Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb;26(2):557-564.
doi: 10.1007/s00520-017-3866-6. Epub 2017 Sep 4.

Chemotherapy-induced nausea and vomiting (CINV) and adherence to antiemetic guidelines: results of a survey of oncology nurses

Rebecca Clark-Snow  1 , Mary Lou Affronti  2 , Cynthia N Rittenberg  3
Affiliations

Chemotherapy-induced nausea and vomiting (CINV) and adherence to antiemetic guidelines: results of a survey of oncology nurses

Rebecca Clark-Snow et al. Support Care Cancer. 2018 Feb.

Abstract

Purpose: Chemotherapy-induced nausea and vomiting (CINV) can be prevented in most patients with use of guideline-recommended antiemetic regimens. However, studies have suggested that adherence to antiemetic guidelines is suboptimal. Oncology nurses, as part of a multidisciplinary team, can help promote appropriate antiemetic prophylaxis. Therefore, nurses were surveyed to assess antiemetic guideline awareness and practice patterns of antiemetic use, determine adherence to guideline recommendations, and query barriers to adherence.

Methods: In September 2015, 531 US-based oncology nurses participated in an online survey administered and analyzed by ONS:Edge.

Results: Nurses were most familiar with National Comprehensive Cancer Network (73%) and American Society of Clinical Oncology (48%) antiemetic guidelines. While most (77%) felt that antiemetics prescribed were consistent with guideline recommendations, practice patterns of antiemetic use revealed low adherence to those guidelines, particularly during the delayed (25-120 h) phase following highly emetogenic chemotherapy, where only 25% of nurses reported administration of guideline-recommended agents. Overutilization of phenothiazines and benzodiazepines was common. Only 17% of respondents reported that most (> 75%) of their patients have CINV optimally controlled; 39% reported between 6 and 20% of patients have an alteration in their chemotherapy due to CINV, and reports of emergency department/hospital visits due to poorly controlled CINV were high. The predominant barrier interfering guideline-recommended antiemetic prophylaxis was reported as physician preference (71%).

Conclusions: This survey revealed an opportunity to increase awareness of antiemetic guidelines and a critical need to address barriers interfering with utilization of guideline-recommended antiemetic agents in order to optimize CINV control for patients undergoing emetogenic chemotherapy.

Keywords: Adherence; Antiemetics; Chemotherapy-induced nausea and vomiting (CINV); Emesis; Guidelines.

PubMed Disclaimer

Conflict of interest statement

The authors have the following conflicts of interest to disclose:

Clark-Snow: Received honoraria from and served as a consultant to Merck and Tesaro; Speaker’s bureau for Merck.

Affronti: Research funding from Eisai, Merck, Tesaro, and Amgen for investigator-initiated clinical trials; participated in Merck Antiemetic Expert Input Forum.

Rittenberg: Has stock in Amgen, Abbott Labs, AbbVie, Biogen, Celgene, J & J, Novartis, Eli Lily, Gilead, Merck, and Pfizer

Figures

Fig. 1
Fig. 1
Nurses’ perceptions of CINV control rates of their patients with currently administered antiemetics
Fig. 2
Fig. 2
Greatest perceived challenges or unmet needs in preventing or managing CINV
Fig. 3
Fig. 3
Classes of antiemetics being used to prevent CINV in the HEC setting (a) and the MEC setting (b)
Fig. 4
Fig. 4
Reported barriers/reasons interfering with using guideline-recommended antiemetics
See this image and copyright information in PMC

References

    1. Navari R, Aapro M. Antiemetic prophylaxis for chemotherapy-induced nausea and vomiting. NEJM. 2016;374:1356–1367. doi: 10.1056/NEJMra1515442. - DOI - PubMed
    1. ASCO 50th anniversary poll names top 5 advances past 50 years. The ASCO Post, October 15, 2014
    1. Jordan K, Jahn F, Aapro M. Recent developments in the prevention of chemotherapy-induced nausea and vomiting (CINV): a comprehensive review. Ann Oncol. 2015;26(6):1081–1090. doi: 10.1093/annonc/mdv138. - DOI - PubMed
    1. Roila F, Molassiotis A, Herrstedt J, et al. (2016) MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol 27:119–133 - PubMed
    1. Hesketh PJ, Bohlke K, Lyman G, et al. Antiemetics: American Society of Clinical Oncology focused guideline update. J Clin Oncol. 2016;34(4):381–386. doi: 10.1200/JCO.2015.64.3635. - DOI - PubMed

Publication types