a mean FLIE vomiting domain
score of 55.3 (50.3 for HEC and 56.5
for MEC; p=0.0097). The authors
noted that this was also reflected
by the NIDL data, with 53.1% of
patients reporting NIDL for nausea
compared with 73.4% with NIDL
for vomiting. CINV associated
with HEC has a significantly lower
mean FLIE score compared with
MEC (95.5 vs 107.8, respectively;
p=0.0049). 14
Rolapitant, a NK1 RA,
significantly improved the
FLIE total score (114.5 vs 109.3,
p<0.001), nausea score (55.3 vs
53.5, p<0.05), and vomiting score
(59.2 vs 55.8, p<0.001) versus
5-HT3 antagonists alone in patients
receiving HEC with similar results
observed for patients receiving
MEC/AC chemotherapy. 9 These
data underline the impact of NK1
RAs on QoL by preventing delayed
nausea and vomiting.
Economic impact
As well as the effect on QoL,
CINV also has an impact on cost
utilisation. 15 Severe CINV episodes
might require hospitalisation,
day hospital, or hospitalisation
extension which results in
significant costs for National
Health Services. Haiderali et al
estimated that total average costs
due to CINV were US$778.58
per patient from the day of
administration through the five
days following the first cycle of
chemotherapy. 15 Carver et al found
36 | 2018 | hospitalpharmacyeurope.com
that there was a 20% CINV event
rate per chemotherapy cycle per
patient among a group of 11,495
patients, of whom 8806 received
prophylaxis for all cycles of
chemotherapy during follow-up
of eight cycles of chemotherapy
or six months, with an associated
all-cause average daily total cost of
approximately US$1850. All-cause
costs included inpatient, hospital
outpatient, emergency visit
costs and pharmacy costs (rescue
medications for CINV treatment). 16
Turini et al calculated costs for the
treatment of severe episodes of
CINV for patients in Italy, France
and Germany. Mean costs per
patient for treatment of a single
severe CINV episode were €389,
€750 and €1017, respectively,
in these countries. 17 These data
underline that a complete control
of CINV is a reasonable approach
for prophylaxis from the economic
point of view.
Guideline recommendations
Patients should be encouraged
to contact their healthcare team
as soon as they notice any signs
of nausea or vomiting, because
CINV can become intractable
and treatment-resistant if left
untreated. However, patients
might be reluctant to talk about
their symptoms for a variety of
reasons. For example, they:
• might assume symptoms are
unavoidable
• think symptoms are trivial and