complete response in 59.9% of
the patients, whereas complete
response in the guideline non-
consistent group was 50.7%
(p=0.008). 10 While this clearly
shows the positive effect of using
antiemetic guidelines on 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. 6
What is clear from the
literature is that, while use
of antiemetic guidelines does
improve clinical outcomes, reduces
healthcare utilisation and costs,
and enables physicians to integrate
the latest clinical research into
their daily practice, 7 uptake is low
for a variety of physician-linked
or institutional reasons. It seems
that providing recommendations
to oncology practices alone is
not an effective way to increase
antiemetic guideline utilisation,
and a combination of educational
strategies is more effective. 8
Furthermore, what the antiemetic
guidelines do not do is identify
those patients at an increased
16 | 2018 | hospitalpharmacyeurope.com
risk for developing nausea and
vomiting during cancer treatments
(patient risk factors are described
in detail in other sections of this
pocket guide). Other effective
methods include patient feedback
to clinicians or a multifaceted
pharmacist-led intervention that
includes guideline dissemination,
use of opinion leaders, interactive
educational workshops,
therapeutic reminders in the
form of preprinted orders, clinical
interventions by pharmacists
for the event of inappropriate
antiemetic orders, and physician
audit and feedback. 7
In addition, a multitude of
personal, sociodemographic and
clinical characteristics are risk
factors for nausea and vomiting. 9
In the same study, anxiety, history
of nausea/vomiting, and patient
expectations of nausea were
important predictors for some
phases and cycles of treatment
but not consistently across the
nausea/vomiting pathway. 9
Also, antiemetic guidelines are
all based on the first cycle of
chemotherapy; hence, there are