Antiemetic guideline consistency and incidence of chemotherapy-induced nausea and vomiting in US community oncology practice: INSPIRE Study.
OBJECTIVE
Consensus guidelines for preventing chemotherapy-induced nausea and vomiting (CINV) are variably implemented in practice. The purpose of this study was to evaluate the impact of guideline-consistent/guideline-inconsistent CINV prophylaxis (GCCP/GICP) on the incidence of no CINV after cycle 1 of highly or moderately emetogenic chemotherapy (HEC or MEC).


METHODS
This prospective observational study enrolled chemotherapy-naive adult outpatients who received single-day HEC or MEC at four oncology practice networks, all using electronic health record (EHR) systems, in Georgia, Tennessee, and Florida. Results from the Multinational Association of Supportive Care in Cancer Antiemesis Tool, a validated tool to measure CINV, administered 5 to 8 days postchemotherapy, were merged with EHR data. The primary end point, no CINV, defined as no emesis and no clinically significant nausea (score < 3 on 0-10 scale), was compared between cohorts using logistic regression.


RESULTS
A total of 1,295 patients were enrolled (mean age, 59.3 years; 70.0% female; 35.5% HEC). The overall prevalence of GCCP was 57.3%. When corticosteroids were prescribed on days 2 to 4 after all HEC, GCCP for HEC increased from 28.7% to 89.8%; when NK1-receptor antagonists were prescribed after all MEC, GCCP for MEC increased from 73.1% to 97.8%. Over 5 days postchemotherapy, the incidence of no CINV was significantly higher in the GCCP cohort than the GICP cohort (53.4% v 43.8%; P < .001). The adjusted odds of no CINV with GCCP was 1.31 (95% CI, 1.07 to 1.69; P = .037).


CONCLUSIONS
Increased adherence to antiemetic guidelines could significantly reduce the incidence of CINV after HEC and MEC.
Georgia Cancer Specialists PC, Atlanta, GA; Tennessee Oncology, Nashville, TN; St John's University, New York, NY; Cancer Specialists of North Florida, Jacksonville; Florida Cancer Specialists, Fort Myers, FL; Temple University, Philadelphia, PA; Merck & Co., Whitehouse Station, NJ.
James W
JW
Gilmore
Nancy W
NW
Peacock
Anna
A
Gu
Stephen
S
Szabo
Melissa
M
Rammage
Joyce
J
Sharpe
Sally T
ST
Haislip
Toni
T
Perry
Tim L
TL
Boozan
Katherine
K
Meador
Xiting
X
Cao
Thomas A
TA
Burke
D000368:Aged; D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005431:Florida / Q000453:epidemiology; D005845:Georgia / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009325:Nausea / Q000453:epidemiology / Q000517:prevention & control*; D009369:Neoplasms / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D014839:Vomiting / Q000453:epidemiology / Q000517:prevention & control*
D000932:Antiemetics; D000970:Antineoplastic Agents