European Survey on Prophylactic Treatment of Chemotherapy-Induced Nausea and Vomiting Suggests Gaps in Practice and Ways to Improve
Using recommended guidelines for antiemetic prophylaxis can prevent chemotherapy-induced nausea and vomiting (CINV). Nurses play a significant role in administering prophylactic treatment for CINV. Therefore, a survey was conducted in 16 European countries among middle medical personnel to evaluate the use of recommended antiemetic prophylaxis in oncology practice and the obstacles to its administration.
Knowledge of Recommended Guidelines
The survey was conducted from March 2016 to February 2017. It contained 20 questions answered online by 212 nurses with 15 years of experience in oncology (median). The majority of them (80%) worked in public healthcare facilities, and 75% were capable of suggesting and prescribing antiemetic prophylaxis. Only 46% of respondents were familiar with the ASCO guidelines for preventing CINV, and just 40% knew the European guidelines (MASCC/ESMO). The most frequently used guidelines (46%) were those established within their own healthcare facility.
Deviations from Recommended Guidelines
The main deviation from the recommended CINV prevention guidelines for highly emetogenic chemotherapy was the insufficient use of the combination of an NK1 receptor antagonist (NK1RA), a 5-HT3 receptor antagonist (5-HT3RA), and a corticosteroid on the first day of the chemotherapy cycle (only 55%) and the overuse of 5-HT3RA on days 2–5 post-chemotherapy (in 50%), when a corticosteroid should be given. Metoclopramide, which is not among the recommended drugs, was widely used in patients receiving highly and moderately emetogenic chemotherapy (in 30% on the first day and in 50% on days 2–5 of the chemotherapy cycle).
Barriers to Adhering to Recommended Guidelines
The main barrier to adhering to the recommended guidelines, as reported by the nurses, was the physician's decision (40%), with the cost of treatment also playing a role.
Problematic Goals in CINV Prevention
The most challenging aspects of CINV prophylaxis, according to the respondents, were the prevention of CINV in the delayed phase (2–5 days post-chemotherapy) (64%) and reducing the impact of CINV on the patients' quality of life (61%).
Conclusion
This European survey highlighted insufficient use of recommended antiemetic prophylaxis guidelines for administering highly and moderately emetogenic chemotherapy and suggested ways to improve their adherence.
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Source: Dielenseger P., Börjeson S., Vidall C. et al. Evaluation of antiemetic practices for prevention of chemotherapy-induced nausea and vomiting (CINV): results of a European oncology nurse survey. Support Care Cancer 2019 Nov; 27 (11): 4099–4106, doi: 10.1007/s00520-019-04697-1.
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