Effect of an electronic quality checklist on prescription patterns of prophylactic antiemetic and pain flare medications in the context of palliative radiotherapy for bone metastases

  • Marc GaudetEmail author
  • Kelly Linden
  • Julie Renaud
  • Rajiv Samant
  • Kristopher Dennis
Original Article



International guidelines are available to guide prescription of antiemetic and pain flare medications in patients receiving palliative radiotherapy for bone metastases, but prescription rates are quite variable. We hypothesized that a simple electronic quality checklist could increase the evidence-based use of these medications.

Materials and methods

We implemented an electronic quality checklist item in our center for all patients treated with palliative radiotherapy for lumbar spine bone metastases. We retrospectively reviewed patients in the 6-month pre- and post-intervention. Patients were stratified according to if they were treated within a dedicated rapid palliative (RPAL) radiotherapy program or not. Chi-square tests were used to compare rates of antiemetic and pain flare medications pre- and post-intervention and RPAL vs not.


A total of 375 patients were identified with 42 (11.2%) treated in dedicated RPAL program. The proportion of patients treated with prophylactic antiemetic and pain flare medications pre-intervention (n = 226) and post-intervention (n = 149) was respectively 34.1% vs 59.1% (p < 0.001) and 26.1% vs 43.0% (p = 0.01). Observed differences for antiemetic prescription rates were greater for patients who were not treated within a dedicated palliative radiotherapy program, but this was not the case for pain flare medications.


Our data shows that a simple quality checklist item can have a significant effect on the evidence-based use of prophylactic antiemetic and pain flare medications in patients treated with palliative radiotherapy for bone metastases. We believe such strategies should be routinely included in other clinical pathways to improve the use of symptom control medications.


Antiemetic Pain flare Checklist Palliative Radiotherapy Bone metastases 



Rapid palliative


Radiation induced nausea or vomiting




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Coleman RE (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 12(20 Pt 2):6243s–6249sCrossRefGoogle Scholar
  2. 2.
    Rich SE, Chow R, Raman S, Liang Zeng K, Lutz S, Lam H, Silva MF, Chow E (2018) Update of the systematic review of palliative radiation therapy fractionation for bone metastases. Radiother Oncol 126(3):547–557CrossRefGoogle Scholar
  3. 3.
    Niglas M, Raman S, Rodin D, Detsky J, DeAngelis C, Soliman H, Chow E, Tsao MN (2018) Should dexamethasone be standard in the prophylaxis of pain flare after palliative radiotherapy for bone metastases?-a debate. Ann Palliat Med 7(2):279–283CrossRefGoogle Scholar
  4. 4.
    Chow E, Meyer RM, Ding K, Nabid A, Chabot P, Wong P, Ahmed S, Kuk J, Dar AR, Mahmud A, Fairchild A, Wilson CF, Wu JSY, Dennis K, Brundage M, DeAngelis C, Wong RKS (2015) Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial. Lancet Oncol 16(15):1463–1472CrossRefGoogle Scholar
  5. 5.
    Ruhlmann CH, Jahn F, Jordan K, Dennis K, Maranzano E, Molassiotis A, Roila F, Feyer P (2017) 2016 updated MASCC/ESMO consensus recommendations: prevention of radiotherapy-induced nausea and vomiting. Support Care Cancer 25(1):309–316CrossRefGoogle Scholar
  6. 6.
    Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, Danso MA, Dennis K, Dupuis LL, Dusetzina SB, Eng C, Feyer PC, Jordan K, Noonan K, Sparacio D, Somerfield MR, Lyman GH (2017) Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 35(28):3240–3261CrossRefGoogle Scholar
  7. 7.
    Dennis K, Zhang L, Lutz S, van Baardwijk A, van der Linden Y, Holt T et al (2012) International patterns of practice in the management of radiation therapy-induced nausea and vomiting. Int J Radiat Oncol Biol Phys 84(1):e49–e60CrossRefGoogle Scholar
  8. 8.
    Dennis K, Linden K, Balboni T, Chow E (2015) Rapid access palliative radiation therapy programs: an efficient model of care. Future Oncol 11(17):2417–2426CrossRefGoogle Scholar
  9. 9.
    Holt TR, Yau VK (2010) Innovative program for palliative radiotherapy in Australia. J Med Imaging Radiat Oncol 54(1):76–81CrossRefGoogle Scholar
  10. 10.
    Howell AM, Panesar SS, Burns EM, Donaldson LJ, Darzi A (2014) Reducing the burden of surgical harm: a systematic review of the interventions used to reduce adverse events in surgery. Ann Surg 259(4):630–641CrossRefGoogle Scholar
  11. 11.
    Kramer HS, Drews FA (2017) Checking the lists: a systematic review of electronic checklist use in health care. J Biomed Inform 71S:S6–S12CrossRefGoogle Scholar
  12. 12.
    Ament SM, de Groot JJ, Maessen JM, Dirksen CD, van der Weijden T, Kleijnen J (2015) Sustainability of professionals' adherence to clinical practice guidelines in medical care: a systematic review. BMJ Open 5(12):e008073CrossRefGoogle Scholar
  13. 13.
    Vidall C, Fernandez-Ortega P, Cortinovis D, Jahn P, Amlani B, Scotte F (2015) Impact and management of chemotherapy/radiotherapy-induced nausea and vomiting and the perceptual gap between oncologists/oncology nurses and patients: a cross-sectional multinational survey. Support Care Cancer 23(11):3297–3305CrossRefGoogle Scholar
  14. 14.
    Dennis K, Zhang L, Lutz S, van der Linden Y, van Baardwijk A, Holt T, Lagrange JL, Foro-Arnalot P, Wong LC, Maranzano E, Wong KH, Liu R, Vassiliou V, Corn BW, de Angelis C, Holden L, Wong CS, Chow E (2013) International radiation oncology trainee decision making in the management of radiotherapy-induced nausea and vomiting. Support Care Cancer 21(7):2041–2048CrossRefGoogle Scholar
  15. 15.
    Lefresne S, Berthelet E, Cashman R, Levy K, Liu M, Carolan H, McKenzie M, Kostuik P, Olson R (2015) The Vancouver rapid access clinic for palliative lung radiation, providing more than just rapid access. Support Care Cancer 23(1):125–132CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Division of Radiation OncologyThe Ottawa Hospital and the University of OttawaOttawaCanada
  2. 2.Radiation Medicine ProgramThe Ottawa HospitalOttawaCanada

Personalised recommendations