Inadequate control over emesis during cancer chemotherapy can adversely affect patient's quality of life and cause poor adherence to treatment. This study was conducted to assess the utilization pattern and appropriateness of anti-emetic agents in comparison to international guidelines.
A prospective observational study was conducted from January 2014 to June 2014 at a HCG-Bharat Hospital and Institute of Oncology, Mysore, India. Medical records of the patients on chemotherapy were reviewed and patients were interviewed, to assess the utilization pattern of anti-emetics and its appropriateness. Chemotherapy regimen and given anti-emetics for each patient were recorded and reviewed in terms of selection of drugs, dose, frequency and duration with respect to National Comprehensive Cancer Network guidelines 2014 for anti-emesis.
Of 346 patients' record reviewed, majority (74%) received highly emetogenic drugs. Others received moderately emetogenic (17%) and low emetogenic potential drugs (9%). Unlike 30% of patients who were added with NK-1 receptor antagonist, majority (70%) of the patients receiving highly emetogenic regimen received only combination of 5-HT3 antagonist and steroids. Majority patients (64%) receiving moderately emetogenic regimen were prescribed combination of 5-HT3 antagonist and steroids and remaining received combination of metoclopramide with steroids. Most of the patients (82%) receiving low emetogenic regimen received combination of metoclopramide and steroids. Over all, selection of anti-emetic regimen was inappropriate for 32% (n = 112) patients. Dosage, frequency and duration of anti-emetic use were inappropriate in 18%, 38% and 8% respectively. Administration errors and inappropriate selection of anti-emetics were found higher (p < 0.05) in government funded patients compare to self-funded patients.
There exist evidence-practice gaps in antiemetic usage. Patient affordability and limited government insurance coverage were limiting factors to choose an appropriate anti-emetic regimen. Appropriate education and monitoring is essential to prevent administration errors and to encourage guideline adherence.
Clinical trial identification
All authors have declared no conflicts of interest.