In a web survey of 154 oncology
practitioners in the UK, it was
shown that there was great
variability in the antiemetic
prescriptions used, most
were not in accordance with
international guidelines, including
in the doses of antiemetics used. 4
Overall, clinicians undertreated
patients receiving highly
emetogenic chemotherapy and
overtreated patients receiving
low and minimally emetogenic
chemotherapy, with more
consistent practice related to
acute nausea and vomiting
rather than delayed nausea and
vomiting. 4 In the same study, it
was reported that by providing
guideline-consistent treatment
in those patients overtreated
unnecessarily, it would also lead
to cost reductions of about £4381
for every 100 patients treated
for each cycle of chemotherapy. 4
In addition, overtreatment can
lead to unwanted side effects (for
example, constipation with the
use of 5-HT3 receptor antagonists
(RAs) or dyspepsia and insomnia
with the use of dexamethasone,
etc), which add to the patients’
symptom burden and necessitate
more healthcare resources for their
management. Similar conclusions
were reported in a Japanese study
that compared costs of a two-drug
antiemetic treatment (ondansetron
and dexamethasone) and a single
agent treatment (dexamethasone
alone, as per guidelines) and found
not only that treatment outcomes
were not significantly different
in the two groups, but also that
in the latter group there was an
annual cost saving of US$78,883
in docetaxel-treated patients. 5 Cost
reductions from using guideline-
consistent antiemetics were also
shown in another large European
prospective study (n=991) where
such use was associated with
significantly fewer specialist visits
(p=0.002), fewer emergency room
visits (p=0.004), fewer visits to
the general practitioner (p=0.062,
borderline not significant), with
five days of hospitalisation on
average in this group compared
with ten in the guideline non-
consistent group (not significant
p value). 6 Most importantly, the
effectiveness of the regimens
used in the guideline-consistent
group led to a nausea/vomiting
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