Inoue, M., Shoji, M., Shindo, N., Otsuka, K., Miura, M., & Shibata, H. (2015). Cohort study of consistency between the compliance with guidelines for chemotherapy-induced nausea and vomiting and patient outcome. BMC Pharmacology and Toxicology, 16, 5-015-0005-1. 

To assess compliance with chemotherapy-induced nausea and vomiting (CINV) guidelines and effects on patient outcomes

Patients were assessed for early and delayed CINV using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool (MAT). Chemotherapy and anti-emetic agents used were extracted from medical records, along with MAT results. Comparison was made between agents used and current practice guidelines used in the organization. Guidelines were dexamethasone for lowly emetogenic chemotherapy (LEC), either triple drug or doublet antiemetics for moderately emetogenic chemotherapy (MEC), and triple drug antiemetics for highly emetogenic chemotherapy (HEC).

• N = 73   
• MEDIAN AGE = 62 years
• AGE RANGE = 28-79 years
• MALES: 49.3%, FEMALES: 49.7%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Varied tumor types; colorectal, breast, and lung were most common.
• OTHER KEY SAMPLE CHARACTERISTICS: About 50% were on LEC, 23% on MEC, and 15% on LEC.

• SITE: Single site   
• SETTING TYPE: Not specified    
• LOCATION: Japan

PHASE OF CARE: Active antitumor treatment

Retrospective cohort

• MASCC MAT
• Complete response (not defined)

Overall compliance with guidelines was 87.7%-98.6% for early phase CINV prophylaxis and 87% for delayed phase. Delayed phase compliance with LEC was 97.4%, with MEC was 82.4%, and with HEC was 54.5%. In the LEC group, CINV was not prevented in 11.3%, where guidelines were used, and 29% in the undertreated group. In the MEC group, it was not prevented in 11.8% with guidelines and 14.3% in the undertreated group. In the HEC group, CINV was not prevented in 45.5% with guidelines and 50% in the undertreated group.

Adherence to CINV prophylaxis guidelines was associated with better CINV prevention compared to undertreated patients; however, adherence to HEC guidelines was low, adherence was particularly low for delayed phase prevention, and guidelines based on emetogenicity of chemotherapy alone appear to be insufficient for CINV prophylaxis, particularly with HEC regimens.

• Small sample (< 100)
• Risk of bias (no random assignment)
• Key sample group differences that could influence results
• Measurement/methods not well described
• Other risk factors not described or used in analysis
• Reports CINV grade but no mention of grading measure used.
• The authors stated that HEC guidelines were effective; however, 45% in whom guidelines were followed had lack of CINV control.

The findings suggest that following professional CINV prophylaxis guidelines may be helpful for CINV control, although insufficient for control with HEC chemotherapy. Adherence to preventive guidelines for delayed phase CINV and HEC appears to be more problematic. Guideline adherence alone based on emetogenicity of chemotherapy appears to be insufficient to achieve complete control of CINV. Nurses need to advocate for consideration of individual risk factors in planning CINV prevention and ensure care planning for delayed phase interventions. Lack of delayed phase effectiveness also points to the need to ensure that patients have medication for any breakthrough CINV and that patients are adherent to medication regimens for prevention.