Adherence to recommendation for chemotherapy induced nausea and vomiting prophylaxis: the proposal of a score
Dear editor, We have read with great interest the article of Burmeister et al. [1] dealing with adherence to recommendation for chemotherapy induced nausea and vomiting (CINV) prevention; through extensive analysis of a large cohort of patients undergoing conventional dose chemotherapy, the article provides interesting data both on single center adherence to guidelines. On this regard, in particular on adherence assessment, we believe we could provide some interesting elements, proposing an original assessment method, developed and applied in our center as part of an internal survey, in the setting of high dose chemotherapy and hemopoietic stem cell transplant (HSCT) [2] In the paper of Burmeister et al. "Adherence failure was defined (a) if a recommended antiemetic was not prescribed, (b) if the recommended dose level was not reached, or (c) if a nonrecommended antiemetic was prescribed" [1] thus distinguishing guidelines consistent CINV prophylaxis and guidelines inconsistent CINV prophylaxis regimens. In our opinion, the use of such a criterion does not allow to adequately define characteristics of a prophylaxis regimen, summarized by two features: (1) the probability of efficiency reduction (due to undertreatment) and (2) the risk of side effect increase (due to overtreatment) compared with a fully guidelines adherent scheme. As part of a survey on the CINV prevention, we recently analyzed the prophylactic regimens used by each of six transplant centers of the Rome Transplant Network, and we observed both great heterogeneity and low guidelines consistency [2] partially justified by the many obstacles to CINV management in the setting of HSCT [3] So, we realized that, to meet the need of identifying priorities for corrective action, it was crucial to develop a score that could assess and quantify both undertreatment (frequently reported as a cause of inconsistency of CINV prophylaxis [1, 2] and overtreatment. Therefore, we developed a multistep procedure (Table 1) allowing to identify two different scores for each given regimen: side effect score (SEs) and effectiveness reduction score (ERs) Fully adherent regimens have both ERs and SEs equal to 0; overtreatment or undertreatment will be quantified with a A. Tendas P. Niscola L. Cupelli :A. D'Apolito T. Dentamaro P. de Fabritiis Hematology, S. Eugenio Hospital, Rome, Italy
Supportive Care in Cancer