Assessing prescribing patterns for the prevention of chemotherapy-induced nausea and vomiting in the national center for cancer care and research.

ABSTRACT

PURPOSE: Chemotherapy is the mainstay of cancer treatment; however, chemotherapy treatment may cause nausea and vomiting, which could cause 25-50% of patients to consider delaying or refusing further cancer treatment. Chemotherapy-induced nausea and vomiting (CINV), can be prevented in 70-80% of patients with evidence-based anti-emetic regimen. The purpose of this study is to assess prescribing patterns with regard to prevention of CINV, in the national center for cancer care and research (NCCCR), and develop and implement a standardized evidence-based guideline for the management of CINV. METHODS: 25 anti-emetic prescriptions were audited to assess their conformity with either of the published guidelines; Multinational Association of Supportive Care in Cancer (MASCC), American Society of Clinical Oncology (ASCO), or the National Comprehensive Cancer Network (NCCN), to establish baseline data. A multidisciplinary team of clinical pharmacists and oncologists developed and implemented a guideline for the prevention of CINV. The guideline was promoted using a variety of strategies; education, pocket cards, academic detailing and pharmacist intervention. Physician anti-emetic orders were audited by pharmacists, to assess their conformity with NCCCR anti-emetic guidelines. A data collection form was developed to capture relevant information including; patient demographics, type and emetogenic level of chemotherapy, and the conformity of anti-emetic order with NCCCR guidelines. SPSS statistical software was used to analyze the data. RESULTS: The conformity of anti-emetic physician order with NCCCR anti-emetic guidelines increased from 0% baseline in June 2008 to an average of 60.006% (n = 331) by December 2010 and consistently increased reaching 94.3827% (n = 792) by December 2013, (p value 0.0002). CONCLUSION: The introduction of anti-emetic guidelines succeeded in standardizing CINV management, toward an evidence-based approach.