Oncologist perspectives on chemotherapy-induced nausea and vomiting (CINV) management and outcomes: A quantitative market research-based survey

Abstract

Background: Chemotherapy-induced nausea and vomiting (CINV) is a distressing side effect that can negatively impact patients' quality of life and could discourage completion of chemotherapy, thereby affecting overall treatment outcomes. Although adherence to antiemetic guidelines can reduce CINV incidence in patients receiving highly or moderately emetogenic chemotherapy, CINV control remains inadequate.

Aims: The objectives of this survey were to determine oncologists' practice patterns in CINV management, identify factors that contribute to antiemetic treatment failure, and determine the outcomes of uncontrolled CINV on health care resource utilisation and on patients' attitude towards chemotherapy.

Methods and results: Quantitative market research was performed using an online questionnaire. Responses from 300 European oncologists who prescribe antiemetics and see ≥50 patients/month were analysed. Results showed that the main reasons reported by oncologists for antiemetic treatment failure were underestimating the emetogenic potential of chemotherapy, utilising weaker antiemetic regimens than required, and patient non-adherence because of administration mistakes or missed/delayed doses. Educational initiatives for the oncology multidisciplinary team may help improve guideline-consistent prescribing. Also, the availability of simpler, more convenient antiemetic therapies may improve guideline adherence and patient compliance during home administration.

Conclusion: Achieving effective CINV control is a crucial goal to improve patients' quality of life, which should optimise chemotherapy outcomes, and would ultimately reduce health care costs.

Keywords: adherence; antiemetic therapy; chemotherapy‐induced nausea and vomiting (CINV); compliance; guidelines.

Figure 1

Level of awareness and use of international antiemetic guidelines. Respondent rates^† to (A) question 1^‡ and (B) question 2.^§ ASCO, American Society of Clinical Oncology; MASCC, Multinational Association of Supportive Care in Cancer; NCCN, National Comprehensive Cancer Network. ^†Combined responses from oncologists from Italy, France, Germany, Spain, and the United Kingdom. ^‡Question 1: Are you aware of the following guidelines for the prescribing of antiemetic therapy? ASCO/MASCC/NCCN. ^§Question 2: To what extent do you adhere to the following guidelines when prescribing antiemetics? ASCO/MASCC/NCCN. Please indicate your level of adherence to these guidelines using a 1 to 7 scale where 1 = I don't adhere to this guideline and 7 = I completely adhere to this guideline

Figure 2

(A) Antiemetic prescription patterns for the prevention of CINV associated with MEC and HEC, and (B) emetogenic risk of chemotherapeutic regimens as perceived by oncologists. Respondent rates^† to (A) question 3^‡ and (B) question 4.^§ 5‐HT₃ RA, 5‐hydroxytryptamine‐3 receptor antagonist; CINV, chemotherapy‐induced nausea and vomiting; HEC, highly emetogenic chemotherapy; MEC, moderately emetogenic chemotherapy; NK₁, neurokinin 1. ^†Combined responses from oncologists from Italy, France, Germany, Spain, and the United Kingdom. ^‡Question 3: Please indicate what percentages of your patients receive each of the indicated antiemetic drugs or drug combinations regardless of line of therapy or administration: Steroids monotherapy; 5‐HT ₃ RA monotherapy +/− steroids; NK ₁ RA monotherapy +/− steroids; 5‐HT ₃ RA + NK ₁ RA +/− steroids; Other drug or drug combination—specify. ^§Question 4: In your personal clinical practice, how do you consider the following regimens in terms of emetogenic potential when it comes to decide for the antiemetic drugs? Cisplatin >50 mg/m²; cisplatin <50 mg/m²; cyclophosphamide >1500 mg/m²; cyclophosphamide <1500 mg/m²; anthracyclines + cyclophosphamide (AC). For each regimen, indicate: mildly emetogenic; moderately emetogenic; highly emetogenic

Figure 3

(A) Incidence of uncontrolled CINV in patients who receive antiemetic drugs prior to HEC and MEC during the acute and delayed phases, and (B) percentage of patients experiencing nausea only, vomiting only, or both. Respondent rates^† to (A) question 5^‡ and (B) question 6.^§ HEC, highly emetogenic chemotherapy; MEC, moderately emetogenic chemotherapy. ^†Combined responses from oncologists from Italy, France, Germany, Spain, and the United Kingdom. ^‡Question 5: For the categories below, please indicate what percentages of your patients who receive antiemetic drugs report emesis, hence you consider as non‐responders to current antiemetic treatments: MEC—Acute emesis; MEC—Delayed emesis; HEC—Acute emesis; HEC—Delayed emesis. ^§Question 6: Considering your patients who reported emesis despite antiemetic treatments, what percentage experience nausea, or vomiting, or both? Patients reporting only nausea; Patients reporting only vomiting; Patients reporting both nausea and vomiting

Figure 4

(A) Reasons for experiencing acute and delayed emesis, (B) frequency of non‐adherence to antiemetic treatment by patients, and (C) oncologists' perceptions about the benefit of patient adherence to simplified antiemetic treatments. Respondent rates^† to (A) question 7^‡, (B) question 8^§, and (C) question 13C.^¶ CINV, chemotherapy‐induced nausea and vomiting; UK, United Kingdom. ^†Combined responses from oncologists from Italy, France, Germany, Spain, and the United Kingdom. ^‡Question 7: In your opinion, what are the main reasons why patients report emesis despite being treated? Please indicate what percentage of patients experience emesis for the following reasons in your personal practice. (Separate questions were asked for acute and delayed emesis.). Actual emetogenicity higher than expected; “Weaker” antiemetics (eg, monotherapy instead of combination) were used; Mistakes/issues with the administration (ie, time of administration, etc); Other: mainly psychological cofactors, anxiety, individual sensitivity. ^§Question 8: Considering all your patients treated with antiemetic therapies for whom you prescribe treatments to take at home, what percentage of these patients made mistakes/missed 1 or more administrations? Please indicate the percentage of patients. ^¶Question 13C: Please indicate how much you agree with the statement below, indicating 7 for agree completely and 1 for disagree completely. “An antiemetic drug administered orally even on day 1 would be much appreciated by me and my patients”

Figure 5

(A) Frequency of patients requiring additional medical visits or rescue therapy because of uncontrolled CINV. (B) Degree of concern amongst oncologists about the clinical consequences of uncontrolled CINV. (C) Changes in the attitudes of oncologists and patients after uncontrolled CINV. Respondent rates^† to (A) question 9^‡, (B) questions 10, 11, and 12^§, and (C) questions 13^¶ A and B. CINV, chemotherapy‐induced nausea and vomiting; HEC, highly emetogenic chemotherapy; MEC, moderately emetogenic chemotherapy. ^†Combined responses from oncologists from Italy, France, Germany, Spain, and the United Kingdom. ^‡Question 9: What percentage of your patients who receive chemotherapy treatment or target therapy undergo additional medical visits or require additional therapy (eg, you had to undertake an unplanned visit and/or prescribe a rescue antiemetic treatment) for emesis‐related reasons after receiving their cycle of chemotherapy? (Separate questions were asked for MEC and HEC.). >30%; 21% to 30%; 11% to 20%; 1% to 10%; None. ^§Question 10: To what extent do you perceive unplanned visits and/or changes in planned antiemetic treatment due to emesis problems in treated patients as an issue in your personal clinical practice? Question 11: To what extent do you perceive hospitalisation due to emesis as an issue in your personal clinical practice?Question 12: To what extent do you perceive patient adherence/compliance to antiemetic treatments as an issue in your personal clinical practice? Please answer using a 1 to 7 scale, where 1 = it is not at all an issue and 7 = it is a major issue. ^¶Question 13: Please indicate how much you agree with the list of statements below, indicating 7 for agree completely and 1 for disagree completely. A. I sometimes avoid or reduce highly emetogenic chemotherapy for some patients because of chemotherapy‐induced nausea and vomiting. B. Patients sometimes ask to change or cancel chemotherapy because they experienced emesis on previous courses of therapy