Abstract

PRESCRIBING PATTERN OF ANTIEMETICS IN THE TREATMENT OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING

Ahmed Salih Sahib*, M.Sc., Ph.D.; Saba Jasim Hamdan, MBChB, MSc.; ImadHashim Mohammed, M.Sc., Ph.D.; and Ali Abdul Razak Khefi

Abstract

Background: Chemotherapy-induced nausea and vomiting (CINV) are major adverse effects of cancer chemotherapy. Inadequate control CINV can have a significant negative impact on quality of life and can compromise adherence to chemotherapy treatment. The objective of this study was to determine the incidence of acute and delayed chemotherapy-induced nausea and vomiting among patients receiving chemotherapy and assess the adherence of prescribed antiemetics compared to standard guidelines. Patients and Methods: A prospective observational study was conducted .Patients completed 5- day daily diaries beginning on the day of single-day chemotherapy and for one to three chemotherapy cycles, the symptoms diary was designed to facilitate collection of data regarding patient’s demographic characteristics, cancer type, chemotherapy regimen, antiemetic medication prescribed and risk factors, in addition to incidence of CINV according to standard methods utilizing modified MORROW ASSESSMENT OF NAUSEA AND EMESIS FOLLOW UP (MANE) form. Results: A total of 260 patients were enrolled in this study, with age range of 18-76 year (40.23±17.51; Mean ±SD) of both sexes (65.38% male and 34.62% female), 57.69 % of the patients classified as receiving high emetogenic chemotherapy, whereas 30.78% of the patients receiving moderate emetogenic chemotherapy. Antiemetic therapy consistent with standard guidelines was used in the treatment of most of these patients. Nearly all the patients 92.27% received a 5-HT3 antagonist, usually accompanied by a corticosteroid 88.43%, metoclopramide also prescribed in combination to 23.06% of patients, while diphenhydramine prescribed in combination to 23.06% of patients and as a single therapy to only 7.69% of patients treated with minimal emetogenic chemotherapy. Despite the administration of antiemetic therapy, the total incidence of nausea and vomiting was 65.38% and 50% respectively post - chemotherapy treatment, 53.83% of patients experience anticipatory CINV triggered by many factors including taste, odor, thoughts, and sight where as the incidence of patients’ related risk factors that may contribute to CINV were female gender 34.61%, young age 23.07% and 15.38% due to previous experience with chemotherapy. Conclusion: the results of this study indicate that the incidence of CINV was relatively high; the results highlight the need to efficient implementation of standard guidelines of antiemetic to clinical practice. Protocols targeting patients’ risk factors and triggering factors are highly recommended as a means to reduce the burden of CINV.

Keywords: Antiemetic, chemotherapy, nausea, vomiting, CINV.