Preventing CINV in most patients is possible when guideline-recommended prophylactic antiemetics are utilized. Because oncology nurses play a critical role in risk assessment and management of CINV, a survey of European nurses was conducted to evaluate antiemetic practices, determine awareness of and adherence to current guideline recommendations, and explore barriers to adherence.
Between March 2016 and March 2017, 212 oncology nurses in 16 European countries completed a 20-question online survey.
Respondents had 15 years (median) experience as an oncology nurse and most were able to suggest or prescribe antiemetics. Most (n = 169, 80%) worked in the public not-for-profit hospital setting, seeing both in- and outpatients (n = 107, 50%). While nurses were most familiar with ASCO (n = 97, 46%) and MASCC/ESMO (n = 84, 40%) guidelines, individual institution guidelines were used most (n = 99, 47%). Key discrepancies between antiemetic use and guideline recommendations were: i) underutilization of NK1RAs, 5-HT3RAs and a steroid on Day 1 in the HEC setting and ii) high use of 5-HT3RAs during days 2-5 when guidelines recommend a steroid (Table 1). Metoclopramide use (not guideline recommended) was also high, with ∼30% and ∼50% of nurses reporting usage for acute and delayed phases, respectively, for both HEC and MEC settings. The most common barrier to the use of guideline-recommended agents was reported as physician preference (n = 84, 40%). Product cost and formulary inclusion also played a role. The 2 most common challenges in managing CINV were “controlling nausea and vomiting in the delayed phase” (n = 135, 64%) and “reducing the impact of CINV on patients’ quality-of-life” (n = 130, 61%).rnTable:
1552P Antiemetic Utilization - European Nurse Surveyrn
|Settingrn||Antiemetic Classrn||Antiemetics Utilized n (% respondents)rn|
|Acute Phase (0-24 h)rn||Delayed Phase (25-120 h)rn|
|HECrn||5-HT3 RA NK1 RA NEPA Steroid (eg, DEX) Phenothiazine Benzodiazepine Antipsychotic Metoclopramidern||171 (81%) 130 (61%) 48 (23%) 173 (82%) 1 (0%) 35 (17%) 10 (5%) 63 (30%)rn||105 (50%) 92 (43%) 23 (11%) 133 (63%) 12 (6%) 25 (12%) 19 (9%) 103 (49%)rn|
|MECrn||5-HT3 RA NK1 RA NEPA Steroid (eg, DEX) Phenothiazine Benzodiazepine Antipsychotic Metoclopramidern||183 (86%) 44 (21%) 17 (8%) 164 (77%) 3 (1%) 14 (7%) 5 (2%) 67 (32%)rn||100 (47%) 38 (18%) 19 (9%) 122 (58%) 10 (5%) 15 (7%) 13 (6%) 108 (51%)rn|
HEC: highly emetogenic, MEC: moderately emetogenic, DEX: dexamethasone, NEPA: fixed combination of netupitant/palonosetronrn
This survey highlights many opportunities to improve utilization of guideline-recommended antiemetics, thereby optimizing prevention of CINV and quality-of-life for patients receiving emetogenic chemotherapy.
Clinical trial identification
Legal entity responsible for the study
Helsinn Healthcare SA
Helsinn Healthcare, SA
P. Dielenseger: Member of advisory boards of Helsinn, Bayer Healthcare, Pfizer, Shire, Tesaro, Janssen, and BMS A. Young: Received honorarium from MSD (advisory board and presentations given), Helsinn (advisory boards) and Chugai (presentation given). P. Jahn: Support includes travel support: Helsinn (2014); Current consulting or advisory role: Bristol-Myers Squibb, Chugai, Norgine, and Clinigen; Clinical Research Fund by Chugai. All other authors have declared no conflicts of interest.