Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Int J Clin Oncol. 2013 Dec;18(6):971-6. doi: 10.1007/s10147-012-0477-6. Epub 2012 Sep 27.
Chemotherapy-induced nausea and vomiting (CINV) substantially affects patient quality of life. Although several guidelines have recommended the use of 5-hydroxytryptamine 3 (5HT3) receptor antagonists with glucocorticoids to alleviate acute CINV, studies in other countries have reported that these recommendations were often not followed. We aimed to assess antiemetic use in community practices just before the Japanese Guidelines for the Appropriate Use of Antiemetics were published.
Using the insurance claims submitted to a public insurance program that covers residents up to 75 years old operated by a city with a population of 250,000, we examined the concurrent use of 5HT3 receptor antagonists and glucocorticoids with high or moderate emetic risk chemotherapy.
Overall, 448 patients received high or moderate emetic risk chemotherapy 1,342 times during the study period. The recommended antiemetic therapy was provided in 61.9 % (95 % confidence interval 55.5-68.3 %) of the treated patients, but the moderate emetic risk chemotherapy group received the recommended antiemetic therapy less frequently than the high emetic risk chemotherapy group (55.5 vs. 82.1 %, P < 0.01). A multivariate analysis showed that the use of non-recommended antiemetics and high emetic risk chemotherapy were associated with the recommended antiemetic therapy. Breast and lung cancer patients receiving high emetic risk chemotherapy received the recommended antiemetics in 100 % of cases, while only 67 % of patients with other cancer types received the recommended antiemetics.
Despite several limitations associated with analysis of insurance claims, our study indicates that substantial room for improvement exists in the practice of preventing CINV.
化疗引起的恶心和呕吐（CINV）会极大地影响患者的生活质量。尽管有几项指南建议使用 5-羟色胺 3（5HT3）受体拮抗剂联合糖皮质激素来缓解急性 CINV，但其他国家的研究报告称，这些建议并未得到普遍遵循。我们旨在评估在日本适当使用止吐药物指南发布之前，社区实践中的止吐药物使用情况。
使用向一个覆盖 25 万人口城市的公共保险计划提交的保险索赔，我们检查了 5HT3 受体拮抗剂和糖皮质激素与高或中度致吐风险化疗的同时使用。
总体而言，448 名患者在研究期间接受了 1342 次高或中度致吐风险化疗。在接受治疗的患者中，推荐的止吐疗法在 61.9%（95%置信区间 55.5-68.3%）的患者中得到了提供，但中度致吐风险化疗组接受推荐的止吐疗法的频率低于高致吐风险化疗组（55.5 比 82.1%，P<0.01）。多变量分析显示，使用非推荐的止吐药物和高致吐风险化疗与推荐的止吐疗法有关。接受高致吐风险化疗的乳腺癌和肺癌患者接受推荐的止吐药物的比例为 100%，而其他癌症类型的患者仅接受推荐的止吐药物的 67%。
尽管对保险索赔的分析存在一些局限性，但我们的研究表明，在预防 CINV 的实践中仍有很大的改进空间。
