Practice Patterns for Prevention of Chemotherapy-Induced Nausea and Vomiting and Antiemetic Guideline Adherence Based on Real-World Prescribing Data

The oncologist

article

Matti Aapro¹  Florian Scotté²  Yolanda Escobar³  Luigi Celio⁴  Richard Berman⁵  Alessandra Franceschetti⁶  Danielle Bell⁶  Karin Jordan⁷ 

[1] Genolier Cancer Centre;Interdisciplinary Cancer Course Department, Gustave Roussy Cancer Center;Department of Medical Oncology, Hospital General Universitario Gregorio Marañón;Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori;The Christie NHS Foundation Trust, United Kingdom;Ipsos Healthcare, United Kingdom;Department of Medicine V, University Hospital Heidelberg

关键词: Physician survey;    Chemotherapy-induced nausea and vomiting;    Antiemetic guidelines;    Guideline adherence;   

DOI  :  10.1002/onco.13716

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background Guideline-recommended antiemetic prophylaxis improves nausea and vomiting control in most patients undergoing chemotherapy. Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO) antiemetic guidelines recommend prophylaxis with a neurokinin-1 receptor antagonist (NK 1 RA), a 5-hydroxytryptamine-3 receptor antagonist (5-HT 3 RA), and dexamethasone for patients receiving highly emetogenic chemotherapy (HEC), including anthracycline-cyclophosphamide (AC)- and carboplatin (considered moderately emetogenic chemotherapy)-based chemotherapy. Here, we analyze the use of NK 1 RA–5-HT 3 RA–dexamethasone for antiemetic prophylaxis associated with HEC and carboplatin. Methods The data source was the Global Oncology Monitor (Ipsos Healthcare). Geographically representative physicians from France, Germany, Italy, Spain, and the U.K. were screened for treatment involvement and number of patients treated per month. Patients’ data from January to December 2018 were collected from medical charts and extrapolated on the basis of the total number of physicians who prescribe chemotherapy. The emetic risk of chemotherapy was classified per MASCC/ESMO guidelines. Results Data from 45,324 chemotherapy-treated patients were collected, representing a total extrapolated prevalence of 1,394,848 chemotherapy treatments included in the analysis. NK 1 RAs were used in 45%, 42%, and 19% of patients receiving cisplatin-, AC-, and carboplatin-based chemotherapy, respectively; 18%, 24%, and 7% received the guideline-recommended NK 1 RA–5-HT 3 RA–dexamethasone combination; no antiemetics were prescribed for 12% of the treatments. Often, physicians’ perception of the emetic risk of chemotherapy did not follow MASCC/ESMO guideline classification. Conclusion Low adherence to antiemetic guidelines was revealed in clinical practice in five European countries, with 15% of all HEC-/carboplatin-based treatments receiving guideline-recommended NK 1 RA–5-HT 3 RA–dexamethasone prophylaxis and 12% of them receiving no antiemetics. New strategies for improving guideline adherence are urgently needed. Implications for Practice Despite recent advances in antiemetic therapy, a substantial proportion of patients experience nausea and vomiting associated with chemotherapy in daily clinical practice. Antiemetic guidelines aim at prevention of chemotherapy-induced nausea and vomiting (CINV), and guideline-consistent antiemetic therapy can effectively prevent vomiting and, to a lesser extent, nausea in most patients with cancer. This study reports low adherence to antiemetic guidelines in the highly emetogenic chemotherapy setting in daily clinical practice across five European countries. Opportunity exists to increase adherence to antiemetic guideline recommendations. Implementation of strategies to facilitate guideline adherence can potentially improve CINV control.

【 授权许可】

CC BY|CC BY-NC