Characterizing and assessing antiemetic underuse in patients initiating highly emetogenic chemotherapy

Background Patients initiating highly emetic chemotherapy (HEC) are at a 90% risk of chemotherapy-induced nausea and vomiting (CINV). Despite guideline-concordant antiemetic prescribing preventing CINV in up to 80% of patients, studies suggest that guideline-concordant antiemetic regimen use by pati...

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Bibliographic Details
Published in:Supportive care in cancer 2019-12, Vol.27 (12), p.4525-4534
Main Authors: Mahendraratnam, Nirosha, Farley, Joel F., Basch, Ethan, Proctor, Amber, Wheeler, Stephanie B., Dusetzina, Stacie B.
Format: Article
Language:English
Subjects:
Antiemetics
Cancer
Chemotherapy
Clinical practice guidelines
Gastrointestinal agents
Health behavior
Medical colleges
Medicine
Medicine & Public Health
Nausea
Nursing
Nursing Research
Oncology
Oncology, Experimental
Original Article
Pain Medicine
Prescription writing
Rehabilitation Medicine
Vomiting
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Summary:Background Patients initiating highly emetic chemotherapy (HEC) are at a 90% risk of chemotherapy-induced nausea and vomiting (CINV). Despite guideline-concordant antiemetic prescribing preventing CINV in up to 80% of patients, studies suggest that guideline-concordant antiemetic regimen use by patients initiating HEC is sub-optimal. However, these studies have been limited to single-site or single-cancer type with limited generalizability. The objective of this study was to describe antiemetic fill regimens and to assess predictors of underuse in the USA. Methods Our study population was adult patients under the age of 65 with cancer initiating intravenous HEC between 2013 and 2015 with employer-sponsored insurance in the IBM Watson/Truven MarketScan Commercial Claims database ( N  = 31,923). Descriptive statistics were used to explain antiemetic prescribing patterns, including antiemetic underuse. Modified Poisson regression was used to identify factors associated with antiemetic underuse. Results Among individuals initiating HEC, 49% underused guideline-concordant antiemetics. Most classified as under-using lacked an NK1 fill. While dexamethasone and 5HT3A uptake was over 80%, olanzapine use was minimal. Having lower generosity for prescription and medical benefits (paying more versus less than 20% out-of-pocket) increased the underuse risk by 3% and 4% (RR,1.03; 95% CI,1.01–1.05; P  = 0.01 and RR,1.04; CI, 1.00–1.09; P  = 0.03), respectively. Additionally, compared to receiving chemotherapy in the physician office setting, patients were at a 28% (RR, 1.28; 95% CI, 1.25–1.30; P  
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-019-04730-3