Impact of Addition of Carboplatin AUC ≥ 4 to Antiemetic Guidelines for Triple Antiemetic Prophylaxis: A Gap in Quality of Care, Guideline Adoption, and Avoiding Acute Care.

Q1 Nursing
R. Navari, K. Ruddy, T. Leblanc, R. Clark-Snow, R. Wickham, G. Binder, T. Coberly, R. Potluri, L. Schmerold, E. Roeland
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引用次数: 3

Abstract

PURPOSE After ASCO and National Comprehensive Cancer Network guideline recommendations for triple antiemetic prophylaxis for carboplatin area under the curve (AUC) ≥ 4, and the publication of studies documenting avoidable acute care after chemotherapy involving nausea and vomiting (NV) and other toxicities, we studied clinician adherence to the guideline change and assessed avoidable acute-care use. METHODS Using a large electronic health record database, we evaluated antiemetic prophylaxis as recommended in the guidelines and post-chemotherapy avoidable acute-care use (defined as involving any of NV or 8 other toxicities) for patients initiating carboplatin or other chemotherapy from October 2012 to August 2018. RESULTS We identified 11,554 carboplatin courses. After the guideline change adding neurokinin-1 receptor antagonists (RAs) for carboplatin AUC ≥ 4, its use rose to 20% of courses from the prior average of 16%; virtually all courses also included a 5-HT3 RA plus dexamethasone. We found avoidable acute care in 23% of courses; one quarter of these events were associated with NV. Acute care rates after carboplatin mirrored those after other highly emetogenic chemotherapy or oxaliplatin and exceeded those after other chemotherapy regimens. The > 80% shortfall in adherence may have been caused by low awareness or acceptance of the guideline change and/or by poor awareness of avoidable acute-care use after carboplatin. CONCLUSION Neurokinin-1 RA prophylaxis for carboplatin AUC ≥ 4 remains low and largely unchanged despite National Comprehensive Cancer Network and ASCO 2017 recommendations for inclusion. NV and avoidable acute care involving NV seen after carboplatin were consistent with other highly emetogenic chemotherapy. Clinician action is required to remediate incomplete prophylaxis and to no longer place patient outcomes, resources for cancer treatment, and clinician reimbursement at risk.
在三重止吐预防的止吐指南中添加卡铂AUC≥4的影响:护理质量、指南采用和避免急性护理方面的差距。
目的ASCO和国家综合癌症网络关于卡铂曲线下面积(AUC)≥4的三重止吐预防的指南建议,以及记录化疗后可避免的包括恶心、呕吐(NV)和其他毒性的急性护理的研究的发表,我们研究了临床医生对指南变更的遵守情况,并评估了可避免的急性护理使用情况。方法利用一个大型电子健康记录数据库,我们评估了指南中建议的止吐预防和2012年10月至2018年8月期间开始卡铂或其他化疗的患者化疗后可避免的急性护理使用(定义为涉及NV或8种其他毒性中的任何一种)。结果我们确定了11554个卡铂疗程。在指南变更后,添加神经激肽-1受体拮抗剂(RA)治疗卡铂AUC≥4,其使用率从之前的平均16%上升到20%;几乎所有疗程也包括5-HT3 RA加地塞米松。我们在23%的疗程中发现了可以避免的急性护理;其中四分之一的事件与NV有关。卡铂治疗后的急性护理率与其他高致吐性化疗或奥沙利铂治疗后相同,超过了其他化疗方案。80%以上的依从性不足可能是由于对指南变更的认识或接受度低和/或对卡铂治疗后可避免的急性护理使用的认识低所致。结论Neurokinin-1 RA对卡铂AUC≥4的预防作用仍然很低,基本上没有变化,尽管国家综合癌症网络和ASCO 2017建议纳入。卡铂治疗后出现的NV和可避免的涉及NV的急性护理与其他高致吐性化疗一致。需要临床医生采取行动来补救不完整的预防措施,不再使患者的结果、癌症治疗资源和临床医生报销面临风险。
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来源期刊
Journal of Oncology Practice
Journal of Oncology Practice Nursing-Oncology (nursing)
CiteScore
4.60
自引率
0.00%
发文量
0
期刊介绍: Journal of Oncology Practice (JOP) provides necessary information and insights to keep oncology practice current on changes and challenges inherent in delivering quality oncology care. All content dealing with understanding the provision of care—the mechanics of practice—is the purview of JOP. JOP also addresses an expressed need of practicing physicians to have compressed, expert opinion addressing common clinical problems.
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