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Antiemetic prophylaxis (AP) in our clinical practice: are we doing it right?

Date

09 Oct 2016

Session

Poster display

Presenters

Enrico Vasile

Citation

Annals of Oncology (2016) 27 (6): 497-521. 10.1093/annonc/mdw390

Authors

E. Vasile, G. Musettini, A. Sbrana, A. Farnesi, I.M. Brunetti, L. Galli, E. Biasco, A. Falcone, S. Ricci, A. Antonuzzo

Author affiliations

  • Polo Oncologico, Azienda Ospedaliera Universitaria S.Chiara, 56126 - Pisa/IT
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Resources

Background

In recent years several national and international guidelines about AP have been drafted; they suggest a different AP according to chemotherapeutic agents' emetic potential (that is, high [HEC], AC/EC regimen, moderate [MEC], low [LEC], or minimal [mEC]). We then decide to perform a survey to assess our adherence to these recommendations.

Methods

We analysed AP prescribed to our patients (pts) who underwent chemotherapy (CT), both oral and intravenous, during 5 days in our Day Hospital Service. We compared it to 2016 MASCC Guidelines with the exception of carboplatin, which was still considered MEC (although the recent “upgrade” to HEC).

Results

We analysed 322 pts, of which 11 (3.4%), 11 (3.4%), 99 (30.8%), 126 (39.1%), and 75 (23.3%) received HEC, AC/EC, MEC, LEC, and mEC regimens, respectively. 82 pts (25.5%) received appropriate AP, whereas 240 (74.5%) had an inconsistent AP. Among HEC regimens, only 9.1% of pts received correct AP, whereas 91.9% had a wrong AP (70% in both acute and delayed AP). For AC/EC schemes, 100% pts received inconsistent AP, of which 36.4% in delayed AP, and 63.6% in both acute and delayed AP. Among MEC schemes, 96% pts received an inconsistent AP (45.3% in delayed AP, and 53.7% in both). For LEC schemes, 93.6% pts received inconsistent AP, among which 96.6% in acute AP. In mEC regimens, 92% pts received inconsistent AP (of which 66.6% in acute AP). The main errors are the abuse of corticosteroids, mainly in the acute AP (46.3% of all pts), and of anti-5HT3 (35.1%).

Total (%) HEC (%) AC/EC (%) MEC (%) LEC (%) mEC (%)
Consistent 25.5 9.1 0 4 6.3 92
Inconsistent, of which: - Only acute - Only delayed - Both acute and delayed 74.5 49.6 21.2 29.2 90.9 0 30 70 100 0 36.4 63.6 96 1 45.3 53.7 93.6 96.6 0 3.4 8 66.6 16.7 16.7

Conclusions

Although the existence of specific AP guidelines, there is still a lack of adherence to evidence-based literature, both in the way of under- and over-prescription. This underlines the need of implementing education for healthcare professionals and usage of informatics tools for antiemetic therapies in everyday clinical practice to reduce inconsistencies and to increase adherence to guidelines.

Clinical trial identification

Legal entity responsible for the study

Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana

Funding

Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana

Disclosure

All authors have declared no conflicts of interest.

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