Approximately 40% of patients treated with anthracyclines are still not receiving National Comprehensive Cancer Network (NCCN) guideline–adherent prophylaxis for chemotherapy-induced vomiting. In most cases, guideline nonadherence was secondary to the lack of a neurokinin 1 (NK1) antagonist.
Patients on highly emetogenic chemotherapy should receive prophylaxis in the form of a 5-HT3 antagonist in combination with steroids and an NK1 antagonist, according to Mariana Chavez-MacGregor, MD. The addition of an NK1 antagonist was incorporated into the NCCN and American Society of Clinical Oncology guidelines in 2006.
“Patients receiving highly emetogenic chemotherapy, and also selected moderately emetogenic regimens commonly used in the treatment of breast cancer, should receive this prophylaxis to relieve their nausea and vomiting, starting with the first dose of the first cycle of chemotherapy,” said Chavez MacGregor, assistant professor in the division of cancer prevention at the University of Texas MD Anderson Cancer Center in Houston.
Chavez-MacGregor and her colleagues conducted a population-based study to evaluate adherence to antiemesis prophylaxis guidelines among breast cancer patients treated with anthracyclines and presented their findings at the 2015 Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology International Symposium on Supportive Care in Cancer.
NCODA’s view: Advances in controlling nausea and vomiting have come a tremendously long way. This article points out that we may still have a ways to go. There are very few reasons why a patient should not be receiving the NCCN recommended antiemesis regimens. Standardizing anitemetic protocols within a practice’s EHR should be a priority for all oncology practices. No patient should needlessly suffer through chemotherapy-induced nausea and vomiting due to inadequate prophylaxis.