title: Adherence to national guidelines for antiemesis prophylaxis in patients undergoing chemotherapy for lung cancer: a population-based study.
abstract: BACKGROUND
  Nausea and vomiting (N/V) during chemotherapy can have profound clinical and economic consequences. Effective antiemetic agents are available for prophylaxis, but barriers may prevent their use. For this population-based study, the authors assessed the rates of antiemetic prophylaxis use, and predictors of such use, among patients who were receiving platinum-based chemotherapy for lung cancer between 2001 and 2007.
  
  
  METHODS
  The authors searched the Texas Cancer Registry-Medicare-linked database for individuals aged >65 years who received platinum-based chemotherapy within 12 months after a first diagnosis of lung cancer from 2001 to 2007; and all patients had continuous Medicare Part A and Part B coverage for the same period. Adherence to recommended regimens for N/V prophylaxis (established by the National Comprehensive Cancer Network) was scored as a binary variable (adherent vs nonadherent) and was calculated as the percentages of treated patients receiving each recommended agent within 1 day of beginning chemotherapy. Logistic regression with stepwise selection was used to examine whether patient characteristics influenced adherence.
  
  
  RESULTS
  Of 4566 selected patients, adherence rates for the receipt of serotonin antagonists (eg, ondansetron) with dexamethasone were 60% to 90% regardless of whether the chemotherapy agent was considered moderately or highly emetogenic. The receipt of substance-P antagonists was much less common (<10%) during any period. On multivariate logistic regression modeling, variables that predicted adherence were older age, white race, higher median income, and concurrent radiation therapy.
  
  
  CONCLUSIONS
  Recommended use of antiemetics for prophylaxis, especially substance-P antagonists, during chemotherapy for lung cancer is suboptimal. Factors that were correlated with adherence suggest socioeconomic barriers in the community.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA. dgomez@mdanderson.org
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Gomez
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Liao
authors.forename: Sharon
authors.initials: S
authors.lastname: Giordano
authors.forename: Hoang
authors.initials: H
authors.lastname: Nguyen
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D008297:Male; D009325:Nausea / Q000517:prevention & control; D017294:Ondansetron / Q000008:administration & dosage; D012702:Serotonin Antagonists / Q000627:therapeutic use; D012959:Socioeconomic Factors; D014839:Vomiting / Q000517:prevention & control
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D012702:Serotonin Antagonists; D017294:Ondansetron; D003907:Dexamethasone