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
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.
KeywordsAntiemetic Pain flare Checklist Palliative Radiotherapy Bone metastases
Radiation induced nausea or vomiting
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 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
- 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
- 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.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