Cohort study of consistency between the compliance with guidelines for chemotherapy-induced nausea and vomiting and patient outcome

Masahiro Inoue, Manabu Shoji, Naomi Shindo, Kazunori Otsuka, Masatomo Miura, Hiroyuki Shibata

Chemotherapy-induced nausea and vomiting is one of the most influential factors that affect patient quality of life; thus, preventing this adverse event could lead to better patient outcome. Standard preventive guidelines for antiemetic treatment have already been established based on the emetogenicity of chemotherapeutic agents. It is important that compliance with in-house guidelines and their effect on patient outcome is monitored. In 3 years since the Akita university hospital antiemetic guidelines were outlined, we assessed the incidence of chemotherapy-induced nausea and vomiting using the antiemesis tool of the Multinational Association of Supportive Care in Cancer. Compliance of the guidelines was extracted from the hospital clinical record, and the chemotherapy-induced nausea and vomiting was examined by the patient reported outcome. Seventy-three patients answered the questionnaire. The overall compliance rate with the guidelines for early nausea and vomiting was 98.6% and with the delayed nausea and vomiting was 87.7%. The complete response rate for the early and delayed chemotherapy-induced nausea and vomiting was 77.8% and 73.8%, respectively. The overall relative risk of early nausea and vomiting was 0.22 (P < 0.05), whereas the relative risk for delayed nausea and vomiting was 2.09 (P < 0.05). Breakthrough vomiting was observed in 3 cases in the low-risk group only. These data suggest that delayed nausea and vomiting is difficult to prevent, particularly in the low-risk group. Further, it seems that the individual sensitivity for emetogenicity might differ among patients. In addition to standard prevention guidelines based on emetogenicity, individual care based on patient reports should be considered for the complete prevention of chemotherapy-induced nausea and vomiting.