Análisis de la efectividad de un protocolo de antiemesis implantado en la Unidad de Oncología

Integrative review of factors related to the nursing diagnosis nausea during antineoplastic chemotherapy

Objective

to identify factors related to the nursing diagnosis nausea among cancer patients undergoing chemotherapy.

Method

integrative review conducted in four electronic databases (PUBMED, EMBASE, CINAHL and LILACS) using the key words: neoplasia, antineoplastic agents and nausea.

Results

only 30 out of 1,258 papers identified met the inclusion criteria. The most frequent related factors were: being younger than 50 years old, motion sickness, being a woman, emetogenic potential of the chemotherapy, anxiety, conditioned stimulus, and expecting nausea after treatment.

Conclusion

this review's findings, coupled with the incidence of nausea among cancer patients undergoing chemotherapy, reveal an important difference between evidence found and that used by NANDA International, Inc. Even though it provides an appropriate definition of related factors, it does not mention chemotherapy, despite the various studies addressing the topic using different designs and presenting various objectives and outcomes.

Incidence and management of chemotherapy-induced nausea and vomiting in women with breast cancer

The objective of this study was to analyze the incidence of chemotherapy-induced nausea and vomiting in women with breast cancer and identify strategies used by them to control these signs and symptoms. Data for this cross-sectional study were collected through interviews during the last cycle of chemotherapy, between August 2011 and March 2012, in a university hospital in the State of São Paulo. The sample consisted of 22 women between the ages of 31 and 70, of whom 77.3% reported nausea and 50% vomiting during treatment. Regarding symptom management, 82% of the women reported having received some information centered on the use of prescribed medication. However, 27.3% did not know what medication they had taken. We concluded that there is a lack of systematic care and institutional protocol to guide professionals in providing standardized information to women so they can better control nausea and vomiting.

Adherence to antiemetic guidelines and control of chemotherapy-induced nausea and vomiting (CINV) in a large hospital

Purpose:

The aim of the study was to determine the antiemetic prescription adherence both to the protocol of our hospital and to international recommendations, as well as to analyze the relationship between this adherence and the incidence of nausea and vomiting (NV) and between the adherence and patients' individual risk.

Methods:

This is a four-month observational study which included antiemetic prescriptions for adult cancer patients. Prescriptions were considered adherent or not to hospital protocol and also to international guidelines. Patients were given a form to record the NV they suffered and this was to be returned at their next appointment.

Results:

A total of 102 prescriptions were analyzed. Taking into account the hospital protocol, 59% and 54% were correct (acute and delayed phase, respectively). Of those considered outside the protocol, 24% and 13% did follow international guidelines. In the delayed phase, complete response was achieved in 76% and 72% of the patients, with compliant and non-compliant prescriptions, respectively (82% and 90% in the acute phase). Adherence to the hospital protocol was higher in patients under 50 years old ( p = 0.015) and in those without previous experience of NV ( p = 0.010). Adherence to international guidelines was higher in female patients ( p = 0.023).

Conclusion:

Our study confirms low adherence with both local and international recommendations for antiemetic prescriptions. However, we could not prove that adherence involves a CINV reduction. Adherence did not seem to be influenced by the doctor's perception of the patient's risk of emesis.

Influence of pharmaceutical care on the delayed emesis associated with chemotherapy

BACKGROUND

Complete control of emesis during chemotherapy remains to be achieved. This could be improved by increasing adherence to medicines and recommendations.

OBJECTIVE

The aim of this study was to analyse the effects of pharmaceutical care on the incidence of delayed chemotherapy-induced nausea and vomiting (CINV) in adult cancer outpatients.

METHOD

This is a longitudinal prospective intervention study. Patients included were those who received a new cancer intravenous treatment. We compared complete response (no vomiting and no rescue treatment) and the incidence of nausea in the control group (CG) and in the intervention group (IG), as well as patients' adherence. Pharmaceutical intervention consisted of: reviewing the antiemetic protocol and giving some recommendations to the patients.

RESULTS

102 patients were studied. In the delayed phase complete response was achieved in 84.8 % of the patients in the IG, compared with 69.6 % in the control group [absolute risk reduction (ARR), 15.2 %; p = 0.144]. Regarding absence of vomiting, the difference was higher (71.0 CG vs 97.0 % IG, ARR, 26.0%; p = 0.002). Absence of delayed nausea were also better in the IG (61 vs. 52 %). Compliant patients increased from 59 to 76 %.

CONCLUSION

The intervention of a pharmacist reduced the incidence of delayed CINV and improved medication adherence.