美国社区肿瘤实践中的止吐指南一致性和化疗引起的恶心和呕吐发生率：INSPIRE 研究。
Antiemetic guideline consistency and incidence of chemotherapy-induced nausea and vomiting in US community oncology practice: INSPIRE Study.
机构信息
Georgia Cancer Specialists PC, Atlanta, GA; Tennessee Oncology, Nashville, TN; St John's University, New York, NY; Cancer Specialists of North Florida, Jacksonville; Florida Cancer Specialists, Fort Myers, FL; Temple University, Philadelphia, PA; Merck & Co., Whitehouse Station, NJ.
出版信息
J Oncol Pract. 2014 Jan;10(1):68-74. doi: 10.1200/JOP.2012.000816. Epub 2013 Sep 24.
PURPOSE
Consensus guidelines for preventing chemotherapy-induced nausea and vomiting (CINV) are variably implemented in practice. The purpose of this study was to evaluate the impact of guideline-consistent/guideline-inconsistent CINV prophylaxis (GCCP/GICP) on the incidence of no CINV after cycle 1 of highly or moderately emetogenic chemotherapy (HEC or MEC).
PATIENTS AND METHODS
This prospective observational study enrolled chemotherapy-naive adult outpatients who received single-day HEC or MEC at four oncology practice networks, all using electronic health record (EHR) systems, in Georgia, Tennessee, and Florida. Results from the Multinational Association of Supportive Care in Cancer Antiemesis Tool, a validated tool to measure CINV, administered 5 to 8 days postchemotherapy, were merged with EHR data. The primary end point, no CINV, defined as no emesis and no clinically significant nausea (score < 3 on 0-10 scale), was compared between cohorts using logistic regression.
RESULTS
A total of 1,295 patients were enrolled (mean age, 59.3 years; 70.0% female; 35.5% HEC). The overall prevalence of GCCP was 57.3%. When corticosteroids were prescribed on days 2 to 4 after all HEC, GCCP for HEC increased from 28.7% to 89.8%; when NK1-receptor antagonists were prescribed after all MEC, GCCP for MEC increased from 73.1% to 97.8%. Over 5 days postchemotherapy, the incidence of no CINV was significantly higher in the GCCP cohort than the GICP cohort (53.4% v 43.8%; P < .001). The adjusted odds of no CINV with GCCP was 1.31 (95% CI, 1.07 to 1.69; P = .037).
CONCLUSION
Increased adherence to antiemetic guidelines could significantly reduce the incidence of CINV after HEC and MEC.
目的
预防化疗引起的恶心和呕吐（CINV）的共识指南在实践中执行情况各不相同。本研究的目的是评估与指南一致/不一致的 CINV 预防（GCCP/GICP）对高度或中度致吐性化疗（HEC 或 MEC）第 1 周期后无 CINV 发生率的影响。
患者和方法
这项前瞻性观察性研究纳入了在佐治亚州、田纳西州和佛罗里达州的四个肿瘤学实践网络接受单天 HEC 或 MEC 的化疗初治成年门诊患者，所有患者均使用电子健康记录（EHR）系统。使用多国支持性护理癌症止吐工具（Multinational Association of Supportive Care in Cancer Antiemesis Tool）的结果进行合并，该工具是一种用于测量 CINV 的经过验证的工具，在化疗后 5 至 8 天进行管理。使用逻辑回归比较队列之间的主要终点（无 CINV，定义为无呕吐和无临床显著恶心（0-10 评分<3））。
结果
共纳入 1295 例患者（平均年龄 59.3 岁；70.0%为女性；35.5%为 HEC）。GCCP 的总体流行率为 57.3%。当在所有 HEC 后第 2 至 4 天给予皮质类固醇时，HEC 的 GCCP 从 28.7%增加到 89.8%；当在所有 MEC 后给予 NK1 受体拮抗剂时，MEC 的 GCCP 从 73.1%增加到 97.8%。化疗后 5 天内，GCCP 组的无 CINV 发生率明显高于 GICP 组（53.4%比 43.8%；P<.001）。GCCP 时无 CINV 的调整后优势比为 1.31（95%CI，1.07 至 1.69；P=.037）。
结论
增加对止吐指南的依从性可以显著降低 HEC 和 MEC 后 CINV 的发生率。
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