Changes in compliance with Japanese antiemetic guideline for chemotherapy-induced nausea and vomiting: a nationwide survey using a distributed research network

Pharmacist intervention and identification of adverse events related to treatment efficacy in cancer chemotherapy to improve clinical outcomes

Adverse events (AEs) induced by cancer chemotherapy reduce not only patient quality of life (QOL) but also the efficacy of treatment. Management of AEs can therefore improve both the efficacy and safety of cancer chemotherapy. This review describes the contribution of pharmacists to the management of adverse events aimed at improving the treatment efficacy of cancer chemotherapy. Efforts to improve the evidence-practice gap are a useful approach to countermeasures against AEs. Pharmacists can intervene in these efforts in the course of their daily practice. Here, we made undertook to improve the evidence-practice gap in prophylaxis pharmacotherapy for chemotherapy-induced nausea and vomiting (CINV) and anti-EGFR antibody-induced acneiform rash. After intervention by pharmacists, the rate of adherence to prophylaxis pharmacotherapy for these AEs was significantly improved, and the incidence of CINV and acneiform rash was significantly decreased. Notably, time to treatment failure (TTF) with anti-EGFR antibody therapy tended to be increased, and may have contributed to an improvement in therapeutic effect. Next, we examined adverse events associated with anti-cancer drugs related to the therapeutic effect of cancer chemotherapy. Incidence of hypomagnesemia in patients receiving anti-EGFR antibodies and neutropenia in patients receiving TAS-102 was significantly associated with the therapeutic effect of cancer chemotherapy. Moreover, we examined the impact of cancer cachexia, a cancer-associated AE, on the therapeutic effect of immune checkpoint inhibitors. In patients receiving nivolumab, the presence of cancer cachexia prior to treatment initiation was associated with shorter OS and TTF. In summary, pharmacist management of AEs was shown to improve treatment response. Further, AEs which are predictive of treatment response in cancer chemotherapy were identified. Management of these AEs is an important role for pharmacists aiming to improve patient QOL and treatment efficacy.

Certified nurse specialists in cancer nursing and prophylactic antiemetic prescription for chemotherapy patients

PURPOSE

The prevention of chemotherapy-induced nausea and vomiting (CINV), a common chemotherapy side effect, should be attempted by oncology nurses. Certified nurses could be certified nurse specialists in cancer nursing (CNSCNs), who have high-level graduate education, or certified nurses in cancer chemotherapy nursing (CNCCNs), who have short-term training. The relationship between these certifications and compliance with the CINV prevention guidelines has not been investigated. We aimed to evaluate the association between certified nurse staffing and prescription of prophylactic antiemetic drugs for chemotherapy patients with high emetic risk.

METHODS

We used health service utilisation data for cancer patients diagnosed in 2016 from 474 hospitals nationwide in Japan and a list of certified nurses published by the Japanese Nurse Association. Patients receiving highly emetic chemotherapy were included. A multilevel mixed-effect logistic regression analysis was conducted to estimate the prescription of prophylactic antiemetic drugs associated with CNSCN and/or CNCCN staffing.

RESULTS

Data of 46,306 patients were analysed. Overall, 68.4% and 94.0% of the patients received chemotherapy at hospitals with CNSCNs and CNCCNs, respectively. Small cell lung cancer, non-small cell lung cancer, breast cancer, and oesophageal cancer were positively associated with the prescription of recommended antiemetic drugs. CNSCNs was significantly associated with the prescription of prophylactic antiemetic drugs, while CNCCNs was positively but non-significantly associated with antiemetic prescriptions.

CONCLUSION

This study is the first to demonstrate that CNSCN placement was significantly associated with prescribing antiemetic drugs recommended by clinical guidelines. Patients are likely to receive appropriate supportive care with the proper placement of CNSCNs.

Comparative investigation of the anti-emetic effects of granisetron and palonosetron during the treatment of acute myeloid leukemia

Chemotherapy-induced nausea and vomiting has a considerable negative impact on the quality of life of patients with cancer. Unfortunately, there has been little progress in the development of supportive therapies for the anti-emetic treatment of patients with hematopoietic tumors. This lack of supportive treatments motivated the present retrospective comparison between two groups of anti-emetic drugs. The current study aimed to compare granisetron and palonosetron in order to determine which is more effective, based on cases of patients undergoing remission induction therapy and consolidation therapy for the treatment of acute myeloid leukemia. Granisetron or palonosetron were administered in Japanese-approved dosages (3 mg granisetron once per day for 5 or 7 days, or one administration of 0.75 mg palonosetron). Patients were randomly selected, and their clinical information was acquired from medical records. The data represent the doctors' and nurses' records. The results demonstrated that palonosetron treatment (in which the drug was administered alone or in combination with aprepitant) was more effective than granisetron treatment for the complete control of acute vomiting. Therefore, in the treatment of hematopoietic malignancies, palonosetron is an effective regimen to be administered alongside more than 5 continuous days of anti-cancer agents. Furthermore, the combination of palonosetron and aprepitant was found to be the optimal combination. In conclusion, palonosetron is superior to granisetron for the prevention of nausea and vomiting induced by chemotherapy for hematological cancers. In Japan, the standard dose of palonosetron is 0.75 mg; a dose of 0.25 mg of palonosetron must be compared with 0.75 mg in future studies.

Associations of Polyethylenimine-Coated AN69ST Membrane in Continuous Renal Replacement Therapy with the Intensive Care Outcomes: Observations from a Claims Database from Japan

BACKGROUND/AIMS

Polyethylenimine-coated polyacrylonitrile (AN69ST) membrane is expected to improve the outcomes of critically ill patients treated by continuous renal replacement therapy (CRRT).

METHODS

Using a Japanese health insurance claim database, we identified adult patients receiving CRRT in intensive care units (ICUs) from April 2014 to October 2015. We used a multivariable logistic regression model to assess in-hospital mortality and Fine and Gray's proportional subhazards model to assess the ICU length of stay (ICU-LOS) accounting for the competing risks.

RESULTS

Of 2,469 ICU patients, 156 were treated by AN69ST membrane. Crude in-hospital mortality was 50.0% in the AN69ST group and 54.0% in the non-AN69ST group. Adjusted odds ratio (OR) of AN69ST membrane use for in-hospital mortality was 0.65 (95% CI 0.45-0.93). The use of AN69ST membrane was also independently associated with shorter ICU-LOS.

CONCLUSION

This retrospective observational study suggested that CRRT with AN69ST membrane might be associated with better in-hospital outcomes.

Risk of disseminated intravascular coagulation in patients with type 2 diabetes mellitus: retrospective cohort study

OBJECTIVES

To determine quantitatively the association between type 2 diabetes mellitus (T2DM) and disseminated intravascular coagulation (DIC).

DESIGN

Retrospective cohort study using a claims database.

SETTING

Medical care institutions representing 9% of all secondary hospitals (acute care hospitals) in Japan.

PARTICIPANTS

In total, 797 324 admissions, comprising 435 354 patients aged 18-79 years at the time of admission, were enrolled between January 2010 and September 2014. All patients were diagnosed with diabetes or admitted to hospitals that provided laboratory data.

MAIN OUTCOME MEASURES

Incidence of DIC reported by physicians in claims data.

RESULTS

Logistic regression analysis found that the risk of DIC was significantly higher in T2DM patients than in non-DM patients (fully adjusted OR: 1.39 (95% CI 1.32 to 1.45)), independent of age, sex, admission year and potential underlying diseases. The higher risk of DIC in T2DM patients was apparent in those who were treated with insulin within the 30-day period prior to admission (1.53 (1.37 to 1.72)). When stratified by the potential underlying diseases, the risk of DIC was higher in T2DM patients with non-septic severe infection (1.67 (1.41 to 1.97)) and with solid tumour (1.59 (1.47 to 1.72)) than in non-DM patients with those underlying diseases. The risk was similar between T2DM and non-DM patients with sepsis (0.98 (0.90 to 1.08)) and lower in T2DM patients with acute leukaemia (0.70 (0.59 to 0.84)).

CONCLUSIONS

T2DM was associated with a higher risk of DIC, particularly when recently treated with insulin, as well as among admissions with solid tumour or non-septic severe infection.

Patterns of antiemetic prophylaxis for chemotherapy-induced nausea and vomiting in China

BACKGROUND

Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapy-induced nausea and vomiting (CINV) at a national level in China or to assess how treatment regimens adhere to current guidelines.

METHODS

We searched the China Health Insurance Research Association (CHIRA) Database to identify patients with cancer who were ≥18 years old and received either moderately or highly emetogenic chemotherapy (MEC and HEC, respectively) between 2008 and 2012. Patients' characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics.

RESULTS

Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC (59.4% vs. 81.3%; P<0.001). The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group (P≤0.012); however, a higher proportion received a mixed regimen containing corticosteroids (P≤0.007). Although more than half of the patients in the HEC group took three antiemetics to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group (both P<0.001). Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic.

CONCLUSIONS

These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.

Control of chemotherapy-induced nausea in patients receiving outpatient cancer chemotherapy

BACKGROUND

Control of chemotherapy-induced nausea is still incomplete, regardless of adherence to the antiemetic guideline. The present study was designed to assess the control rates of nausea and vomiting in the outpatient chemotherapy clinic and to determine risk factors for nausea.

METHODS

A single-center prospective observational study was carried out in 779 patients who received 5511 chemotherapy cycles from January 2013 to December 2014 in the outpatient chemotherapy clinic. A checklist for adverse events was provided to all patients, and nausea and vomiting were monitored on the next visit. Complete protection from nausea and vomiting during acute (within 24 h) and delayed (during 2-7 days) periods was assessed.

RESULTS

Under the condition of 76-99 % rates of adherence to the Japanese Society of Clinical Oncology guideline for antiemesis, the rates of complete protection from acute and delayed nausea in the first cycle of chemotherapy were 60 % and 45 %, respectively, for high emetic risk chemotherapy (HEC), and 85 % and 70 % for moderate emetic risk chemotherapy (MEC). The rates were improved in the overall cycles. On the other hand, vomiting was well controlled, in which complete protection ranged from 83 % (HEC) to 99 % (minimum). A multivariate analysis indicated that being female, age less than 60 years, high or moderate risk chemotherapy, and anthracycline/cyclophosphamide (A/C) were significant risks for overall nausea. Indeed, the control of delayed nausea was extremely poor in the first cycle of A/C, although there was no difference in the control of nausea among MEC.

CONCLUSION

Antiemetic medication in consideration of the risk factors is required to improve the control of nausea.

Addressing the value of novel therapies in chemotherapy-induced nausea and vomiting

Chemotherapy-induced nausea and vomiting (CINV) is a troubling side effect of cancer treatment and is often poorly controlled. As a consequence, CINV is associated with substantially increased costs of care and significant interference with patients' lives. Inadequate control over CINV results from factors that include failure to provide guideline-adherent prophylactic medication and limitations in available therapies. Newer serotonin receptor antagonists, such as palonosetron, and addition of neurokinin-1 (NK-1) receptor antagonists to treatment have significantly decreased both acute and delayed CINV. A fixed-dose combination of palonosetron and a new NK-1 receptor, netupitant, is significantly superior to palonosetron alone and has small, but consistent, numerical advantages over aprepitant plus palonosetron for prevention of CINV. The combination of a serotonin receptor antagonist plus an NK-1 receptor antagonist has been shown to be cost-effective for prevention of CINV and the availability of a fixed-dose combination of netupitant and palonosetron may enhance this benefit.