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Impact of chemotherapy-induced nausea and vomiting (CINV) on emergency department (ED) visits and disruption of chemotherapy: results of a survey of oncology nurses

Date

09 Oct 2016

Session

Poster display

Presenters

Cynthia Rittenberg

Citation

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

Authors

C. Rittenberg1, R. Clark-Snow2, M.L. Affronti3

Author affiliations

  • 1 Medical Oncology, Rittenberg Oncology Consulting, 70005 - Metairie/US
  • 2 Medical Oncology, University of Kansas Cancer Center, Westwood/US
  • 3 School Of Nursing, Duke University, Durham/US
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Background

Prevention of CINV is possible in most patients undergoing emetogenic chemotherapy with the current antiemetic armamentarium. Because nurses play a critical role in symptom management and supportive care, a survey of oncology nurses was conducted to (1) assess practice patterns of antiemetic use for prevention of CINV, (2) determine adherence to guideline recommendations and (3) query barriers to adherence. Estimates of CINV control rates and proportions of patients having chemotherapy postponed/stopped/changed or requiring ED/hospital visits due to CINV was also evaluated and is the focus of this abstract.

Methods

In Sept 2015, 531 US-based oncology nurses participated in an online survey administered and analyzed by ONS:Edge.

Results

The majority of respondents were staff nurses (73%) working in the outpatient setting (64%) with >5 years of oncology experience (70%). Practice patterns of antiemetic use revealed low adherence to antiemetic guidelines, particularly during the delayed (25-120h) phase following highly emetogenic chemotherapy, where only 25% of nurses reported administration of guideline-recommended agents. Only 17% reported most (>75%) of their patients having CINV optimally controlled; 39% reported between 6-20% of patients have an alteration in their chemotherapy due to CINV, and reports of ED/hospital visits due to poorly controlled CINV were high (Table).

Response Options Percentage Total Respondents
% Patients with Complete Response (No Emesis/Rescue Use) 30% 14% 37% 26% 13% 5% 4%
Any Patients Requiring Emergency Visits or Hospitalization Due to Poorly Controlled CINV Yes No Unsure 61% 22% 17%

Conclusions

This nursing survey revealed poor adherence to antiemetic guideline recommendations, low CINV control rates and a surprisingly high proportion of patients having changes made to their cancer treatment or ED/hospital visits due to poorly controlled CINV. There is a critical need to address barriers interfering with use of guideline-recommended antiemetics in order to optimize CINV control for patients undergoing emetogenic chemotherapy.

Clinical trial identification


Legal entity responsible for the study

ONS: Edge

Funding

Eisai, Inc.

Disclosure

C. Rittenberg: Stock in Amgen, Abbott labs, Abbie Vie, Biogen, Celgene, J & J, Novartis, Eli Lily, Gilead, Merck, Pfizer; Consultant for Heron. R. Clark-Snow: Honoraria received from Merck and Tesaro Consutant/Advisor for Merck and Tesaro Speaker's Bureau for Merck. M.L. Affronti: Research funding from Eisai, Merck and Amgen for investigator-initiated trials.

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