Alexandre Chan|Xiu Hui Low|Kevin Yi?Lwern Yap
Assessment of the Relationship Between Adherence with Antiemetic Drug Therapy and Control of Nausea and Vomiting in Breast Cancer Patients Receiving Anthracycline-Based Chemotherapy
National Cancer Centre Singapore|National University of Singapore|University of Warwick|Coventry (United Kingdom)|National Cancer Centre Singapore|National University of Singapore|University of Warwick|Coventry (United Kingdom)|National Cancer Centre Singapore|National University of Singapore|University of Warwick|Coventry (United Kingdom)
little prevalence data literature nonadherence outpatient antiemetic regimens prophylaxis chemotherapyinduced nausea vomiting cinv unclear whether adherence outpatient antiemetic regimens associated better cinv control previous survey research supports work clinical pharmacists collaborative practice medical oncologists improving adherence antiemetic therapy women undergoing highly emetic chemotherapy breast cancerto evaluate impact adherence delayed antiemetics days 24 following anthracyclinebased chemotherapy cinv control breast cancer patients anthracyclinebased chemotherapy b identify patientrelated factors associated nonadherence delayed antiemeticsa singlecenter prospective observational study conducted december 2006 january 2011 breast cancer patients receiving anthracyclinebased chemotherapy doxorubicin epirubicin antiemetics national cancer centre singapore nccs largest ambulatory cancer center singapore included patients aged 21 years older confirmed diagnoses breast cancer receiving anthracyclinecontaining chemotherapy antiemetics patients excluded diagnosed intestinal obstruction received concurrent radiotherapy predisposed nausea vomiting b vomited 24 hours preceding chemotherapy c brain metastases would impair judgment patients documented standardized diary emesis events severity nausea use rescue therapy metoclopramide compliance dose instructions antiemetic drug therapy 5 days day 1 day chemotherapy first day antiemetic therapy day 5 day completion delayed antiemetic therapy days 24 three definitions used describe cinv outcomes complete response emetic episodes rescue therapy b complete protection emetic episodes rescue therapy significant nausea likert score 2 less c complete control emetic episodes rescue therapy nausea delayed days 25 postchemotherapy phase endpoints analyzed nonadherence defined missing least 1 dose delayed antiemetics prescribed regimen pearson chisquare fishers exact tests multiple logistic regression analysis used assess relationship adherence cinv outcomesof 519 eligible patients 88 170 patients declined participation 35 67 lost followup another 35 67 excluded due absence therapy delayed antiemetics according guideline protocol 361 696 patients included final analysis mean sd age 500 89 majority chinese 801 diagnosed stage 2 higher breast cancer 881 total 152 patients 421 selfreported nonadherent use delayed antiemetics among nonadherent patients n152 164 n25 achieved complete control 342 n52 achieved complete protection 586 n89 achieved complete response compared rates 268 n56 397 n83 627 n131 respectively adherent patients n209 rate adherence dexamethasone prescribed study patients low 626 adjusting potential confounders ethnicity educational level disease stage adherent patients likely achieve complete control cinv adjusted odds ratio174 95 ci101301 p0048 among demographic cinv riskfactor variables higher education alcohol consumption prior exposure nonanthracyclinebased chemotherapy regimens associated nonadherence p 005although 42 breast cancer patients receiving anthracyclinebased chemotherapy nonadherent dose administration protocol postchemotherapy antiemetic therapy significant difference control cinv compared adherent patients except category complete cinv control defined nausea emesis use rescue medication metoclopramide