Assessment of oncologist adherence to National Comprehensive Cancer Network (NCCN) antiemetics guidelines for management of chemotherapy induced nausea and vomiting in Karbala province
Keywords:Adherence, NCCN guideline, cancer, chemotherapy induced nausea and vomiting, antiemetics therapy.
Background: Nausea and vomiting induced by chemotherapy is one of the most feared side effects of chemotherapy that affect patients’ quality of life and may lead to discontinuation of chemotherapy cycles. Adherence to antiemetics guidelines such as NCCN antiemetics guidelines significantly improve the quality of treatment provided to patients while minimizing the time and money spent on each individual case.
Aim: Assessment of the current practice adherence of physicians to NCCN antiemesis guidelines.
Method: the study is an observational cross-sectional study conducted in three oncology centers in the Iraqi province of Karbala. The study included twenty oncologists who agree to participate in the survey.
Results: Seventy percent of participants oncologists follow NCCN antiemetics guidelines, while thirty percent do not. The mean patient related risk score for Imam Al-Hussein Oncology Center, Warith International Cancer Institute, and Al-Imam Al-Hasan Al-Mujtaba Hospital was 13.5, 12.4, 14.7 respectively.
Conclusion: The current study demonstrates the knowledge and practices of participating oncologists regarding nausea and vomiting caused by chemotherapy across various oncology centers. In addition, there are a number of obstacles that make following antiemetics guidelines difficult or inconvenient, such as increased cost, a lack of awareness about antiemetics guidelines, and guidelines that are difficult or inconvenient to use.
Aapro, M. (2018). CINV: still troubling patients after all these years. Supportive Care in Cancer, 26, 5–9.
Aapro, M., Jordan, K., Scotté, F., Celio, L., Karthaus, M., & Roeland, E. (2022). Netupitant-palonosetron (NEPA) for Preventing Chemotherapy-induced Nausea and Vomiting: From Clinical Trials to Daily Practice. Current Cancer Drug Targets, 22(10), 806–824.
Aapro, M., Molassiotis, A., Dicato, M., Peláez, I., Rodríguez-Lescure, Á., Pastorelli, D., Ma, L., Burke, T., Gu, A., & Gascon, P. (2012). The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER). Annals of Oncology, 23(8), 1986–1992.
Adel, N. (2017). Overview of chemotherapy-induced nausea and vomiting and evidence-based therapies. The American Journal of Managed Care, 23(14 Suppl), S259–S265.
Affronti, M. Lou, Schneider, S. M., Herndon, J. E., Schlundt, S., & Friedman, H. S. (2014). Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice. Supportive Care in Cancer, 22, 1897–1905.
Albassam, N. Y., Mohammed, A., & Murtada, S. (2021). Evaluation of Community Pharmacists Knowledge, Attitude and Practice towards Modified Release Dosage Forms (Conference Paper). Iraqi Journal of Pharmaceutical Sciences (P-ISSN 1683-3597 E-ISSN 2521-3512), 30(Suppl.), 40–47.
Aljarallah, B. M. (2011). Evaluation of modified essay questions (MEQ) and multiple choice questions (MCQ) as a tool for assessing the cognitive skills of undergraduate medical students. International Journal of Health Sciences, 5(1), 39.
Almazrou, S., & Alnaim, L. (2012). Evaluation of adherence to chemotherapy-induced nausea and vomiting guidelines. An observational study.
Barbour, S. Y. (2012). Corticosteroids in the treatment of chemotherapy-induced nausea and vomiting. Journal of the National Comprehensive Cancer Network, 10(4), 493–499.
Bossi, P., Cortinovis, D., Fatigoni, S., Rocca, M. C., Fabi, A., Seminara, P., Ripamonti, C., Alfieri, S., Granata, R., & Bergamini, C. (2017). A randomized, double-blind, placebo-controlled, multicenter study of a ginger extract in the management of chemotherapy-induced nausea and vomiting (CINV) in patients receiving high-dose cisplatin. Annals of Oncology, 28(10), 2547–2551.
Briesacher, B. A., Gurwitz, J. H., & Soumerai, S. B. (2007). Patients at-risk for cost-related medication nonadherence: a review of the literature. Journal of General Internal Medicine, 22, 864–871.
Burmeister, H., Aebi, S., Studer, C., Fey, M. F., & Gautschi, O. (2012). Adherence to ESMO clinical recommendations for prophylaxis of chemotherapy-induced nausea and vomiting. Supportive Care in Cancer, 20, 141–147.
Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P.-A. C., & Rubin, H. R. (1999). Why don’t physicians follow clinical practice guidelines?: A framework for improvement. Jama, 282(15), 1458–1465.
Dranitsaris, G., Molassiotis, A., Clemons, M., Roeland, E., Schwartzberg, L., Dielenseger, P., Jordan, K., Young, A., & Aapro, M. (2017). The development of a prediction tool to identify cancer patients at high risk for chemotherapy-induced nausea and vomiting. Annals of Oncology, 28(6), 1260–1267.
Fernández-Ortega, P., Caloto, M. T., Chirveches, E., Marquilles, R., Francisco, J. S., Quesada, A., Suárez, C., Zorrilla, I., Gómez, J., & Zabaleta, P. (2012). Chemotherapy-induced nausea and vomiting in clinical practice: impact on patients’ quality of life. Supportive Care in Cancer, 20, 3141–3148.
Feyer, P., & Jordan, K. (2011). Update and new trends in antiemetic therapy: the continuing need for novel therapies. Annals of Oncology, 22(1), 30–38.
Jordan, K., Sippel, C., & Schmoll, H.-J. (2007). Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations. The Oncologist, 12(9), 1143–1150.
Lau, T. K. H., Yip, C. H. W., & Yeo, W. (2016). State of the art antiemetic therapy for cancer patients. Current Oncology Reports, 18, 1–13.
Lees, J., & Chan, A. (2011). Polypharmacy in elderly patients with cancer: clinical implications and management. The Lancet Oncology, 12(13), 1249–1257.
Lohr, L. (2008). Chemotherapy-induced nausea and vomiting. The Cancer Journal, 14(2), 85–93.
Lorusso, D., Bria, E., Costantini, A., Di Maio, M., Rosti, G., & Mancuso, A. (2017). Patients’ perception of chemotherapy side effects: Expectations, doctor–patient communication and impact on quality of life–An Italian survey. European Journal of Cancer Care, 26(2), e12618.
Mawe, G. M., & Hoffman, J. M. (2013). Serotonin signalling in the gut—functions, dysfunctions and therapeutic targets. Nature Reviews Gastroenterology & Hepatology, 10(8), 473–486.
Mitchell, E. P. (1992). Gastrointestinal toxicity of chemotherapeutic agents. Seminars in Oncology, 19(5), 566–579.
Molassiotis, A., Brearley, S. G., & Stamataki, Z. (2011). Use of antiemetics in the management of chemotherapy-related nausea and vomiting in current UK practice. Supportive Care in Cancer, 19, 949–956.
Natale, J. J. (2018). Overview of the prevention and management of CINV. Am J Manag Care, 24(18 Suppl), S391–S397.
Navari, R. M., & Aapro, M. (2016). Antiemetic prophylaxis for chemotherapy-induced nausea and vomiting. New England Journal of Medicine, 374(14), 1356–1367.
Riechelmann, R. P., & Saad, E. D. (2006). A systematic review on drug interactions in oncology. Cancer Investigation, 24(7), 704–712.
Roeland, E. J., Ruddy, K. J., LeBlanc, T. W., Nipp, R. D., Binder, G., Sebastiani, S., Potluri, R., Schmerold, L., Papademetriou, E., & Schwartzberg, L. (2020). What the HEC? Clinician adherence to evidence-based antiemetic prophylaxis for highly emetogenic chemotherapy. Journal of the National Comprehensive Cancer Network, 18(6), 676–681.
Roila, F., & Research, I. G. for A. (2004). Transferring scientific evidence to oncological practice: a trial on the impact of three different implementation strategies on antiemetic prescriptions. Supportive Care in Cancer, 12, 446–453.
Schwartzberg, L., Harrow, B., Lal, L. S., Radtchenko, J., & Lyman, G. H. (2015). Resource utilization for chemotherapy-induced nausea and vomiting events in patients with solid tumors treated with antiemetic regimens. American Health & Drug Benefits, 8(5), 273.
Shirley, M. (2021). Netupitant/palonosetron: a review in chemotherapy-induced nausea and vomiting. Drugs, 81, 1331–1342.
Tienchaiananda, P., Nipondhkit, W., Maneenil, K., Sa-Nguansai, S., Payapwattanawong, S., Laohavinij, S., & Maneechavakajorn, J. (2019). A randomized, double-blind, placebo-controlled study evaluating the efficacy of combination olanzapine, ondansetron and dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients receiving doxorubicin plus cyclophosphamide. Ann Palliat Med, 8(4), 372–380.
Vidall, C., Dielenseger, P., Farrell, C., Lennan, E., Muxagata, P., Fernández-Ortega, P., & Paradies, K. (2011). Evidence-based management of chemotherapy-induced nausea and vomiting: a position statement from a European cancer nursing forum. Ecancermedicalscience, 5.
Vidall, C., Fernández-Ortega, P., Cortinovis, D., Jahn, P., Amlani, B., & Scotté, F. (2015). Impact and management of chemotherapy/radiotherapy-induced nausea and vomiting and the perceptual gap between oncologists/oncology nurses and patients: a cross-sectional multinational survey. Supportive Care in Cancer, 23, 3297–3305.
Wickham, R. J. (2020). Revisiting the physiology of nausea and vomiting—challenging the paradigm. Supportive Care in Cancer, 28, 13–21.
How to Cite
Copyright (c) 2023 Journal of Contemporary Medical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.