title: Testing the effectiveness of antiemetic guidelines: results of a prospective registry by the CINV Study Group of Japan.
abstract: BACKGROUND
  Many cancer patients suffer from the common side effect of chemotherapy-induced nausea and vomiting (CINV). Guidelines recommend a combination of two prophylactic antiemetics for moderately emetogenic chemotherapy (MEC) and three for highly emetogenic chemotherapy (HEC) and certain MEC regimens.
  
  
  METHODS
  This multicenter, prospective, observational study analyzed data for 1,910 patients in Japan scheduled for MEC or HEC. Use of antiemetic prophylaxis in relation to type of chemotherapy, incidences of and risk factors for nausea, vomiting, and acute versus delayed CINV, and estimated incidence of CINV by staff were analyzed using Fisher's exact test and multivariate logistic regression. The patients recorded the incidence of CINV and severity of nausea by visual analogue scales daily for 7 days after receiving chemotherapy.
  
  
  RESULTS
  A total of 240 (20.1 %) HEC and 476 MEC patients (66.6 %) received 2 antiemetics, compared with 883 (73.9 %) and 200 (28.0 %), respectively, who received 3 antiemetics. Approximately 74 % of HEC and 95 % of MEC patients received antiemetic therapy in compliance with guidelines. Acute nausea and vomiting were well controlled, but high incidences of delayed nausea occurred in both HEC and MEC patients. Delayed vomiting (p < 0.0001) was significantly less frequent in patients receiving three compared with 2 antiemetics. Female sex was a major risk factor for CINV. Medical staff tended to overestimate the incidence of CINV. Among HEC regimens, the incidence of CINV and the degree of nausea on day 1 of anthracycline-cyclophosphamide combination therapy were higher than with a cisplatin-based regimen.
  
  
  CONCLUSIONS
  Adherence to antiemetic guidelines effectively controls vomiting but is less effective against delayed nausea in HEC and MEC patients. Identification of individual risk factors, such as female sex, will assist in the development of personalized treatments for CINV. More intensive antiemetic therapy or a different modality of prophylaxis should be considered for the control of acute CINV in an anthracycline-cyclophosphamide regimen.
authors: Division of Medical Oncology, Hematology and Infectious Diseases, Department of Medicine, School of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoko, 814-0180, Japan. ktamura@fukuoka-u.ac.jp.
authors: Kazuo
authors: K
authors: Tamura
authors: Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors: Keisuke
authors: K
authors: Aiba
authors: Breast Oncology Service, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan.
authors: Toshiaki
authors: T
authors: Saeki
authors: Research Institute for Diseases of the Chest, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan.
authors: Yoichi
authors: Y
authors: Nakanishi
authors: Department of Obstetrics and Gynecology, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
authors: Toshiharu
authors: T
authors: Kamura
authors: Department of Gastroenterological Surgery, Kumamoto University, 1-1-1, Honjomachi, Chuo-ku, Kumamoto, Kumamoto, 860-0811, Japan.
authors: Hideo
authors: H
authors: Baba
authors: Department of Surgical Oncology, Gifu University, 1-1 Yanagito, Gifu, Gifu, 501-1194, Japan.
authors: Kazuhiro
authors: K
authors: Yoshida
authors: Division of Thoracic Oncology, Shizuoka Cancer Center, 1007, Nagaizumicho, Sunto-gun, Shizuoka, 411-0934, Japan.
authors: Nobuyuki
authors: N
authors: Yamamoto
authors: Department of Surgery, School of Medicine, Keio University, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan.
authors: Yuko
authors: Y
authors: Kitagawa
authors: Department of Surgery and Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan.
authors: Yoshihiko
authors: Y
authors: Maehara
authors: Department of Cancer Information Research, National Hospital Organization Kyushu Cancer Center, 3-1-1, Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan.
authors: Mototsugu
authors: M
authors: Shimokawa
authors: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1 W17, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan.
authors: Koichi
authors: K
authors: Hirata
authors: International University of Health and Welfare, 2600-1 Kitakanemaru, Ohtawara, Tochigi, 324-8501, Japan.
authors: Masaki
authors: M
authors: Kitajima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy*; D009369:Neoplasms / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D012042:Registries; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents
keywords: Antiemetics; Cancer chemotherapy; Guidelines; Nausea; Vomiting