Abstract 468P
Background
There is dearth of data comparing different antiemetics for opioid induced nausea vomiting (OINV) in patients with advanced cancer not planned for further disease directed treatment in low resource settings. Our aim was to compare effectiveness of various clinician preferred antiemetic agents for OINV in oncological palliative care services.
Methods
We did prospective observational study in adult advanced cancer patients on best supportive care alone referred to oncological palliative care services, started newly on oral strong opioids for pain management. Patients with refractory nausea vomiting, already prescribed antiemetics like haloperidol or olanzapine were excluded. Eligible patients were assessed at baseline prescribed antiemetics according to clinician preferences, were followed up on day 3 and 7. The primary outcome measure was number of vomiting episodes on day 3. Changes in severity of nausea were measured using Edmonton Symptom Assessment Scale Revised (ESAS-R) from baseline to day 7.
Results
A total of 101 patients with 53males and 48females with median age of 52 years were included in study. Majority were outpatients and most common cancer was hepatobiliary. The patients received three antiemetics: ondansetron, haloperidol, metoclopramide. There was no statistically significant difference in number of vomiting episodes on day 3 among three antiemetics [H(2)=0.068 p=0.966]. The difference in severity of nausea from baseline till day 7 was statistically significant among three antiemetics [H(2)=7.724 p =0.021]. Patients on haloperidol, when compared to metoclopramide, had statistically significant reduction in nausea score compared to other groups on day 7 (U=243 z=-2.537 p=0.011 r=0.3).
Conclusions
We found no statistically significant difference in total vomiting episodes at 72h among three antiemetics in this study. Nausea was significantly reduced on day 7 in all three antiemetics with a statistically significant reduction in severity of nausea in haloperidol as compared to metoclopramide group. Further research in OINV management in different cancer populations in low-resource settings is required.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.