Poor Adherence to Antiemetic Guidelines Among Patients Undergoing Chemotherapy
Adherence to antiemetic regimens is poor among patients receiving emetogenic cancer chemotherapy, likely due to a lack of awareness among clinicians of guidelines for the prevention of chemotherapy-induced nausea and vomiting, according to a recent study published in Supportive Care in Cancer (online September 4, 2017; doi:10.1007/s00520-017-3866-6).
Adherence to guidelines for prophylactic antiemetic regimens set forth by the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) has been shown to prevent an estimated 85% of cases of chemotherapy-induced nausea and 65% of cases of chemotherapy-induced vomiting.
Rebecca Clark-Snow, RN, BSN, OCN, University of Kansas Cancer Center, and colleagues evaluated survey data obtained from 531 oncology nurses regarding the current guidelines for prophylactic antiemetic regimens.
Results of the survey indicated that only 48% of participants were familiar with the ASCO antiemetic guidelines, and 73% were familiar with the NCCN guidelines. Ultimately, the researchers found that familiarity rates with guidelines contribute to low rates of treatment adherence.
Furthermore, although 77% of participants had responded that antiemetic prescribing matched that of guideline recommendations, only 25% had reported administration of these agents. The lowest rates of adherence were observed during the delayed, 25 to 120-hour phase after highly emetogenic chemotherapy.
The researchers noted that neuroleptic phenothiazines and benzodiazepines were often overused, and that only 17% of participants felt that the majority (at least 75%) of their patients had controlled chemotherapy-induced nausea and vomiting. According to 39% of survey participants, approximately 6% to 20% of patients had an alteration in their chemotherapy, and ED and hospital visits were high due to chemotherapy-induced nausea and vomiting.
Other factors contributing to therapy nonadherence included physician preference (reported by 71% of participants), patient dissatisfaction with antiemetics during highly-emetogenic chemotherapy (27%), insurance coverage and antiemetic treatment costs (26%), and not having guideline-recommended medications in their institutions’ formulary (25%).
“Oncology nurses, as part of a multidisciplinary team, are in a unique position to promote and reinforce guideline-recommended antiemetic prophylaxis and to improve health care providers’ adherence to evidence-based guideline recommendations,” the researchers concluded.—Christina Vogt