International patterns of practice in the management of radiation therapy-induced nausea and vomiting.
OBJECTIVE
To investigate international patterns of practice in the management of radiation therapy-induced nausea and vomiting (RINV).


METHODS
Oncologists prescribing radiation therapy in the United States, Canada, The Netherlands, Australia, New Zealand, Spain, Italy, France, Hong Kong, Singapore, Cyprus, and Israel completed a Web-based survey that was based on 6 radiation therapy-only clinical cases modeled after the minimal-, low-, moderate-, and high-emetic risk levels defined in the antiemetic guidelines of the American Society of Clinical Oncology and the Multinational Association of Supportive Care in Cancer. For each case, respondents estimated the risks of nausea and vomiting separately and committed to an initial management approach.


RESULTS
In total, 1022 responses were received. Risk estimates and management decisions for the minimal- and high-risk cases varied little and were in line with guideline standards, whereas those for the low- and moderate-risk cases varied greatly. The most common initial management strategies were as follows: rescue therapy for a minimal-risk case (63% of respondents), 2 low-risk cases (56% and 80%), and 1 moderate-risk case (66%); and prophylactic therapy for a second moderate-risk case (75%) and a high-risk case (95%). The serotonin (5-HT)₃ receptor antagonists were the most commonly recommended prophylactic agents. On multivariate analysis, factors predictive of a decision for prophylactic or rescue therapy were risk estimates of nausea and vomiting, awareness of the American Society of Clinical Oncology antiemetic guideline, and European Society for Therapeutic Radiology and Oncology membership.


CONCLUSIONS
Risk estimates and management strategies for RINV varied, especially for low- and moderate-risk radiation therapy cases. Radiation therapy-induced nausea and vomiting are under-studied treatment sequelae. New observational and translational studies are needed to allow for individual patient risk assessment and to refine antiemetic guideline management recommendations.
Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Kristopher
K
Dennis
Liying
L
Zhang
Stephen
S
Lutz
Angela
A
van Baardwijk
Yvette
Y
van der Linden
Tanya
T
Holt
Palmira Foro
PF
Arnalot
Jean-Léon
JL
Lagrange
Ernesto
E
Maranzano
Rico
R
Liu
Kam-Hung
KH
Wong
Lea-Choung
LC
Wong
Vassilios
V
Vassiliou
Benjamin W
BW
Corn
Carlo
C
De Angelis
Lori
L
Holden
C Shun
CS
Wong
Edward
E
Chow
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011878:Radiotherapy / Q000009:adverse effects*; D016879:Salvage Therapy / Q000379:methods; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000627:therapeutic use; D014839:Vomiting / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*
D000932:Antiemetics; D058831:Serotonin 5-HT3 Receptor Antagonists