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Supportive Care in Cancer

, Volume 21, Issue 9, pp 2395–2402 | Cite as

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

  • Sonja KochEmail author
  • Axel Wein
  • Jürgen Siebler
  • Frank Boxberger
  • Markus F. Neurath
  • Hanns-Detlev Harich
  • Werner Hohenberger
  • Frank Dörje
Original Article

Abstract

Purpose

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.

Methods

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) [1]). 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.

Results

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.

Conclusions

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.

Keywords

Chemotherapy-induced nausea and vomiting Palliative first-line treatment of colorectal cancer Antiemetic prophylaxis Guidelines Supportive care IVOPAK 

Notes

Acknowledgments

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.

References

  1. 1.
    Emmert M, Pohl-Dernick K, Wein A et al. (2012) Palliative treatment of colorectal cancer in Germany: cost of care and quality of life. Eur J Health Econ. doi: 10.1007/s10198-012-0408-5 CrossRefGoogle Scholar
  2. 2.
    Statistisches Bundesamt (2012) Gesundheit: Todesursachen in Deutschland 2010, Fachserie 12 Reihe 4. WiesbadenGoogle Scholar
  3. 3.
    Schmiegel W, Pox C, Reinacher-Schick A et al (2010) S3 guidelines for colorectal carcinoma: results of an evidence-based consensus conference on February 6/7, 2004 and June 8/9, 2007 (for the topics IV, VI and VII). Z Gastroenterol 48(1):65–136CrossRefGoogle Scholar
  4. 4.
    Basch E, Prestrud AA, Hesketh PJ et al (2011) Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 29(31):4189–4198CrossRefGoogle Scholar
  5. 5.
    Roila F, Herrstedt J, Aapro M et al (2010) Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 21(Suppl 5):v232–v243CrossRefGoogle Scholar
  6. 6.
    Kaiser R (2005) Antiemetic guidelines: are they being used? Lancet Oncol 6(8):622–625CrossRefGoogle Scholar
  7. 7.
    Griffin AM, Butow PN, Coates AS et al (1996) On the receiving end. V: patient perceptions of the side effects of cancer chemotherapy in 1993. Ann Oncol 7(2):189–195CrossRefGoogle Scholar
  8. 8.
    Roila F, Hesketh PJ, Herrstedt J (2006) Prevention of chemotherapy- and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol 17(1):20–28PubMedGoogle Scholar
  9. 9.
    DCTD N, NIH, DHHS (1999) Cancer Therapy Evaluation Program Common Toxicity Criteria, version 2.0.Google Scholar
  10. 10.
    Burmeister H, Aebi S, Studer C et al (2012) Adherence to ESMO clinical recommendations for prophylaxis of chemotherapy-induced nausea and vomiting. Support Care Cancer 20(1):141–147CrossRefGoogle Scholar
  11. 11.
    Drug Utilization Review Team in Oncology (2003) Antiemetic prescription in Italian breast cancer patients submitted to adjuvant chemotherapy. Support Care Cancer 11(12):785–789CrossRefGoogle Scholar
  12. 12.
    Fabi A, Barduagni M, Lauro S et al (2003) Is delayed chemotherapy-induced emesis well managed in oncological clinical practice? An observational study. Support Care Cancer 11(3):156–161PubMedGoogle Scholar
  13. 13.
    The Italian Group for Antiemetic Research (1998) Transferability to clinical practice of the results of controlled clinical trials: the case of antiemetic prophylactic treatment for cancer chemotherapy-induced nausea and vomiting. Ann Oncol 9(7):759–765CrossRefGoogle Scholar
  14. 14.
    Brugnatelli S, Gattoni E, Grasso D et al (2011) Single-dose palonosetron and dexamethasone in preventing nausea and vomiting induced by moderately emetogenic chemotherapy in breast and colorectal cancer patients. Tumori 97(3):362–366CrossRefGoogle Scholar
  15. 15.
    Abbrederis K, Lorenzen S, Rothling N et al (2009) Chemotherapy-induced nausea and vomiting in the treatment of gastrointestinal tumors and secondary prophylaxis with aprepitant. Onkologie 32(1–2):30–34PubMedGoogle Scholar
  16. 16.
    Cabana MD, Rand CS, Powe NR et al (1999) Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 282(15):1458–1465CrossRefGoogle Scholar
  17. 17.
    Grunberg S (2012) Patient-centered management of chemotherapy-induced nausea and vomiting. Cancer Control 19(2 Suppl):10–15CrossRefGoogle Scholar
  18. 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
  19. 19.
    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(8):611–618CrossRefGoogle Scholar
  20. 20.
    Mertens WC, Higby DJ, Brown D et al (2003) Improving the care of patients with regard to chemotherapy-induced nausea and emesis: the effect of feedback to clinicians on adherence to antiemetic prescribing guidelines. J Clin Oncol 21(7):1373–1378CrossRefGoogle Scholar
  21. 21.
    Majek O, Gondos A, Jansen L et al (2012) Survival from colorectal cancer in Germany in the early 21st century. Br J Cancer 106(11):1875–1880CrossRefGoogle Scholar
  22. 22.
    Grunberg S (2012) Improving control of chemotherapy-induced nausea and vomiting. Cancer Control 19(2 Suppl):2CrossRefGoogle Scholar
  23. 23.
    Molassiotis A, Coventry PA, Stricker CT et al (2007) Validation and psychometric assessment of a short clinical scale to measure chemotherapy-induced nausea and vomiting: the MASCC antiemesis tool. J Pain Symptom Manage 34(2):148–159CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Sonja Koch
    • 1
    Email author
  • Axel Wein
    • 2
  • Jürgen Siebler
    • 2
  • Frank Boxberger
    • 2
  • Markus F. Neurath
    • 2
  • Hanns-Detlev Harich
    • 3
  • Werner Hohenberger
    • 4
  • Frank Dörje
    • 1
  1. 1.Pharmacy Department, Erlangen University HospitalFriedrich-Alexander-University Erlangen-NurembergErlangenGermany
  2. 2.Department of Medicine 1-Gastroenterology, Pneumology and EndocrinologyFriedrich-Alexander-University Erlangen-NurembergErlangenGermany
  3. 3.Private Oncology PracticeHofGermany
  4. 4.Department of SurgeryFriedrich-Alexander-University Erlangen-NurembergErlangenGermany

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