1493P - Chemotherapy induced nausea & vomiting (CINV)-auditing our practice at The Christie Hospital against established MASCC/ESMO guidelines

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Complications of Treatment
Supportive Care
Bioethics, Legal, and Economic Issues
Presenter Rebecca Leon
Citation Annals of Oncology (2014) 25 (suppl_4): iv517-iv541. 10.1093/annonc/mdu356
Authors R.O. Leon1, G. Saunders2, J. Lowe2, T. Scannell2, K. Mais3, R. Berman4
  • 1Palliative Care, The Christie NHS Trust, M20 4BX - Manchester/GB
  • 2Pharmacy, Christie Hospital, Manchester/GB
  • 3Oncology, Christie Hospital, manchester/GB
  • 4Medical Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB

Abstract

Aim

Few side effects of chemotherapy are more feared by patients than nausea and vomiting (CINV). For certain patients, it causes distress, morbidity and in some cases hospital admission. CINV can be Anticipatory (as a conditioned response), Acute (within hours of chemotherapy and peaking in the first four to six hours) and Delayed (occurring 24hrs after treatment). The aim of this audit was to assess current prescribing practice and outcomes at one of Europe's major cancer centres, and to benchmark practice against established international guidelines from the MASCC/ESMO 2009 Perugia consensus. We were also interested in what proportion of patients required admission due to CINV.

Methods

Prospective study of case notes and e- prescribing records of 360 patients from four primary cancer disease sites (Head and Neck, Breast, Colorectal, and Ovarian). Each cohort was followed through three cycles of chemotherapy. Data on severity of nausea and vomiting, anti-emetic use, hospital admission and concordance with international guidelines was recorded.

Results

Concordance with MASCC guidelines ranged from 88% (Head and Neck) to 0% (colorectal and ovarian. 57% of the total cohort reported nausea and 32% vomiting. 11% of patients were admitted to hospital with CINV a contributory factor. Aprepitant was added at a later cycle in 15% patients, which resulted in better symptom control.

Conclusions

The objective of antiemetic therapy is the complete prevention of CINV. Treatment should individualise to the patient's regime, and other factors such as physical and psychological comorbidity. Patients should have access to information and alternative treatments. Admission as a consequence of CINV should be considered as a treatment failure. Where control is poor other causes such as CNS or gastrointestinal pathology, metabolic problems, and drugs should be considered prior to changing antiemetics. In our Centre the introduction of MASCC guidance, comprehensive clinical assessment prior to and after the first cycle (with the early addition of aprepitant for symptomatic patients), could reduce debilitating symptoms, improve QOL, and reduce unnecessary admissions.

Disclosure

All authors have declared no conflicts of interest.