Original Article

Assessment of the Adherence Rate of Acute Chemotherapy Induced Nausea and Vomiting Prophylaxis Regimens by Medical Team to NCCN Clinical Recommendations: Cross-Section Observation

Abstract

Backgrounds: Chemotherapy induced nausea and vomiting (CINV) is still distressing adverse effect for patients. Thus, we conducted this study to assess the compliance of CINV prophylaxis patterns with NCCN guideline.Methods: 136 Patients with any kind of malignancy who undergoes chemotherapy in Shahid Ghazi hospital, Tabriz, Iran, were included in this study. Adherence rate to the NCCN guideline of anti-emetic therapy for different emetogenic potential chemotherapy regimens was evaluated.Results: All patients received their prophylaxis 30 min before chemotherapy, which is completely adherent to guideline. Hematological malignancies were associated with higher adherence rate (P=0.032). For high and moderate emetic risk patients, dexamethasone and ondansetron were remarkably under-dosed, whereas Granisetron was over-dosed. Adherence rate to guideline in high and moderate and minimal emetic risk chemotherapy was 72.3%, 22.9% and 69.2% respectively. None of low emetic risk patients received guideline compliant prophylaxis. In all emetic risk levels, 50 (36.8%) patients received guideline adherent prophylaxis.Conclusion: As results indicated, adherence rate wasn’t optimal. Available dosage form of a medication has great impact on appropriate prescription. Thus, it is suggested for pharmaceutical companies to be informed about recent guidelines’ updates and subsequently produce proper dosage forms for different indications.

1. 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.
2. Kaiser R. Antiemetic guidelines: are they being used? Lancet Oncol 2005;6(8):622-5.
3. Schnell FM. Chemotherapy-induced nausea and vomiting: the importance of acute antiemetic control. Oncologist 2003;8(2):187-98.
4. Berger MJ, Ettinger DS, Aston J, et al. NCCN Guidelines Insights: Antiemesis, Version 2.2017. J Natl Compr Canc Netw 2017;15(7):883-93.
5. Grunberg SM, Deuson RR, Mavros P, et al. Incidence of chemotherapy-induced nausea and emesis after modern antiemetics. Cancer 2004;100(10):2261-8.
6. Alamri A, Alawlah YA, Qiao Y, Wang J. A retrospective review of treatment patterns of antiemetic agents for chemotherapy-induced nausea and vomiting. SAGE Open Med 2018;6:2050312118767234.
7. Encinosa W, Davidoff AJ. Changes in Antiemetic Overuse in Response to Choosing Wisely Recommendations. JAMA Oncol 2017;3(3):320-6.
8. Lorusso D, Bria E, Costantini A, Di Maio M, Rosti G, Mancuso A. Patients' perception of chemotherapy side effects: Expectations, doctor-patient communication and impact on quality of life - An Italian survey. Eur J Cancer Care (Engl) 2017;26(2):e12618.
9. Aapro M, Molassiotis A, Dicato M, et al. The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER). Ann Oncol 2012;23(8):1986-92.
10. França MS, Usón Junior PL, Antunes YP, et al. Assessment of adherence to the guidelines for the management of nausea and vomiting induced by chemotherapy. Einstein (Sao Paulo) 2015;13(2):221-5.
11. LeBlanc TW, El-Jawahri A. When and why should patients with hematologic malignancies see a palliative care specialist? Hematology Am Soc Hematol Educ Program 2015;2015:471-8.
12. Hochman MJ, Yu Y, Wolf SP, Samsa GP, Kamal AH, LeBlanc TW. Comparing the Palliative Care Needs of Patients with Hematologic and Solid Malignancies. J Pain Symptom Manage 2018;55(1):82-88.e1.
13. Chizuka A, Suda M, Shibata T, et al. Difference between hematological malignancy and solid tumor research articles published in four major medical journals. Leukemia 2006;20(10):1655-7.

14. Bevoor DB, Patel H, Dinnimath BM, Chitti R. Drug Utilization Evaluation of Antiemetics in Chemotherapy Induced nausea and vomiting in oncology setting. Acta Scientific Pharmaceutical Sciences 2018;2(8):30-39.
15. Burmeister H, Aebi S, Studer C, Fey MF, Gautschi O. Adherence to ESMO clinical recommendations for prophylaxis of chemotherapy-induced nausea and vomiting. Support Care Cancer 2012;20(1):141-7.
16. Tamura K, Aiba K, Saeki T, et al. Testing the effectiveness of antiemetic guidelines: results of a prospective registry by the CINV Study Group of Japan. Int J Clin Oncol 2015;20(5):855-65.
17. Italian Group for Antiemetic Research. Double-blind, dose-finding study of four intravenous doses of dexamethasone in the prevention of cisplatin-induced acute emesis. Italian Group for Antiemetic Research. J Clin Oncol 1998;16(9):2937-42.
18. Bagnes C, Panchuk PN, Recondo G. Antineoplastic chemotherapy induced QTc prolongation. Curr Drug Saf 2010;5(1):93-6.
19. Ganjare A, Kulkarni AP. Comparative electrocardiographic effects of intravenous ondansetron and granisetron in patients undergoing surgery for carcinoma breast: A prospective single-blind randomised trial. Indian J Anaesth 2013;57(1):41-5.
20. Affronti ML, Schneider SM, Herndon JE 2nd, Schlundt S, Friedman HS. Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice. Support Care Cancer 2014;22(7):1897-905.
Files
IssueVol 9, No 1 (Winter 2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jpc.v9i1.6033
Keywords
Antiemetics; Antineoplastic Agents; Nausea; Vomiting
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Mohammadzadeh M, Hatefi S, Reshadi N, Sanaat Z, Ghaffary S. Assessment of the Adherence Rate of Acute Chemotherapy Induced Nausea and Vomiting Prophylaxis Regimens by Medical Team to NCCN Clinical Recommendations: Cross-Section Observation. J Pharm Care. 2021;9(1):24-30.