A substantial number of patients with cancer receiving chemotherapy with minimal and low emetogenic potential are prescribed unnecessary antiemetic drugs for the prevention of chemotherapy-induced nausea and vomiting (CINV), a study published in JAMA Oncology has shown.1
Guidelines recommend against the use of antiemetic agents in patients receiving chemotherapy with low or minimal emetic risk as it is associated with increased health care costs and potential risks to the patient without a need to prevent CINV. Because there are limited data on the use of antiemetic prophylaxis or treatment of emesis associated with chemotherapy of low emetogenic potential, researchers sought to examine the pattern of overprescribing prophylactic antiemetic drugs in Japan.
For the study, investigators analyzed data from 8545 patients who were diagnosed with breast, cervical, colorectal, lung, prostate, or stomach cancer, age 20 years or older at the time of diagnosis, and received intravenous chemotherapy with minimal or low emetic risk. Data were collected from a health insurance claims database linked with the hospital-based cancer registry of 122 designated cancer care hospitals.
Patients underwent a total of 73,577 administrations of chemotherapy with minimal or low emetic risk. Among those, researchers found that patients who received approximately 48% of administrations of chemotherapy with a low emetic risk and nearly 3% of administrations of chemotherapy with a minimal emetic risk were prescribed serotonin receptor antagonists, such as ondansetron and granisetron, and dexamethasone.
Results also showed that outpatients who received chemotherapy of low emetogenic potential received more frequent administrations of chemotherapy than inpatients, thereby leading to approximately $1.6 million being unnecessarily spent on antiemetic drugs for these patients.
Although no prophylactic antiemetic drugs were recommended by any of the clinical practice guidelines for these populations, 12.4% of the chemotherapy with minimal emetic risk administered included prescription of an antiemetic drug.
The findings ultimately demonstrated the overuse of prophylactic antiemetic drugs in patients undergoing chemotherapy with minimal or low emetic risk. Adhering to the clinical practice guidelines on the use of antiemetic prophylaxis could lead to a reduction in health care costs.
1. Okuyama A, Nakamura F, Higashi T. Prescription of prophylactic antiemetic drugs for patients receiving chemotherapy with minimal and low emetic risk. JAMA Oncol. 2016 Nov 3. doi: 10.1001/jamaoncol.2016.4096. [Epub ahead of print]