What the HEC? Clinician Adherence to Evidence-Based Antiemetic Prophylaxis for Highly Emetogenic Chemotherapy

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Background: Clinician adherence to antiemetic guidelines for preventing chemotherapy-induced nausea and vomiting (CINV) caused by highly emetogenic chemotherapy (HEC) remains poorly characterized. The primary aim of this study was to evaluate individual clinician adherence to HEC antiemetic guidelines. Patients and Methods: A retrospective analysis of patients receiving HEC was conducted using the IBM Watson Explorys Electronic Health Record Database (2012–2018). HEC antiemetic guideline adherence was defined as prescription of triple prophylaxis (neurokinin-1 receptor antagonist [NK1 RA], serotonin type-3 receptor antagonist, dexamethasone) at initiation of cisplatin or anthracycline + cyclophosphamide (AC). Clinicians who prescribed ≥5 HEC courses were included and individual guideline adherence was assessed, noting the number of prescribing clinicians with >90% adherence. Results: A total of 217 clinicians were identified who prescribed 2,543 cisplatin and 1,490 AC courses. Patients (N=4,033) were primarily women (63.3%) and chemotherapy-naïve (92%) with a mean age of 58.6 years. Breast (36%) and thoracic (19%) cancers were the most common tumor types. Guideline adherence rates of >90% were achieved by 35% and 58% of clinicians using cisplatin or AC, respectively. Omission of an NK1 RA was the most common practice of nonadherence. Variation in prophylaxis guideline adherence was considerable for cisplatin (mean, 71%; SD, 29%; coefficient of variation [CV], 0.40) and AC (mean, 84%; SD, 26%; CV, 0.31). Conclusions: Findings showed substantial gaps in clinician adherence to HEC CINV guidelines, including a high variability across clinicians. Clinicians should review their individual clinical practices and ensure adherence to evidence-based CINV guidelines to optimize patient care.

Submitted August 4, 2019; accepted for publication December 19, 2019.

Author contributions: Study design: Roeland, Binder, Schmerold, Navari. Data collection: Potluri, Papdemetriou. Data analysis: Roeland, Ruddy, LeBlanc, Nipp, Binder, Sebastiani, Schmerold, Schwartzberg, Navari. Drafting of manuscript: Roeland, Ruddy, LeBlanc, Nipp, Binder, Sebastiani, Schmerold, Schwartzberg, Navari. Critical revision: All authors.

Disclosures: Dr. Roeland has disclosed that he has received consulting fees from Asahi Kasei Pharmaceuticals, DRG Consulting, American Imaging Management, Napo Pharmaceuticals, Immuneering Corporation, and Prime Oncology; and was a scientific advisor for Heron Pharmaceuticals, Vector Oncology, Oragenics, Inc., Galera Pharmaceuticals, and Enzychem Lifesciences Pharmaceutical Company. Dr. LeBlanc has disclosed that he has received grant/research support from Jazz Pharmaceuticals and Seattle Genetics; has served as a scientific advisor for AbbVie, Agios, Amgen, Daiichi-Sankyo, Heron Therapeutics, Medtronic, and Otsuka; receives royalties from UpToDate; and receives consultant fees from Agios, AstraZeneca, CareVive, Flatiron, Helsinn Therapeutics, Otsuka, Pfizer, Seattle Genetics, and Welvie. Mr. Binder and Dr. Sebastiani have disclosed that they are employees of Helsinn Therapeutics and Helsinn Healthcare. Mr. Potluri, Mr. Schmerold, and Mr. Papdemetriou have disclosed that they have received consulting fees from Helsinn Therapeutics. Dr. Schwartzberg has disclosed that he receives consulting fees from or is a scientific advisor for Amgen, Pfizer, Helsinn Therapeutics, Genentech/Roche, Genomic Health, Bristol-Myers Squibb, Myriad, AstraZeneca, Bayer, Spectrum, and Napo. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.

Funding: This study was sponsored by Helsinn Therapeutics (US), Inc. Dr. Roeland is also sponsored by the Cambia Health Foundation Sojourns Scholar Award.

Correspondence: Eric J. Roeland, MD, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7E, Boston, MA 02114. Email: eroeland@mgh.harvard.edu

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