Monitoring the adherence to an adapted evidence-based clinical practice guideline on antiemetics in 669 patients with cancer receiving 1451 chemotherapy doses at a University oncology center in Saudi Arabia

Abstract

Objectives: Chemotherapy-induced nausea and vomiting (CINV) is a common medication safety issue among cancer patients worldwide. However, there remains a research gap on adherence to the clinical practice guidelines (CPGs) for antiemetic medications to prevent and treat CINV in Saudi Arabia. Further, the adherence to our center's CPG for antiemetics for CINV at our center was never quantified before. Therefore, this audit was designed as an implementation and quality improvement intervention to fill the knowledge gaps. Methods: We conducted a retrospective cross-sectional observational study of the adult cancer patients attending the University Oncology Center at King Saud University Medical City. Data were extracted from the electronic health records' database for patients receiving chemotherapy in the months of February and November 2017. Results: Among the 669 adult cancer patients who received 1451 chemotherapy doses at our center, nearly 48% of the antiemetic prescriptions adhered to our adopted CPG's recommendations. The adherence of prescribers was more likely to moderate emetogenic agents such as doxorubicin and ifosfamide as compared to the high emetogenic agents such as cisplatin and cyclophosphamide >1500 mg/m2. Conclusions: Adherence to the antiemetics for CINV-CPG was suboptimal due to the unavailability of neurokinin1-receptor antagonists (NK1) antagonists and the lack of knowledge by prescribers. NK1 antagonists should be available to maximize the level of cancer care. Regular physician's education and training sessions must be conducted to familiarize them with the CPG evidence-based recommendations.

Keywords

• adherence
• antiemetic
• chemotherapy
• practice guideline