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1.
Support Care Cancer ; 27(3): 1041-1047, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30084104

RESUMO

BACKGROUND: Fatigue is one of the most distressing symptoms of cancer patients. Its characteristics and impact on quality of life have not been fully explored and treatment of cancer-related fatigue in Italian oncological centers has not been codified. METHODS: A cross-sectional study was carried out on all patients attending for any reason the 24 participating centers in two non-consecutive days. Patients with fatigue filled out the Brief Fatigue Inventory (BFI) questionnaire and reported any pharmacological or non-pharmacological treatment for fatigue. RESULTS: From October 2014 to May 2015, 1394 cancer patients agreed to participate in the study. Fatigue was referred by 866 (62.1%) of patients; its duration was > 4 months in 441 patients (50.9%). In the investigators' opinion, the most important (probable or almost sure) determinants of fatigue were reduced physical activity (271 patients), anxiety (149), pain (131), insomnia (125), anemia (123), and depression (123). Fatigue of moderate/severe intensity was reported by 43%/29.2% of patients, while usual fatigue in the last 24 h by 45%/33.1%, and the worst fatigue in the last 24 h by 33%/54.8%, respectively. Concerning the impact on quality of life, fatigue interfered moderately/severely with general activity in 30.8%/38.6% of patients, with mood in 26.1%/32.8%, with the ability to work in 27.9%/35.6%, with normal work in 26.7%/38.9%, with relationships with others in 21%/23.4% and with the ability to amuse themselves in 22.2%/33.1%. Only 117/866 patients (13.5%) received a pharmacological treatment represented by a corticosteroid in 101 patients (86.3%) while 188 patients (21.7%) received a non-pharmacological treatment such as physical exercise (120 patients, 63.8%) and various alimentary supplements (52 patients, 27.6%). CONCLUSIONS: Cancer-related fatigue is frequently reported by oncological patients; its intensity and impact on quality of life is relevant.


Assuntos
Fadiga/epidemiologia , Fadiga/etiologia , Neoplasias/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/complicações , Dor do Câncer/complicações , Estudos Transversais , Depressão/complicações , Exercício Físico/psicologia , Terapia por Exercício , Fadiga/terapia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
2.
Support Care Cancer ; 25(1): 289-294, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27510316

RESUMO

PURPOSE: An update of the recommendations for the prophylaxis of acute and delayed emesis induced by moderately emetogenic chemotherapy published after the last MASCC/ESMO antiemetic consensus conference in 2009 has been carried out. METHODS: A systematic literature search using PubMed from January 1, 2009 to January 6, 2015 with a restriction to papers in English was conducted. RESULTS: Overall, two randomized phase II and seven randomized phase III studies plus the results of three subgroup analysis of large phase III trials and those of a pilot study have been included. CONCLUSIONS: In carboplatin-treated patients, a moderate benefit from adding an NK1 receptor antagonist to dexamethasone and a 5-HT3 receptor antagonist has been shown. However, in oxaliplatin-treated patients, contrasting results about the role of NK1 receptor antagonists have been obtained. At present, it is not possible to suggest a specific 5-HT3 receptor antagonist to use for the prevention of acute emesis in these patients. No routine prophylaxis for delayed emesis is recommended but in patients receiving moderately emetogenic chemotherapy with known potential for delayed emesis (e.g., oxaliplatin, doxorubicin, cyclophosphamide) the use of dexamethasone for days 2-3 can be considered.


Assuntos
Antieméticos/uso terapêutico , Antineoplásicos/efeitos adversos , Eméticos/efeitos adversos , Náusea/prevenção & controle , Vômito/prevenção & controle , Consenso , Humanos , Náusea/induzido quimicamente , Projetos Piloto , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Vômito/induzido quimicamente
4.
Support Care Cancer ; 19 Suppl 1: S33-6, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20803222

RESUMO

PURPOSE: The purpose of this study is to update the guidelines for antiemetic therapy to be used with anticancer agents of low to minimal emetic potential. METHODS: Experts from the Multinational Association of Supportive Care in Cancer (MASCC) met in Perugia in 2009 to revise the MASCC antiemetic consensus guidelines. There is an increasing number of anticancer agents which are classified as being associated with a low or minimal risk of nausea and vomiting. However, the emetic potential of such agents and particularly those given as prolonged oral therapy is not well documented, and neither is the optimal antiemetic therapy. RESULTS: The consensus is that patients receiving anticancer therapy of low emetic potential should receive single-agent antiemetic prophylaxis such as dexamethasone, 5 hydroxytryptamine3 (5HT3) receptor antagonists, or dopamine receptor antagonists. Those receiving anticancer therapy of minimal emetic potential and who have no prior history of nausea and vomiting should not receive antiemetic prophylaxis. Those who experience nausea and vomiting subsequently can receive single-agent dexamethasone, 5HT3 receptor antagonists, or dopamine receptor antagonists. CONCLUSIONS: More data are needed on the emetic potential and the outcome of antiemetic treatment with agents likely to fall into the low or minimal emetic potential category.


Assuntos
Antieméticos/administração & dosagem , Antineoplásicos/efeitos adversos , Náusea/induzido quimicamente , Náusea/prevenção & controle , Vômito/induzido quimicamente , Vômito/prevenção & controle , Dexametasona/administração & dosagem , Antagonistas de Dopamina/administração & dosagem , Humanos , Náusea/tratamento farmacológico , Antagonistas dos Receptores de Neurocinina-1 , Guias de Prática Clínica como Assunto , Antagonistas da Serotonina/administração & dosagem , Vômito/tratamento farmacológico
5.
Support Care Cancer ; 19 Suppl 1: S25-32, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20803039

RESUMO

In this update of our 2005 document, we used an evidence-based approach whenever possible to formulate recommendations, emphasizing the results of controlled trials concerning the best use of antiemetic agents for the prevention of emesis and nausea following anticancer chemotherapies of high emetic risk. A three-drug combination of a 5-hydroxytryptamine type 3 receptor (5-HT(3)) receptor antagonist, dexamethasone, and aprepitant beginning before chemotherapy and continuing for up to 4 days remains the standard of care. We address issues of dose, schedule, and route of administration of five selective 5-HT(3) receptor antagonists. We conclude that, for each of these five drugs, there is a plateau in therapeutic efficacy above which further dose escalation does not improve outcome. In trials designed to prove the equivalence of palonosetron to ondansetron and granisetron, palonosetron proved superior in emesis prevention, while adverse effects were comparable. Furthermore, for all classes of antiemetic agents, a single dose is as effective as multiple doses or a continuous infusion. The oral route is as efficacious as the intravenous route of administration.


Assuntos
Antieméticos/administração & dosagem , Antineoplásicos/efeitos adversos , Náusea/induzido quimicamente , Náusea/prevenção & controle , Vômito/induzido quimicamente , Vômito/prevenção & controle , Dexametasona/administração & dosagem , Vias de Administração de Medicamentos , Esquema de Medicação , Humanos , Náusea/tratamento farmacológico , Antagonistas dos Receptores de Neurocinina-1 , Antagonistas da Serotonina/administração & dosagem , Vômito/tratamento farmacológico
6.
Tumori ; 95(6): 647-51, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20210223

RESUMO

AIMS AND BACKGROUND: An appropriate use of drugs should follow the registered indications. Different reasons can induce oncologists to prescribe drugs off-label. The aim of this study was to describe incidence and characteristics of these prescriptions in Italy. METHODS: Patients submitted to chemotherapy in 15 Italian oncology centers were evaluated for two randomized non-consecutive days of two weeks in May 2006. RESULTS: The study enrolled 644 patients receiving 1,053 drugs. Overall, 199 of 1053 (18.9%) prescriptions were off-label. In 92 of 199 cases (46.2%), the drugs were used for a neoplasm for which they were not approved, but there was scientific evidence (one or more randomized clinical trials or more phase II studies published in a major oncology journal) justifying the prescription. In 27 cases (13.6%), the drugs were prescribed for a rare neoplasm (cisplatin and gemcitabine in mesothelioma). In 20/21 cases (10.1%/10.5%), drugs were used in association/alone in contrast with the approved use (capecitabine in association in colorectal cancer). In 28/11 cases (14.0%/5.6%), the drugs were used in lines of chemotherapy subsequent/previous to that approved. CONCLUSIONS: Off-label use of antineoplastic drugs, in this observational survey, represents less than 20% of the prescriptions, and most of them are based on scientific evidence of efficacy.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico , Uso Off-Label/estatística & dados numéricos , Adulto , Idoso , Antimetabólitos Antineoplásicos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Institutos de Câncer/estatística & dados numéricos , Cisplatino/administração & dosagem , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Aprovação de Drogas , Medicina Baseada em Evidências , Feminino , Humanos , Itália/epidemiologia , Masculino , Mesotelioma/tratamento farmacológico , Pessoa de Meia-Idade , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Gencitabina
7.
Recenti Prog Med ; 99(1): 42-7, 2008 Jan.
Artigo em Italiano | MEDLINE | ID: mdl-18389873

RESUMO

Aim of the paper is to outline the methodology of pharmacoeconomic studies dealing with therapeutical interventions. The specificities of the cost evaluation are described, highlighting that the perspective of the evaluation must be always defined. The main types of pharmacoeconomic analyses are discussed, particularly the cost-effectiveness analysis (CEA) and the cost-utility analysis (CUA), and, in both cases, the importance of the incremental cost ratio is stressed. Moreover, sensitivity analysis is introduced as a tool to evaluate the stability of the results, when there is uncertainty in some estimation. Finally, the importance of pharmacoeconomic models is highlighted, although a great caution should be adopted in interpreting their results.


Assuntos
Antineoplásicos/economia , Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico , Neoplasias/economia , Custos e Análise de Custo , Árvores de Decisões , Farmacoeconomia , Humanos , Modelos Econômicos
8.
BMJ Open ; 8(6): e020912, 2018 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-29961019

RESUMO

OBJECTIVES: To assess Italian medical oncologists' opinion on the implications of conflict of interest (COI) on medical education, care and research, and to evaluate their direct financial relationships. DESIGN: National cross-sectional survey conducted between March and April 2017 among Italian oncologists. SETTING: Online survey sponsored by the Italian College of Medical Oncology Chiefs through its website. PARTICIPANTS: Italian oncologists who filled out an anonymous questionnaire including 19 items and individual and working characteristics. MAIN OUTCOME MEASURE: The proportion of medical oncologists perceiving COI as an outstanding issue and those receiving direct payments from industry. RESULTS: There were 321 respondents, representing 13% of Italian tenured medical oncologists. Overall, 62% declared direct payments from the pharmaceutical industry in the last 3 years. Sixty-eight per cent felt the majority of Italian oncologists have a COI with industry, but 59% suppose this is not greater than that of other specialties. Eighty-two per cent consider that most oncology education is supported by industry. More than 75% believe that current allocation of industry budget on marketing and promotion rather than research and development is unfair, but 75% consider it appropriate to receive travel and lodging hospitality from industry. A median net profit margin of €5000 per patient enrolled in an industry trial was considered appropriate for the employee institution. Sixty per cent agree to receive a personal fee for patients enrolled in industry trials, but 79% state this should be reported in the informed consent. Over 90% believe that scientific societies should publish a financial report of industry support. Finally, 79% disagree to being a coauthor of an article written by a medical writer when no substantial scientific contribution is made. CONCLUSIONS: Among Italian oncologists COI is perceived as an important issue influencing costs, education, care and science. A more rigorous policy on COI should be implemented.


Assuntos
Conflito de Interesses , Indústria Farmacêutica/ética , Oncologia/ética , Oncologistas/ética , Adulto , Idoso , Estudos Transversais , Revelação , Feminino , Apoio Financeiro , Humanos , Internet , Itália , Masculino , Oncologia/economia , Pessoa de Meia-Idade , Inquéritos e Questionários
11.
Tumori ; 93(1): 78-81, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17455876

RESUMO

AIMS AND BACKGROUND: To obtain proof of external validity of the visual analogue scale and re-evaluate the use of this instrument in assessing cancer patients' quality of life. METHODS: Consecutive patients attending 79 Italian medical oncology and radiotherapy centers over a period of 1 week were asked to fill out both a questionnaire concerning the presence of 19 problems and a 100-mm linear visual analogue scale evaluating their quality of life. Quality of life was rated as "good" and "bad" when given a score of 70-100 and 0-30, respectively. Multifactorial logistic models were used where good and bad quality of life were correlated with explanatory variables including patient and disease characteristics and the presence or absence of the 19 problems. RESULTS: Gender, level of education, treatment setting, Karnofsky performance status, disease extent, and the presence of 12 out of 19 problems were found to be correlated with good quality of life. A similar pattern of correlations was found with bad quality of life. CONCLUSIONS: Due to the difficulties in attaining reliable assessment of quality of life using psychometric questionnaires, the further proof of validity obtained in this study allows us to propose the re-evaluation of the role of the uniscale in measuring the quality of life of cancer patients.


Assuntos
Neoplasias/psicologia , Medição da Dor , Qualidade de Vida , Inquéritos e Questionários , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Tumori ; 93(6): 540-3, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18338486

RESUMO

AIMS AND BACKGROUND: The dose of delivered chemotherapy is important to evaluate the appropriateness of the anticancer treatment. This aspect has been scarcely studied in Italy. About 7 years ago, the Italian Group for Antiemetic Research (IGAR) published a large controlled study on the effectiveness of different antiemetic prophylaxis in patients submitted to moderately emetogenic chemotherapy, where the prescribed chemotherapy was recorded. The aim of our study was to evaluate the incidence of undertreatment and to detect clinical and nonclinical factors able to explain its variability. METHODS: An observational study on the IGAR databank was performed to evaluate the incidence of undertreatment in the prescription in conditions of clinical trial, where the doses belonged to the eligibility criteria, and to analyze the importance of clinical and nonclinical factors using multifactorial logistic models. RESULTS: 317 patients receiving cyclophosphamide, methotrexate, and fluorouracil (CMF) and 224 anthracycline-based chemotherapy were considered. In the CMF-treated patients, 22.4% received full doses, whereas in 53.6% all three drugs of the schedule were down-dosed. In the anthracycline-treated group, 38.6% and 3.4% of patients submitted to chemotherapy containing epirubicin and doxorubicin, respectively, were undertreated. Logistic models showed that undertreatment in CMF-treated patients depended significantly on the geographic area and setting of chemotherapy administration. Although not significant, differences between age class and Karnofsky performance status were also detected. In the epirubicin-treated group, all these factors were significant. CONCLUSIONS: The undertreatment of cancer patients is a relevant problem, because it could give, in daily clinical practice, worse results than those reported in clinical studies. Considering the setting of a clinical trial where our study was carried out, the incidence of undertreatment is surprisingly high. We do not know whether today, about 8 years after the IGAR study was carried out, the inappropriate dose of chemotherapy is still as frequent as we reported, but surely the topic deserves more attention.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Adulto , Fatores Etários , Idoso , Antraciclinas/administração & dosagem , Ensaios Clínicos como Assunto/normas , Ciclofosfamida/administração & dosagem , Relação Dose-Resposta a Droga , Doxorrubicina/administração & dosagem , Esquema de Medicação , Epirubicina/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Humanos , Itália , Avaliação de Estado de Karnofsky , Modelos Logísticos , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Health Qual Life Outcomes ; 1: 46, 2003 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-14521717

RESUMO

It is commonly claimed that the nausea and vomiting accompanying cytotoxic chemotherapy have a negative impact on health-related quality of life. While this may seem self-evident, until a few years ago there was little empirical data demonstrating that the failure to control postchemotherapy emesis affects aspects of quality of life. In spite of their limitations, several observational studies showed that nausea and vomiting associated with chemotherapy induced a decrease in health-related quality of life with respect to patients without nausea and vomiting. This has also been demonstrated after the adjustment for health-related quality of life before chemotherapy that is an important prognostic factor of chemotherapy-induced nausea and vomiting. Furthermore, one study suggests that the optimal time of assessment of quality of life to evaluate the impact of chemotherapy-induced nausea and vomiting is day 4 if a 3-day recall period is used or day 8 when the recall period is 7 days. In double-blind studies the efficacy, tolerability and impact on quality of life of the 5-HT3 receptor antagonists was superior with respect to metoclopramide, alizapride and prochlorperazine. Similar results have been achieved with the combination of ondansetron with dexamethasone, the standard treatment for the prevention of acute emesis induced by moderately emetogenic chemotherapy, with respect to the metoclopramide plus dexamethasone combination. Instead, in another double-blind study, in patients submitted to moderately emetogenic chemotherapy, a 5-HT3 antagonist did not seem to significantly increase complete protection from delayed emesis and the patients' quality of life with respect to dexamethasone alone. In conclusion, the evaluation of quality of life in randomized trials comparing different antiemetic drugs for the prevention of chemotherapy-induced nausea and vomiting can add important information useful for the choice of the optimal antiemetic treatment.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Náusea/induzido quimicamente , Neoplasias/tratamento farmacológico , Qualidade de Vida , Vômito/induzido quimicamente , Antieméticos/efeitos adversos , Antieméticos/uso terapêutico , Feminino , Humanos , Masculino , Náusea/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Vômito/prevenção & controle
14.
Assist Inferm Ric ; 33(2): 97-115, 2014.
Artigo em Italiano | MEDLINE | ID: mdl-25002061

RESUMO

Update on anticancer drugs. A thorough review of the clinical trials published over the last two years in major medical and oncological journals on a comprehensive spectrum of oncological conditions aims to provide at the same time (as the authors are well known representatives of the critical and complementary competences of clinical care and research methodology) an interesting double opportunity of update on: a) what is truly (i.e.documented and reliable) innovative and deserves adoption in daily care,vs what is either purely suggestive or clearly misleading; b) what are the methological, concrete, simple rules to observe in a field which is certainly moving fast, but at the same time generates highly controversial behaviors in research as well as in daily practices. The accompanying editorial (pag 60-63) further illustrates the way and the yield of using this material and approach both in the areas of nursing sciences and practice.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico , Anticorpos Monoclonais Humanizados , Neoplasias da Mama/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Ensaios Clínicos como Assunto , Neoplasias Colorretais/tratamento farmacológico , Everolimo , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Melanoma/tratamento farmacológico , Metástase Neoplásica , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Sirolimo/análogos & derivados , Terminologia como Assunto
15.
J Clin Oncol ; 32(2): 101-6, 2014 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-24323030

RESUMO

PURPOSE: A combination of aprepitant, a 5-HT3 receptor antagonist, and dexamethasone is recommended for the prophylaxis of acute or delayed emesis induced by chemotherapy containing anthracyclines plus cyclophosphamide in patients with breast cancer. The aim of this study was to verify whether dexamethasone is superior to aprepitant in preventing delayed emesis in patients receiving the same prophylaxis for acute emesis. PATIENTS AND METHODS: A randomized double-blind study comparing aprepitant versus dexamethasone was completed in chemotherapy-naive patients with breast cancer treated with anthracyclines plus cyclophosphamide. Before chemotherapy, all patients were treated with intravenous palonosetron 0.25 mg, dexamethasone 8 mg, and oral aprepitant 125 mg. On days 2 and 3, patients randomly received oral dexamethasone 4 mg twice per day or aprepitant 80 mg once per day. Primary end point was rate of complete response (ie, no vomiting or rescue treatment) from days 2 to 5 after chemotherapy. RESULTS: Of 580 enrolled patients, 551 were evaluable: 273 received dexamethasone, and 278 received aprepitant. Day 1 complete response rates were similar: 87.6% for dexamethasone and 84.9% for aprepitant (P < .39). From days 2 to 5, complete response rates were the same with both antiemetic prophylaxes (79.5%; P < 1.00), as were results of secondary end points (ie, complete protection, total control, no vomiting, no nausea, score of Functional Living Index-Emesis; P < .24). Incidences of insomnia (2.9% v 0.4%; P < .02) and heartburn (8.1% v 3.6%; P < .03) were significantly greater with dexamethasone on days 2 to 5. CONCLUSION: In patients with breast cancer treated with anthracycline plus cyclophosphamide chemotherapy and receiving the same antiemetic prophylaxis for acute emesis, dexamethasone was not superior to aprepitant but instead had similar efficacy and toxicity in preventing delayed emesis.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Dexametasona/uso terapêutico , Morfolinas/uso terapêutico , Vômito/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Antraciclinas/administração & dosagem , Antraciclinas/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Aprepitanto , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Método Duplo-Cego , Esquema de Medicação , Feminino , Azia/induzido quimicamente , Azia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/prevenção & controle , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Distúrbios do Início e da Manutenção do Sono/prevenção & controle , Fatores de Tempo , Resultado do Tratamento , Vômito/induzido quimicamente
17.
Support Care Cancer ; 15(2): 179-85, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16941136

RESUMO

GOAL OF WORK: The objectives of this prospective observational study were to estimate the frequency of patients who reported an impact of chemotherapy-induced nausea and vomiting (CINV) on their daily life and to evaluate the determinants of such an impact. MATERIALS AND METHODS: Adult cancer patients at seven Italian oncology centers who were receiving cisplatin-containing regimens reported incidence and intensity of CINV for eight consecutive days in a diary and completed a Functional Living Index for Emesis (FLIE) questionnaire. MAIN RESULTS: Overall, 34% of patients reported vomiting and 62% reported nausea after chemotherapy. On days 1 to 5 after receiving chemotherapy, 67% of patients who had at least one emetic episode and 77% of those who suffered from at least mild nausea experienced an impact on their daily activities as measured on the FLIE questionnaire. More than 90% of all patients with both acute and delayed nausea or vomiting reported an impact on their daily life. Both acute and delayed vomiting contributed in similar measure to impact daily life; however, the importance of delayed nausea was greater than that of acute nausea. CONCLUSIONS: Despite antiemetic prophylaxis, CINV is still prevalent and often impacts the daily life of patients in Italy, especially in the delayed phase. The duration more than the severity seems to be responsible for the impact of CINV on the patients' daily lives.


Assuntos
Antineoplásicos/efeitos adversos , Náusea/induzido quimicamente , Vômito/induzido quimicamente , Idoso , Antieméticos/uso terapêutico , Cisplatino/efeitos adversos , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Náusea/psicologia , Observação , Estudos Prospectivos , Qualidade de Vida/psicologia , Vômito/psicologia
18.
Support Care Cancer ; 15(1): 31-8, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16788840

RESUMO

GOALS OF WORK: The aim of this paper is to analyze the costs of chemotherapy-induced nausea and vomiting (CINV) in Italy. MATERIALS AND METHODS: In this prospective observational study at seven public oncology centers, incidence and intensity of CINV daily for 8 days after chemotherapy in consecutive patients receiving cisplatin-containing chemotherapy were recorded. All costs related to CINV (direct medical, direct nonmedical, and indirect) were recorded (in 2003 euros). MAIN RESULTS: A total of 172 patients were enrolled; cost data were available for 168 patients. Thirty-seven percent of patients experienced acute CINV, and 57% experienced delayed CINV; 39% achieved total control, defined as no nausea, vomiting, or rescue therapy. Mean per-patient costs of acute and delayed CINV were 30.03 euro from the hospital perspective, 4.9 euro from the patient perspective, and 26.85 euro from the National Health Service (NHS) perspective. Costs of CINV were highly variable among oncology centers, largely because of differences in procedures for preventing delayed CINV. These costs were four times higher when antiemetic drugs were prescribed and paid for by the NHS than when antiemetic prophylaxis was provided directly from hospital pharmacies. Moreover, in the delayed phase, the NHS incurred a 94% increase in costs for patients without total control. Overall costs for patients who did not experience total control of CINV were 35.57 euro higher than for those who did (85% increase). CONCLUSIONS: Costs of CINV for the Italian NHS could be reduced if hospitals furnished antiemetic prophylaxis directly to patients. Better control of both acute and delayed CINV would improve patient well-being as well as reduce the budgetary impact of CINV in Italy.


Assuntos
Antineoplásicos/economia , Efeitos Psicossociais da Doença , Náusea/economia , Medicina Estatal/economia , Vômito/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antieméticos/economia , Antieméticos/uso terapêutico , Antineoplásicos/efeitos adversos , Institutos de Câncer/economia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/tratamento farmacológico , Observação , Estudos Prospectivos , Vômito/induzido quimicamente , Vômito/tratamento farmacológico
19.
Support Care Cancer ; 13(2): 109-11, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15714358

RESUMO

For patients treated with low or minimally emetogenic chemotherapy there is little evidence from clinical trials supporting the choice of a given antiemetic therapy or of any treatment at all. The panel recognized the necessity of considering the introduction into clinical practice of new agents in these categories, particularly oral cytotoxic agents and targeted biological agents and also the possibility of over-treatment with antiemetics. There was consensus among panel members regarding the recommended treatment for patients receiving chemotherapy agents with low and minimal emetic risk. Patients without a history of nausea and vomiting for whom minimally emetic risk chemotherapy is prescribed should not routinely receive antiemetic prophylaxis. A single agent such as a low-dose corticosteroid is suggested for patients receiving agents of low emetic risk. If nausea and vomiting occurs during subsequent cycles of chemotherapy, prophylaxis with a single agent such as a substituted benzamide, a corticosteroid, or a phenothiazine should be administered. Only patients with persistent nausea and vomiting despite treatment with these recommended agents should receive a 5-HT3 receptor antagonist in the following cycles.


Assuntos
Antieméticos/uso terapêutico , Antineoplásicos/efeitos adversos , Vômito/induzido quimicamente , Vômito/prevenção & controle , Antieméticos/administração & dosagem , Antineoplásicos/classificação , Ensaios Clínicos como Assunto , Humanos , Guias de Prática Clínica como Assunto
20.
Support Care Cancer ; 13(2): 85-96, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15565277

RESUMO

This paper uses an evidence-based approach whenever possible to formulate recommendations, emphasizing the results of controlled trials concerning the best use of antiemetic agents. We address issues of dose, schedule, and route of administration of five selective 5-HT(3) antagonists. We conclude that for each of these five drugs, there is a plateau in therapeutic efficacy above which further dose escalation does not improve outcome. Furthermore, for all classes of antiemetic agents, a single dose is as effective as multiple doses or a continuous infusion. The oral route is as efficacious as the intravenous route of administration, even with chemotherapy of high emetic risk. Selective antagonists of the type 3 serotonin receptor (5-HT(3)) in combination with dexamethasone and aprepitant are the standard of care for the prevention of emesis following chemotherapy of high emetic risk.


Assuntos
Antieméticos/uso terapêutico , Antineoplásicos/efeitos adversos , Náusea/prevenção & controle , Vômito/prevenção & controle , Antieméticos/administração & dosagem , Ensaios Clínicos como Assunto , Consenso , Dexametasona/uso terapêutico , Vias de Administração de Medicamentos , Esquema de Medicação , Quimioterapia Combinada , Medicina Baseada em Evidências , Humanos , Náusea/induzido quimicamente , Antagonistas dos Receptores de Neurocinina-1 , Guias de Prática Clínica como Assunto , Antagonistas do Receptor 5-HT3 de Serotonina , Vômito/induzido quimicamente
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