp. 283-288
[19] W. C. Mertens, et al., “Improving the Care of Patients with Regard to Chemotherapy-Induced Nausea and Emesis: The Effect of Feedback to Clinicians on Adherence to Antiemetic Prescribing Guidelines,” Journal of Clinical Oncology, Vol. 21, No. 7, 2003, pp. 1373-1378. doi:10.1200/JCO.2003.08.118
[20] T. Sarcev, et al., “The Influence of Dexamethasone in the Decrease of Chemotherapy-Induced Nausea and Vomiting,” Journal of the Balkan Union of Oncology, Vol. 12, No. 2, 2007, pp. 245-252.
[21] S. M. Grunberg, “Obstacles to the Implementation of Antiemetic Guidelines,” Journal of the National Comprehensive Cancer Network, Vol. 7, No. 5, 2009, pp. 601-605.
[22] P. J. Greco and J. M. Eisenberg, “Changing Physicians’ Practices,” The New England Journal of Medicine, Vol. 329, Suppl. 1, 1993, pp. 1271-1274.doi:10.1056/NEJM199310213291714

  
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