Evaluation of outcomes in converting from intravenous ondansetron to oral granisetron: an observational study

Chemotherapy-induced nausea and vomiting in routine practice: a European perspective

GOALS OF WORK

The aim of this study was to evaluate the occurrence of chemotherapy-induced nausea and vomiting (CINV) and its effect on patients' ability to carry out daily life activities following moderately to highly emetogenic, first-cycle chemotherapy in routine practice in cancer centers of four different European countries.

PATIENTS AND METHODS

This was a prospective, cross-sectional, nonrandomized, self-assessment study in 249 patients enrolled from cancer centers in Spain, Austria, Germany, and Switzerland. The study population consisted of 78% women, with a mean age of 54. Breast, lung, and ovarian cancers made up 75% of all cancers in the study. Patients received a mean of 2.0 chemotherapy agents and 2.5 antiemetic drugs.

MAIN RESULTS

A total of 450 emetic episodes experienced by 243 patients was recorded over 5 days following chemotherapy, with an average of 1.8 episodes per patient (range: 0-28). A higher percentage of patients (38%) suffered from delayed compared to acute emesis (13%). Between 42% and 52% of all patients suffered from nausea (visual analogue scale > or = 5 mm) on any one day, peaking at day 3. Using the Functional Living Index for Emesis (FLIE) questionnaire, 75% of patients with nausea and 50% with vomiting reported a negative impact of these conditions on performance of daily living.

CONCLUSIONS

CINV remains a significant problem in routine practice, particularly in the delayed phase posttreatment. Overall, CINV had a negative impact on patients' daily life.

Economics of antiemetics

Numerous studies about postoperative nausea and vomiting management are available and meta-analyses have helped to define the appropriate doses of the effective drugs. Almost all recent papers include some economical considerations. In order to rationalize the therapeutic protocols, strategies including systematic prophylaxis, treatment of established postoperative nausea and vomiting only, targeted prophylaxis, treatment combinations aimed at secondary prophylaxis, and global management have all been proposed. Published data are not always valid for every clinical setting and a cost-effective policy needs an evaluation effort from the local care providers (incidence of immediate and delayed postoperative nausea and vomiting, cost of an emetic episode, indirect impact of postoperative nausea and vomiting). This is the only way to avoid improper use of conclusions possibly drawn in totally different medical and economical circumstances. Patients consider postoperative nausea and vomiting as the worst postoperative symptom. This translates into the sizeable amount of money patients are willing to pay in order to avoid this major side effect.