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

Abstract

<strong>Objective: </strong>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. <strong>Methods: </strong>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. <strong>Key Findings: </strong>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. <strong>Conclusion:</strong> 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

Cost-Effectiveness Analysis of Granisetron-Based versus Standard Antiemetic Regimens in Low-Emetogenic Chemotherapy: A Hospital-based Perspective from Malaysia

“…It is currently listed in the National Drug Formulary of Malaysia for two indications: chemotherapy-induced and post-operative nausea and vomiting (CINV and PONV) (Pharmacy Services Division Malaysia, 2011). Consistent with the trend reported by two previous studies (Almazron and Alnaim, 2012;Burmeister et al, 2012), it appears to be overprescribed for low emetogenic chemotherapy (LEC) among some of the general hospitals in Malaysia. In fact, it is only recommended to be used as the primary prophylaxis in moderately and highly-emetogenic chemotherapy (MEC and HEC) by both the local and international antiemetic guidelines (Ismail et al, 2011;Ettinger et al, 2012).…”

Can Granisetron Injection Used as Primary Prophylaxis Improve the Control of Nausea and Vomiting with Low-Emetogenic Chemotherapy?

“…From our observation, granisetron injection appears to be overprescribed for the low emetogenic chemotherapy (LEC) in these settings at the maximum dosage of 3mg (0.04mg/kg). The similar trends were reported in Saudi Arabia and Switzerland recently (Almazron and Alnaim, 2012;Burmeister, 2012). It is believed to be crucial in order to provide patients the highest level of protection from CINV in LEC by some of the local prescribers including oncologists.…”

“…It was defined as "overtreatment" and reported to bring about collateral side effects including stypsis, headache and gastrointestinal disturbances in patients already being subjected to the administration of toxic drugs. It had also led to the unnecessarily high cost (Almazron and Alnaim, 2012). According to the recently updated NCCN guidelines, 5-HT3 antagonist is not recommended to be used in chemotherapy regimens with low or minimal emetogenic potentials.…”

Adherence to guidelines on prophylaxis of chemotherapy-induced nausea and vomiting in the National Cancer Institute, Sudan

“…Similarly, underuse of dexamethasone was described in a previous study from Saudi Arabia. 16 In 14% of patients in this study, dexamethasone was prescribed as antiemetic prophylaxis to patients already receiving prednisolone-containing chemotherapy. The steroid duplication was also described in a previous study.…”

“…Similar result has been reported in Saudi Arabia. 16 Koch et al also reported extremely low adherence rate (3%) in 113 patients with colorectal cancer receiving MEC or LEC. 17 The pattern of non-adherence to ASCO guidelines in our study included overuse of ondansetron before chemotherapy regimens classified as having low or minimal emetic risk.…”