An Evidence Practice Gap in Antiemetic Prescription with Chemotherapy

  • Chepsy C-Philip Department of Clinical Haematology, CMC Vellore, Tamil Nadu, India.
  • Biju George Department of Clinical Haematology, CMC Vellore, Tamil Nadu, India.
Keywords: Nausea, Vomiting, Chemotherapy, Antiemetics


Background: Chemotherapy induced nausea and vomiting is an added distress to patients burdened by the illness. In an effort to tackle the emetogenic potential of the agents, guidelines have been proposed to maintain uniformity in prescription and improvement in patient tolerance; but their utility and practice is not consistent. The aim of this clinical audit was to assess the antiemetic.practice and investigate the adherence to antiemetic clinical practice guideline
Methods: We performed an audit of the antiemetic practices in our tertiary referral centre. A.questionnaire based interview was completed at the outpatient visit to tabulate the data
Results: 99 (81.8%) patients received chemotherapy of at least low emetogenic risk. 83 (84%) patients received prophylaxis which was appropriate in 65% based on the our centre’s antiemetic regimen. This was however inappropriate in 76% of patients based on the international practice.parameters
Conclusions: Guidelines are not uniformly representative of all populations and modifications toguidelines based on local data are required to ensure success of such policies. There exist evidence-.practice gaps in antiemetic policies


de Boer-Dennert M, de Wit R, Schmitz PI, et al. Patient perceptions of the side-effects of chemotherapy: the influence of 5HT3 antagonists. Br J Cancer 1997; 76(8):1055-61.

Gralla RJ, Roila F, Tonato M, Herrstedt Jr. MASCC/ESMO antiemetic guideline . English_2011.pdf .

Basch E, Prestrud AA, Hesketh PJ, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2011; 29(31):4189-98.

Jordan K, Roila F, Molassiotis A, Maranzano E, Clark-Snow RA, Feyer P. Antiemetics in children receiving chemotherapy. MASCC/ESMO guideline update 2009. Support Care Cancer 2011;19(1):37-42.

Jordan K, Gralla R, Jahn F, Molassiotis A. International antiemetic guidelines on chemotherapy induced nausea and vomiting (CINV): Content and implementation in daily routine practice. Eur J Pharmacol 2014;722:197-202.

Roila F, Herrstedt J, Aapro M, et al. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 2010;21(Suppl. 5):v232-v43.

Basch E, Prestrud AA, Hesketh PJ, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2011;29(31):4189-98.

Ettinger DS, Armstrong DK, Barbour S, et al. Antiemesis. J Natl Compr Canc Netw 2012;10(4):456-85.

Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med 2008; 358(23):2482-94.

Antonarakis ES, Hain RDW. Nausea and vomiting associated with cancer chemotherapy: drug management in theory and in practice. Arch Dis Child 2004; 89(9):877-80.

Partridge MR. Translating research into practice: how are guidelines implemented? Eur Respir J 2003; 21(Suppl. 39):23s-9s.

Grol R, Grimshaw J. Evidence-based implementation of evidence-based medicine. Jt Comm J Qual Improv 1999; 25(10):503-13.

Clinton F, Dowling M, Capra M. An audit of chemotherapy-induced nausea and vomiting in children. Nurs Child Young People 2012; 24(7):18-23.

Miller M, Kearney N. Chemotherapy-related nausea and vomiting-past reflections, present practice and future management. Eur J Cancer Care 2004;13(1):71-81.

Vidall C, Dielenseger P, Farrell C, et al. Evidence-based management of chemotherapy-induced nausea and vomiting: a position statement from a European cancer nursing forum. Ecancermedicalscience 2011;5:211.

Gomez DR, Liao KP, Giordano S, Nguyen H, Smith BD, Elting LS. Adherence to national guidelines for antiemesis prophylaxis in patients undergoing chemotherapy for lung cancer. Cancer 2013;119(7):1428-36.

Caracuel F, Munoz N, Banos U, Ramirez G. Adherence to antiemetic guidelines and control of chemotherapy-induced nausea and vomiting (CINV) in a large hospital. J Oncol Pharm Pract 2014, Epub ahead of print.

Harrison MB, Legare F, Graham ID, Fervers B. Adapting clinical practice guidelines to local context and assessing barriers to their use. CMAJ 2010;182(2):E78-E84.

How to Cite
C-Philip C, George B. An Evidence Practice Gap in Antiemetic Prescription with Chemotherapy. J Pharm Care. 2(1):22-26.
Original Article(s)