do not want to waste the doctor’s
time
• do not know whether their
symptoms are severe enough to
warrant attention
• believe symptoms will not last
long
• do not know treatment is
available
• see symptoms as proof that
chemotherapy is having an effect
• are afraid that if they ‘complain’
their chemotherapy dose will be
reduced, delayed or stopped
• do not want to seem weak
• might have forgotten the
severity by the time of their next
assessment if symptoms develop
after they have returned home.
With the correct use of
antiemetic drugs, CINV can
be prevented in almost
70%, and even up to
80%, of patients.
However, despite
the availability
of guidelines,
there is emerging
evidence that
adherence to, and
implementation
of, treatment
recommendations
are less than optimal. 18
Only 11% of HEC, 29% of AC and
39% of MEC patients receive an
antiemetic prophylaxis consistent
with international antiemetic
guidelines. 19 Adherence to
treatment guidelines can improve
outcomes. In a prospective
observational study of almost
1000 chemotherapy-naïve patients
receiving single-day HEC or MEC,
59.9% (172/287) of patients in
the guideline consistent CINV
prophylaxis group achieved a
complete response (CR) compared
with 50.7% (357/704) in the
guideline-inconsistent CINV
prophylaxis group (p=0.008). 1
Adherence to a single dose of
NEPA and efficacy of NEPA was
shown in those 1286 (88%) patients
who participated in a Phase III trial
with a multiple-cycle extension for
a total of 5969 cycles. Out of these
patients 76% completed ≥4 cycles.
The proportion of patients with an
overall CR was significantly greater
for NEPA than oral palonosetron
for cycles 1–4 (74.3 vs
66.6 %, 80.3 vs 66.7 %,
83.8 vs 70.3 %, and
83.8 vs 74.6 %,
respectively;
p≤0.001 each
cycle). The
cumulative
percentage of
patients with a
sustained CR over
all four cycles was
also greater for NEPA
(p<0.0001). 19
Choice and convenience
Patient choice and patient
preference might influence
adherence to antiemesis regimens.
For example, being offered an oral
rather than an IV formulation
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