From April 1 to April 30, 2019, a total of 1000 patients were randomly selected from 5468 patients at different departments. After quality inspection, 875 questionnaires were included in statistical analysis after rejecting 25 unqualified questionnaires: 501 from internal medicine department, 184 from surgery department, 172 from radiotherapy department, 18 from interventional department. The average patient age was 56.3 ± 10.5 years within a range of 18–81 years. There were 375 males (42.86%) and 500 females (57.14%). The demographic and clinical characteristics of the patients were pictured in Table 1.
Table 1. Baseline characteristics and demographics of survey respondents.
Baseline characteristics
|
Patients (N [%])
|
Department
Internal Medicine
Surgery
Radiotherapy
Interventional
Age
Mean ± SD
< 60
≥ 60
|
501 (57.26)
184 (21.03)
172 (19.66)
18 (2.05)
56.3 ± 10.5
517 (59.09)
358 (40.91)
|
Gender
|
Male
|
375 (42.86)
|
Female
Diagnosis
Lung cancer
Breast cancer
Gastric cancer
Colorectal cancer
Ovarian cancer
Gallbladder cancer
Pancreatic cancer
Duodenal cancer
Cervical cancer
Endometrial cancer
Nasopharyngeal cancer
Lymphoma
Esophageal cancer
|
500 (57.14)
154 (17.60)
189 (21.60)
73 (8.34)
138 (15.77)
78 (8.91)
11 (1.26)
19 (2.17)
3 (0.34)
47 (5.37)
10 (1.14)
37 (4.23)
27 (3.09)
29 (3.31)
|
Abbreviation: SD, standard deviation
In this study, 66 antineoplastic drugs were investigated, of which 52 were given intravenously and 14 orally. There were 9, 7, 50 drugs with high, moderate and low emetic risk respectively. The most prescribed prophylactic regimens for the management of CINV in our hospital were neurokinin-1 receptor antagonists (NK-1RA, such as aprepitant), 5-hydroxytryptamine3 receptor antagonists (5-HT3RA), promethazine and dexamethasone (DEX) and metoclopramide.
Analysis of compliance with CINV guideline
Adherence to different regimens for the prophylaxis of CINV in our hospital was compliant in 61.68%, 61.41%, 52.91%, and 27.78% at internal medicine department, surgery department, radiotherapy department, and interventional department, respectively (Table 2).
Table 2. Prevalence of Guideline-Consistent CINV Prophylaxis for Chemotherapy, and the Main Cause of Inconsistency (n = 875)
Emetogenic potential group
|
Guideline consistency N (%)
|
N of patients with guideline inconsistency
|
Type of drugs
|
i.v. high
lack of NK-1RA
metoclopramide, DEX and 5-HT3RA
promethazine, DEX and 5-HT3RA
low DEX dose in the acute period
|
60 (21.28)
|
222
187
25
33
82
|
i.v. moderate
lack of DEX
both different 5-HT3RA
DEX and metoclopramide
extra DEX dose in the acute period
|
96 (44.65)
|
119
96
23
5
4
|
i.v. low
no antiemetic treatment
i.v. minimal
oral high/moderate
no antiemetic treatment
DEX and promethazine
oral low
type of departments
internal medicine
surgery
radiotherapy
interventional
|
231 (95.45)
36 (100)
2 (28.57)
93 (100)
309 (61.68)
113 (61.41)
91 (52.91)
5 (27.78)
|
11
8
0
5
4
1
0
|
P = 0.01
|
As depicted in Table 2, in the highly emetogenic risk group, the most two essential reasons for lack of adherence to the guideline recommendations were lack of NK-1RA like aprepitant prescription, and low dose of DEX. Across moderate emetogenic potential group, omission of DEX and extra 5-HT3RA prescription were the principal cause of nonadherence.
CINV incidence and Rate of complete control
With respect to the primary outcome, the incidence rate of acute phase CINV was 24.57%, delayed phase CINV was 39.54%, and the overall CINV was 44.23%. 19.89% patients had both acute and delayed CINV (Fig.1). During the overall period, the incidence of CINV was higher in the delayed phase than in the acute phase; nausea was more frequent across the overall observation period (43.66% VS 18.86%). However, vomiting was more sever and had a greater impact on life than nausea (Fig.2).
Rate of complete control (CC) was defined absence of nausea and vomiting. The CC rates of emetogenic regimens in overall phases was increased by 14.52% (61.58% VS 47.06%, P < 0.001) when compliance antiemetic regimens were compared with non-compliance regimens (Table 3). Compliance with the antiemetic guideline could better prevent occurrence of CINV beyond the overall risk period.
Table 3. Relationship between CINV complete control rate and antiemetic regimens recommended by the guideline
|
Patients [N (%)]
|
Rate of CC (%)
|
|
i.v. HEC
Guideline consistency
Guideline inconsistency
|
60 (21.28)
222 (78.72)
|
60.00
46.85
|
|
i.v. MEC
|
|
|
|
Guideline consistency
|
96 (44.65)
|
57.29
|
|
Guideline inconsistency
i.v. LEC
Guideline consistency
Guideline inconsistency
oral HEC and MEC
Guideline consistency
Guideline inconsistency
The overall
Guideline consistency
Guideline inconsistency
|
119 (55.35)
231 (95.45)
11 (4.55)
2 (28.57)
5 (71.43)
518 (59.20)
357 (40.80)
|
48.74
62.34
45.45
100.00
20.00
61.85
47.06
|
P < 0.001
|