Are Antiemetic Prophylactics Being Overprescribed for Chemotherapy?
Results from a secondary analysis indicate that a "substantial number of patients receiving chemotherapy with minimal and low emetic risk were prescribed potentially unnecessary prophylactic emetic drugs," according to study author Ayako Okuyama, RN, PHN, PhD. The full findings are published in JAMA Oncology.
Not many studies have looked at antiemetic prophylaxis or treatment associated with chemotherapy with lower emetic risk. The use of these agents for patients receiving chemotherapy with low or minimal emetic risk has been raised as a concern for healthcare costs and patients' welfare.
In order to characterize the pattern of overprescribing prophylactic antiemetics to patients who have received intravenous (IV) chemotherapy with minimal or low emetic risk, Dr. Okuyama and colleagues conducted a secondary analysis of a health insurance claims database in Japan. The database was linked to the hospital-based cancer registry spanning September 1, 2010 to December 31, 2012. Included patients were diagnosed with breast, lung, colorectal, stomach, cervical, or prostate cancer, were ≥20 years old at the time of diagnosis, and received IV chemotherapy with minimal or low emetic risk.
The study's main outcome was the percentage of chemotherapy administration that involved patients being prescribed prophylactic antiemetics: neurokinin 1 receptor antagonist, serotonin receptor antagonist, and/or dexamethasone.
Study authors identified a total of 8,545 patients undergoing 73,577 administrations of chemotherapy with minimal or low emetic risk. Of the total, 47.8% of the chemotherapy with a low emetic risk group and 2.8% of the chemotherapy with minimal emetic risk group were prescribed serotonin receptor antagonists and dexamethasone. Further, outpatients in the low emetic risk group had more frequent administration of chemotherapy that included prescription of both drugs compared to inpatients (53.1% vs. 33.7%). The study authors also calculated a cost of approximately $1.6 million for antiemetic prophylaxis for these patients.
Dr. Okuyama added, "The judicious use of these drugs could spare the burden of extra costs and the potential risk for adverse effects for patients."
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