Antiemetic prophylaxis and frequency of chemotherapy-induced nausea and vomiting in palliative first-line treatment of colorectal cancer patients: the Northern Bavarian IVOPAK I Project
- 457 Downloads
This study aims to evaluate adherence to guidelines of antiemetic prophylaxis and frequency of chemotherapy-induced nausea and vomiting (CINV) in the palliative first-line treatment of colorectal cancer (CRC) patients in Northern Bavaria.
We collected detailed information on chemotherapy and supportive drugs in 103 patients within a prospective observational study. The study was conducted to determine quality of care within an interdisciplinary context (first endpoint) and direct costs of palliative treatment for patients with CRC between 2006 and 2010 (second endpoint, Emmert et al. (Eur J Health Econ, 2012) ). In this paper, we evaluate adherence to Multinational Association of Supportive Care in Cancer (MASCC) 2006 recommendations for prophylaxis of CINV during the first administration of chemotherapy as well as incidence and grade of CINV within 120 h thereafter.
Of the patients studied, 95 patients (92 %) received moderately emetogenic (oxaliplatin- and/or irinotecan-containing combined chemotherapy treatment) and eight (8 %) received low emetogenic chemotherapy (either 5-fluorouracil (5-FU) or capecitabine monotherapy). Antiemetic prophylaxis could be assessed in 101 out of 103 (98 %) of patients. MASCC-recommended antiemetic prophylaxis was prescribed in three patients (3 %). Nonadherence was mainly caused by omission of dexamethasone. Nausea and/or vomiting occurred in 18 patients (18 %) within a 120-h period. All documented episodes were grade 1 or 2 according to the Common Toxicity Criteria of the National Cancer Institute. None of these patients received the recommended prophylaxis for CINV. In only one patient, antiemetic prophylaxis was intensified during the next chemotherapy application.
In the Integrated Health Care in the Palliative Treatment of Colorectal Carcinoma (IVOPAK) I Project, adherence to the MASCC clinical recommendations was very poor. Extent of CINV in this patient population seems to be underestimated. There is an urgent need to improve clinicians' awareness of this patient-relevant side effect.
KeywordsChemotherapy-induced nausea and vomiting Palliative first-line treatment of colorectal cancer Antiemetic prophylaxis Guidelines Supportive care IVOPAK
We would firstly like to thank the participating study sites for their cooperation. We are also indebted to Mrs. Gudrun Maennlein, who considerably made a contribution to the success of IVOPAK by coordinating the project. We acknowledge with particular gratitude Mrs. Melanie Hempel for her valuable comments. The IVOPAK project was supported by AOK Bayern, Fresenius, Medac, Merck Serono, Pfizer, and Roche.
Conflict of interest
All authors have completed and submitted the Disclosure Form of Potential Conflicts of Interest. Dr. Dörje reports being a member of the Pfizer National Advisory Board Germany. No other conflict of interest disclosures were reported.
- 2.Statistisches Bundesamt (2012) Gesundheit: Todesursachen in Deutschland 2010, Fachserie 12 Reihe 4. WiesbadenGoogle Scholar
- 9.DCTD N, NIH, DHHS (1999) Cancer Therapy Evaluation Program Common Toxicity Criteria, version 2.0.Google Scholar
- 18.Bero LA, Grilli R, Grimshaw JM et al (1998) Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ 317(7156):465–468CrossRefGoogle Scholar