While there is abundant research supporting antiemetic regimens, evidence-based guidelines are not always followed. Recently, MASCC members Rebecca Clark-Snow, Mary Lou Affronti, and Cynthia N. Rittenberg published the results of an online survey undertaken to assess adherence to antiemetic guidelines on treatment of CINV. Clark-Snow and her colleagues surveyed 531 US oncology nurses to determine nurses’ awareness of guidelines and practice patterns, perceived adherence to guideline recommendations, and perceived barriers to adherence. This research is reported in the February 2018 issue of Supportive Care in Cancer.
The most relevant, up-to-date guidelines include the MASCC/ESMO Antiemetic Guidelines, as well as those of ASCO and the National Comprehensive Cancer Network (NCCN). The study respondents were most familiar with the ASCO and NCCN guidelines. Most felt that antiemetics are prescribed in accordance with guideline recommendations, yet perceived patterns of use suggest that adherence may actually be low — especially during the delayed phase following highly emetogenic chemotherapy. 25% of nurses reported the administration of guideline-recommended agents, with phenothiazines and benzodiazepines commonly overused.
Only 17% of nurses said that their patients’ CINV is optimally controlled and nearly 40% said that CINV requires changes in the treatment regimen in up to 20% of patients. Reports of emergency department and hospital visits due to poorly controlled CINV were also high. Physician preference was most often reported as a barrier to guideline adherence.
This survey reveals the need to increase awareness of antiemetic guidelines and to address barriers that interfere with prescription of guideline-recommended antiemetic agents. On the basis of this sample of US nurses, awareness and use of the MASCC/ESMO guidelines appears to be low, especially compared with the NCCN guidelines. This study, however, suggests some directions for making progress toward meeting identified needs.
Few studies have evaluated barriers related to following CINV guidelines or explored ways to improve adherence. The limited research suggests that communicating CINV outcomes to physicians is critical, and multifaceted strategies are necessary. The nurses in this study offered numerous suggestions for improving adherence, including education of healthcare providers, use of standardized protocols, electronic orders that incorporate recommendations of evidence-based guidelines, improved patient education, and follow- up. The authors note that improved communication between patients, nurses, and doctors would prove helpful, as well as use of an assessment tool, such as the MASCC Antiemesis Tool (MAT) to increase awareness about CINV and its treatment. Oncology nurses are in a unique position to increase awareness and promote best practices. They also serve as a primary liaison with patients and play a key role in education about antiemetics in the clinic and at home.
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Clark-Snow R, Affronti, ML, Rittenberg CN. Chemotherapy-induced nausea and vomiting (CINV) and adherence to antiemetic guidelines: results of a survey of oncology nurses. Support Care Cancer. 2018 Feb;26(2):557-564.
Rebecca Clark-Snow, RN, BSN, OCN, is an Oncology Supportive Care Consultant, Overland Park, Kansas, USA. She is Past Chair of the MASCC Antiemetic Study Group and is a co- author on the MASCC/ESMO and ASCO Antiemetic Guidelines. Rebecca is currently a member of MASCC Study Groups on Antiemetics, Education, and Rehabilitation, Survivorship, and Quality of Life.
Mary L. Affronti, DNP, MHSc, RN, ANP, is an Associate Professor, a nurse practitioner, and researcher at Duke University School of Nursing and The Preston Robert Tisch Brain Tumor Center at Duke Cancer Institute in Durham, North Carolina, USA. She is a member of MASCC’s Antiemetics Study Group.
Cynthia N. Rittenberg, RN, MN, AOCN, FAAN, is President of Rittenberg Oncology Consulting in Metairie, Louisiana, USA, where she works with both individual and corporate clients. She served as the first Executive Director of MASCC (2001-2010) and is currently a member of MASCC Study Groups on Antiemetics, Education, and Neutropenia, Infection, and Myelosuppression.
