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Impact of adherence to antiemetic guidelines on the incidence of chemotherapy-induced nausea and vomiting and quality of life

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Abstract

Background International guidelines are tools enabling physicians to incorporate the latest evidence based clinical information into practice. Objective This study aimed to evaluate the impact of antiemetic guidelines adherence on the incidence of chemotherapy-induced nausea and vomiting (CINV) and patient quality of life. Setting Marmara University Pendik Training and Research Hospital chemotherapy unit, Istanbul, Turkey. Method The study included 100 chemotherapy naive patients. Antiemetic prescribing patterns and their consistency with MASCC/ESMO 2014 guidelines were assessed. Patients recorded incidences of vomiting in a daily dairy and described their nausea using a 7-item Likert Scale. The incidence of CINV was recorded over five days. To assess the patient's quality of life, a modified Turkish version of the Functional Living Index-Emesis (FLIE) questionnaire was administered before and after receiving chemotherapy. A questionnaire on the existence and severity of side effects was developed and administered. Main outcome measures Incidence of side effects on CINV and quality of life according to the FLIE. Results The primary outcome revealed differences in complete control (no emetic episodes, rescue therapy or nausea), FLIE scores and side effects. Guidelines consistency was observed more with acute (A) than with delayed (D) prevention of CINV, with significant differences in complete control between the guideline adherent group (GAG) and the guideline nonadherent group (GNG). Significant differences in the FLIE score were noticed between GAG(D) and GNG(D), and GNG(D) had a higher incidence of diarrhoea, headache, swallowing difficulties and dark-coloured stool. Conclusion Consistency with guidelines resulted in significant reduction in the incidence of both cute and delayed CINV and other side effects, and with improvement of the patient quality of life.

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Acknowledgements

The authors are grateful to Merve Sarı who assisted in identifying patients.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, School of Pharmacy, Istanbul Kemerburgaz University, Istanbul, Turkey

    Nibal Abunahlah

  2. Department of Clinical Pharmacy, School of Pharmacy, Marmara University, Istanbul, Turkey

    Nibal Abunahlah & Mesut Sancar

  3. Department of Internal Medicine, Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey

    Faysal Dane

  4. Molecular Medicine Department, Division of Hospital Management, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey

    Mustafa Kerem Özyavuz

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  1. Nibal Abunahlah
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Appendix

Appendix

Functional Living Index-EMESIS (English Version)

The Functional Living Index-Emesis (FLIE) is an emesis-specific questionnaire with 18 questions answered on a scale of 1–7. The FLIE can be divided into nausea- and vomiting-specific questions. A FLIE nausea summary score was determined by totalling the responses to the first 9 questions, and a FLIE vomiting summary score by totalling the responses to the last 9 questions. The FLIE includes 1 question that specifically asks about nausea and 1 that specifically asks about vomiting; the other questions assess how nausea and vomiting are interfering with the patient’s daily life. A lower score represents increased symptoms or worse quality of life (QoL). Patients completed the FLIE at baseline and at days 5 after completion of first chemotherapy cycle.

figure a
figure b

Fonksiyonel Yaşam ölçeği-Emesis(Turkish Version)

Fonksiyonel Yaşam Endeksi-Kusma (FlIE) 1–7 bir ölçekte cevap 18 soru ile bir kusma özgü bir ankettir. FLIE bulantı- ve kusma-spesifik sorulara ayrılabilir. Bir FlIE bulantı özeti skoru ilk 9 soruların yanıtları toplam belirlenir ve son 9 soruların yanıtları toplam bir FlIE kusma özeti puan aldı. FlIE özellikle bulantı ve kusma özellikle sorar yaklaşık 1 sorar 1 soru içerir; Diğer sorular mide bulantısı ve kusma hastanın günlük yaşam müdahale nasıl değerlendirmek. Düşük puan artan belirtiler ya da yaşam (YK) daha kötü kalitesini temsil eder. Hastalar ilk kemoterapi devrinin tamamlanmasından sonra 5 başlangıçta ve gün FlIE tamamladı.

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Abunahlah, N., Sancar, M., Dane, F. et al. Impact of adherence to antiemetic guidelines on the incidence of chemotherapy-induced nausea and vomiting and quality of life. Int J Clin Pharm 38, 1464–1476 (2016). https://doi.org/10.1007/s11096-016-0393-3

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