title: Antiemetic prophylaxis and frequency of chemotherapy-induced nausea and vomiting in palliative first-line treatment of colorectal cancer patients: the Northern Bavarian IVOPAK I Project.
abstract: OBJECTIVE
  This study aims to evaluate adherence to guidelines of antiemetic prophylaxis and frequency of chemotherapy-induced nausea and vomiting (CINV) in the palliative first-line treatment of colorectal cancer (CRC) patients in Northern Bavaria.
  
  
  METHODS
  We collected detailed information on chemotherapy and supportive drugs in 103 patients within a prospective observational study. The study was conducted to determine quality of care within an interdisciplinary context (first endpoint) and direct costs of palliative treatment for patients with CRC between 2006 and 2010 (second endpoint, Emmert et al. (Eur J Health Econ, 2012) [1]). In this paper, we evaluate adherence to Multinational Association of Supportive Care in Cancer (MASCC) 2006 recommendations for prophylaxis of CINV during the first administration of chemotherapy as well as incidence and grade of CINV within 120 h thereafter.
  
  
  RESULTS
  Of the patients studied, 95 patients (92%) received moderately emetogenic (oxaliplatin- and/or irinotecan-containing combined chemotherapy treatment) and eight (8%) received low emetogenic chemotherapy (either 5-fluorouracil (5-FU) or capecitabine monotherapy). Antiemetic prophylaxis could be assessed in 101 out of 103 (98%) of patients. MASCC-recommended antiemetic prophylaxis was prescribed in three patients (3%). Nonadherence was mainly caused by omission of dexamethasone. Nausea and/or vomiting occurred in 18 patients (18%) within a 120-h period. All documented episodes were grade 1 or 2 according to the Common Toxicity Criteria of the National Cancer Institute. None of these patients received the recommended prophylaxis for CINV. In only one patient, antiemetic prophylaxis was intensified during the next chemotherapy application.
  
  
  CONCLUSIONS
  In the Integrated Health Care in the Palliative Treatment of Colorectal Carcinoma (IVOPAK) I Project, adherence to the MASCC clinical recommendations was very poor. Extent of CINV in this patient population seems to be underestimated. There is an urgent need to improve clinicians' awareness of this patient-relevant side effect.
authors.affiliation: Pharmacy Department, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany. sonja.koch@uk-erlangen.de
authors.forename: Sonja
authors.initials: S
authors.lastname: Koch
authors.forename: Axel
authors.initials: A
authors.lastname: Wein
authors.forename: Jürgen
authors.initials: J
authors.lastname: Siebler
authors.forename: Frank
authors.initials: F
authors.lastname: Boxberger
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.forename: Hanns-Detlev
authors.initials: HD
authors.lastname: Harich
authors.forename: Werner
authors.initials: W
authors.lastname: Hohenberger
authors.forename: Frank
authors.initials: F
authors.lastname: Dörje
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002166:Camptothecin / Q000009:adverse effects / Q000031:analogs & derivatives; D000069287:Capecitabine; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives; D005858:Germany; D006801:Humans; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*; D009369:Neoplasms / Q000188:drug therapy; D009944:Organoplatinum Compounds / Q000009:adverse effects; D000077150:Oxaliplatin; D010166:Palliative Care / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000932:Antiemetics; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D000077146:Irinotecan; D003907:Dexamethasone; D005472:Fluorouracil; D002166:Camptothecin