Evaluation of patient quality care in Spain in prevention of nausea and vomiting induced by chemotherapy.

OBJECTIVE: To characterise current management of chemotherapy-induced nausea and vomiting in Spain, as well as professional adherence to antiemetic guidelines. MATERIALS AND METHODS: Retrospective observational study. A multicenter has been designed including 360 patient case files from 18 hospitals. The involvement of pharmacists and nurses was studied, and also indicators of structure, process, and selected outcomes previously recruited from antiemetic guidelines. RESULTS: We found 94.4% of hospitals used a written protocol for managing chemotherapy-induced nausea and vomiting and only 44.4% had educational programs for patients regarding this. Patients were prescribed antiemetic prophylactic treatment for delayed emesis in varying degree between highly and moderately emetogenic chemotherapy (77.8% and 58.9%, respectively). Dexamethasone was the most prescribed antiemetic drug for patients receiving highly and moderately emetogenic chemotherapy (98.3% and 90%, respectively), followed by ondansetron (68.9% and 95%, respectively). Nursing was more involved than pharmacy units in evaluating emetic risk factors in patients (64.7% vs 21.4%), and tracking symptom onset (88.2% vs 57.1%) and adherence to treatment (94.1% vs 28.6%). Pharmacy units were more involved than nursing in choosing the antiemetic treatment (78.6% vs 47%). CONCLUSIONS: Although antiemetic guidelines were used by all hospitals, there were differences in management of chemotherapy-induced nausea and vomiting. Increased education directed towards patients and oncology professionals is needed to improve adherence.

Management and perception of therapeutic adherence of breakthrough cancer pain by oncologists in Spain / Manejo y percepción de la adherencia al tratamiento del dolor irruptivo oncológico por oncólogos españoles

Objectives:The objective of this study was to evaluate the perception of oncologists on adherence to opioid treatment for breakthrough cancer pain (BTcP) in current clinical practice. Our study also included an assessment of other aspects of the management of BTcP, such as the reasons for non-adherence, the adequacy of the treatment, or the possible interventions required to improve adherence.Methods:This observational, multicentric study was carried out in 84 hospitals throughout Spain. Oncologists were surveyed by means of an online questionnaire on their management of background cancer pain and BTcP, and their perception of adherence to the treatments.Results:Oncologists (N = 97) reported that their first choice for BTcP was fentanyl (various formulations), with high perceived tolerance (> 76 % of patients). Most oncologists (96.8 %) evaluated adherence in their patients but only 69. 1% always prescribed medication to prevent adverse effects of opioids and only 74.2 % always titrated the minimum dose. Most oncologists (51.0 %) perceived that 25-50 % of the patients did not adhere to the treatment for BTcP. Adherence to background pain treatments was high, although many oncologists considered that patients usually stopped taking the medication when feeling better. The main reported reasons for non-adherence were the self-perceived feeling that treatment was unnecessary, perceived inefficacy of the treatment, concerns about potential adverse effects, and lack of family support.Conclusions:Oncologists perceived that adherenceto BTcP treatment can be improved and recommended treatment of adverse effects, better education about pain management to patients and relatives, written prescription instructions, and simplification of drug regimens.(AU)

Introducción:El objetivo de este estudio fue evaluar la percepción de los oncólogos sobre la adherencia al tratamiento con opioides para el dolor irruptivo oncológico (DIO) en la práctica clínica real. El estudio también incluyó una evaluación de otros aspectos del manejo del DIO, como las razones de la no adherencia, la adecuación del tratamiento, o las posibles intervenciones necesarias para mejorar la adherencia.Métodos:Este estudio observacional multicéntrico se realizó en 84 hospitales de toda España. Los oncólogos fueron encuestados por medio de un cuestionario online sobre su manejo del dolor oncológico basal y del DIO, y su percepción de la adherencia a los tratamientos.Resultados:Los oncólogos (n = 97) indicaron que su primera opción para el DIO fue el fentanilo (varias formulaciones), con alta tolerancia (> 76 % de los pacientes). La mayoría de los oncólogos (96,8 %) evaluaron la adherencia en sus pacientes, pero solo el 69,1 % siempre prescribió medicamentos para prevenir los efectos adversos de los opioides, y solo el 74,2 % siempre tituló la dosis mínima. La mayoría de los oncólogos (51 %) percibieron que el 25-50 % de los pacientes no mostraban buena adherencia al tratamiento para DIO. La adherencia a los tratamientos de dolor basal fue alta, aunque muchos oncólogos consideraron que los pacientes generalmente dejaban de tomar el medicamento cuando se sentían mejor. Las principales razones para la no adherencia fueron la sensación de que el tratamiento era innecesario, la ineficacia percibida del tratamiento, la preocupación por los posibles efectos adversos y la falta de apoyo familiar.Conclusiones:Los oncólogos percibieron que la adherencia al tratamiento para el DIO puede mejorarse y recomendaron el tratamiento de los efectos adversos de la medicación, una mejor educación sobre el manejo del dolor a los pacientes y familiares, instrucciones escritas de prescripción y simplificación de los regímenes de medicamentos.(AU)

Study of the prevalence of tumour-related asthenia in Spanish cancer patients.

INTRODUCTION: Asthenia is the most prevalent symptom in oncological patients but it is underestimated by the majority of healthcare professionals. The aim of the present study is to estimate the prevalence of tumour-related asthenia in the Spanish population, while defining the associated factors. METHODS: An epidemiological, multicentre, cross-sectional study was conducted in oncology services from Spain, including 712 cancer patients (58.4+/-13.5 years). RESULTS: 42.5% patients showed asthenia. This prevalence appeared to be tumour-related (p<0.05) and increased among patients with a more advanced stage of disease or with a worsening of performance status (p<0.001). The prevalence of asthenia increased in the presence of the following factors: chemotherapy (in the past: 52.1% vs. 31.0%; at the time of the study: 46.1% vs. 38.2%), symptomatic treatment (in the past: 60.4% vs. 39.8%; at the time of the study: 61.3% vs. 38.6%), present interferon treatment (100%), anaemia (59.7% vs. 31.3%), dehydration/waterelectrolyte imbalance (58.3% vs. 41.6%), respiratory failure (61.4% vs. 39.7%), liver disease (59.5% vs. 41.3%), malnutrition (76.1% vs. 38.7%), pain (57.7% vs. 27.0%), anxiety (56.1% vs. 38.6%), depression (57.9% vs. 40.0%) and sleep disturbances (51.1% vs. 39.4%). A multivariate logistic regression showed that a model including performance status, patient circumstance, chemotherapy, anaemia, pain and anxiety correctly diagnosed asthenia in 70.9% of cases. CONCLUSIONS: The physiopathology of tumour-related asthenia remains relatively unknown, despite its high prevalence and considerable quality of life impact. Determining factors related to asthenia in clinical practice can favour the use of concrete treatments and improve the conditions of cancer patients.

Study of the prevalence of tumour-related asthenia in Spanish cancer patients

INTRODUCTION: Asthenia is the most prevalent symptom in oncological patients but it is underestimated by the majority of healthcare professionals. The aim of the present study is to estimate the prevalence of tumour-related asthenia in the Spanish population, while defining the associated factors. METHODS: An epidemiological, multicentre, cross-sectional study was conducted in oncology services from Spain, including 712 cancer patients (58.4+/-13.5 years). RESULTS: 42.5% patients showed asthenia. This prevalence appeared to be tumour-related (p<0.05) and increased among patients with a more advanced stage of disease or with a worsening of performance status (p<0.001). The prevalence of asthenia increased in the presence of the following factors: chemotherapy (in the past: 52.1% vs. 31.0%; at the time of the study: 46.1% vs. 38.2%), symptomatic treatment (in the past: 60.4% vs. 39.8%; at the time of the study: 61.3% vs. 38.6%), present interferon treatment (100%), anaemia (59.7% vs. 31.3%), dehydration/waterelectrolyte imbalance (58.3% vs. 41.6%), respiratory failure (61.4% vs. 39.7%), liver disease (59.5% vs. 41.3%), malnutrition (76.1% vs. 38.7%), pain (57.7% vs. 27.0%), anxiety (56.1% vs. 38.6%), depression (57.9% vs. 40.0%) and sleep disturbances (51.1% vs. 39.4%). A multivariate logistic regression showed that a model including performance status, patient circumstance, chemotherapy, anaemia, pain and anxiety correctly diagnosed asthenia in 70.9% of cases. CONCLUSIONS: The physiopathology of tumour-related asthenia remains relatively unknown, despite its high prevalence and considerable quality of life impact. Determining factors related to asthenia in clinical practice can favour the use of concrete treatments and improve the conditions of cancer patients (AU)

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