Supportive Care in Cancer

, Volume 20, Issue 8, pp 1805–1810

Implementation of institutional antiemetic guidelines for low emetic risk chemotherapy with docetaxel: a clinical and cost evaluation

  • Toshinobu Hayashi
  • Hiroaki Ikesue
  • Taito Esaki
  • Mami Fukazawa
  • Motoaki Abe
  • Shinji Ohno
  • Tatsuru Tomizawa
  • Ryozo Oishi
Original Article

Abstract

Purpose

The purposes of this study were to evaluate the effect of implementation of institutional guidelines for low emetic risk chemotherapy with docetaxel and estimate the cost saving for all low emetic risk chemotherapies.

Methods

We examined the clinical effect of preparing and implementing institutional antiemetic guidelines for the breast cancer patients receiving adjuvant docetaxel therapy. Although the antiemetic medication for such patients used to be ondansetron 4 mg plus dexamethasone 8 mg (OND + DEX), it was changed to dexamethasone (DEX) 12 mg alone after implementation of the institutional guidelines. The effectiveness and adverse effects of DEX alone (56 patients, 205 courses) were compared with those of OND + DEX (41 patients, 151 courses). The cost saving was calculated from the antiemetic costs in both groups. The annual cost saving was estimated from the number of all low emetic risk chemotherapies in a year.

Results

The incidences of nausea (19.5% versus 16.1%), vomiting (2.4% versus 0%), constipation (34.1% versus 30.4%), and insomnia (17.1% versus 17.9%) were not significantly different between the OND + DEX group and DEX alone group. In all low emetic risk chemotherapies, US $78,883 of potential cost saving was estimated in the first year after changing the antiemetic treatment.

Conclusion

The present results suggest that DEX alone is equally effective for preventing nausea and vomiting and less expensive compared with a 5-HT3 receptor antagonist plus DEX in low emetic risk chemotherapy with docetaxel.

Keywords

Low emetic risk chemotherapy Docetaxel Antiemetics Dexamethasone Cost-minimization analysis 

References

  1. 1.
    Berard CM, Mahoney CD (1995) Cost-reducing treatment algorithms for antineoplastic drug-induced nausea and vomiting. Am J Health Syst Pharm 52:1879–1885PubMedGoogle Scholar
  2. 2.
    Dranitsaris G, Warr D, Puodziunas A (1995) A randomized trial of the effects of pharmacist intervention on the cost of antiemetic therapy with ondansetron. Support Care Cancer 3:183–189PubMedCrossRefGoogle Scholar
  3. 3.
    Nolte MJ, Berkery R, Pizzo B et al (1998) Assuring the optimal use of serotonin antagonist antiemetics: the process for development and implementation of institutional antiemetic guidelines at Memorial Sloan-Kettering Cancer Center. J Clin Oncol 16:771–778PubMedGoogle Scholar
  4. 4.
    Brown RS, Brown TK, Hoare D et al (1998) An audit of antiemetic use with CMF chemotherapy. Clin Oncol 10:313–317CrossRefGoogle Scholar
  5. 5.
    Engstrom C, Hernandez I, Haywood J et al (1999) The efficacy and cost effectiveness of new antiemetic guidelines. Oncol Nurs Forum 26:1453–1458PubMedGoogle Scholar
  6. 6.
    Walker PC, Biglin KE, Constance TD et al (2001) Promoting the use of oral ondansetron in children receiving cancer chemotherapy. Am J Health Syst Pharm 58:598–602PubMedGoogle Scholar
  7. 7.
    Dranitsaris G, Leung P, Warr D (2001) Implementing evidence based antiemetic guidelines in the oncology setting: results of a 4-month prospective intervention study. Support Care Cancer 9:611–618PubMedCrossRefGoogle Scholar
  8. 8.
    McCune JS, Oertel MD, Pfeifer D et al (2001) Evaluation of outcomes in converting from intravenous ondansetron to oral granisetron: an observational study. Ann Pharmacother 35:14–20PubMedCrossRefGoogle Scholar
  9. 9.
    Steiner MA, Yorgason RZ, Vermeulen LC et al (2003) Patient outcomes after therapeutic interchange of dolasetron for granisetron. Am J Health Syst Pharm 60:1023–1028PubMedGoogle Scholar
  10. 10.
    Kris MG, Hesketh PJ, Somerfield MR et al (2006) American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 24:2932–2947PubMedCrossRefGoogle Scholar
  11. 11.
    Gralla RJ, Osoba D, Kris MG et al (1999) Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. American Society of Clinical Oncology. J Clin Oncol 17:2971–2994PubMedGoogle Scholar
  12. 12.
    The Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC) (2006) Prevention of chemotherapy- and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol 17:20–28CrossRefGoogle Scholar
  13. 13.
    National Comprehensive Cancer Network (NCCN) NCCN clinical practice guidelines in oncology. Antiemesis. V.2.2010. http://www.nccn.org/professionals/physician_gls/PDF/antiemesis.pdf. Accessed 17 June 2010
  14. 14.
    Herrstedt J, Aapro MS, Smyth JF et al (1998) Corticosteroids, dopamine antagonists and other drugs. Support Care Cancer 6:204–214PubMedCrossRefGoogle Scholar
  15. 15.
    Braithwaite SS, Barr WG, Rahman A et al (1998) Managing diabetes during glucocorticoid therapy. How to avoid metabolic emergencies. Postgrad Med 104:163–176PubMedCrossRefGoogle Scholar
  16. 16.
    Italian Group for Antiemetic Research (2004) Cancer patients submitted to innovative chemotherapeutic agents of intermediate emetic potential: antiemetic prescriptions and incidence of emesis. Tumori 90:103–106Google Scholar
  17. 17.
    Molassiotis A, Saunders MP, Valle J et al (2008) A prospective observational study of chemotherapy-related nausea and vomiting in routine practice in a UK cancer centre. Support Care Cancer 16:201–208PubMedCrossRefGoogle Scholar
  18. 18.
    Grunberg SM, Osoba D, Hesketh PJ et al (2005) Evaluation of new antiemetic agents and definition of antineoplastic agent emeticity: an update. Support Care Cancer 13:80–84PubMedCrossRefGoogle Scholar
  19. 19.
    Kataoka A, Ohno S, Sagara Y et al (2005) Team approach to providing the multidisciplinary medical treatment derived by the patients and their family. Breast Cancer 12:21–25PubMedCrossRefGoogle Scholar
  20. 20.
    The Statistics Bureau, Ministry of Internal Affairs and Communications Basic Survey on Wage Structure 2008. http://www.e-stat.go.jp/SG1/estat/List.do?bid=000001022183&cycode=0. Accessed 17 June 2010 (in Japanese)
  21. 21.
    Roché H, Fumoleau P, Spielmann M et al (2006) Sequential adjuvant epirubicin-based and docetaxel chemotherapy for node-positive breast cancer patients: the FNCLCC PACS 01 Trial. J Clin Oncol 24:5664–5671PubMedCrossRefGoogle Scholar
  22. 22.
    National Comprehensive Cancer Network (NCCN) (2010) NCCN clinical practice guidelines in oncology. Breast cancer. V.2.2010. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf. Accessed 17 June 2010
  23. 23.
    Vardy J, Chiew KS, Galica J et al (2006) Side effects associated with the use of dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy. Br J Cancer 94:1011–1015PubMedCrossRefGoogle Scholar
  24. 24.
    Italian Group for Antiemetic Research (2004) Randomized, double-blind, dose-finding study of dexamethasone in preventing acute emesis induced by anthracyclines, carboplatin, or cyclophosphamid. J Clin Oncol 22:725–729CrossRefGoogle Scholar
  25. 25.
    Suminaga M, Furue H, Taguchi T et al (1992) Clinical evaluation of ondansetron (injection of a single intravenous dose) against nausea and emesis associated with anti-cancer drugs–dose-finding study in patients receiving cisplatin. Gan To Kagaku Ryoho 19:1333–1345 (in Japanese)PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Toshinobu Hayashi
    • 2
  • Hiroaki Ikesue
    • 1
  • Taito Esaki
    • 3
  • Mami Fukazawa
    • 2
  • Motoaki Abe
    • 2
  • Shinji Ohno
    • 4
  • Tatsuru Tomizawa
    • 2
  • Ryozo Oishi
    • 1
  1. 1.Department of PharmacyKyushu University HospitalFukuokaJapan
  2. 2.Department of PharmacyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
  3. 3.Department of Medical OncologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
  4. 4.Department of Breast OncologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan

Personalised recommendations