manage nausea and vomiting.
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 HEC and overtreated
patients receiving LEC and MiEC,
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
prophylaxis 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-HT 3 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) in LEC-
treated patients and found not
16 | 2019 | hospitalpharmacyeurope.com
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 was also
shown in another large European
prospective study (n=991) where
such use was associated with
significantly less specialist
visits (p=0.002), less emergency
room visits (p=0.004), lower
number of 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 complete response in
59.9% of the patients, whereas
complete response in the guideline
non-consistent group was 50.7%
(p=0.008). 6 While this clearly
shows the positive effect of using
antiemetic guidelines in response
to CINV, use of guideline-consistent
antiemetics was reported by only
55% in the acute phase of nausea
and vomiting, 46% in the delayed
phase, and 29% overall (only 11% of
HEC patients). 6
What is clear from the
literature is that, while use
of antiemetic guidelines does
improve clinical outcomes, reduces