To analyse the effectiveness of an antiemetic protocol in patients receiving chemotherapy treatment.
MethodProspective study in patients with solid tumours receiving chemotherapy in an oncology day hospital between January 2006 and 2007. We conducted a literature review and an evaluation of the recommendations of different clinical practice guidelines. The emetogenic potential was calculated according to the Hesketh level (HL), and the antiemetic premedication was determined for each regimen. We evaluated the effectiveness of an antiemetic protocol by using a survey as a method for measuring emetic episodes and nausea in the acute and delayed phases.
Results172 patients completed the survey. 13.4% vomited in the acute phase and 16.9% in the delayed phase; the median number of times was 2 (1–8) and 1 (1–5) for each respective phase. With treatment regimens classed as HL 4–5, 18.5% experienced vomiting in the acute phase and 20.2% in the delayed phase, with 46% experiencing nausea in the acute phase and 38.4% in the delayed phase. Control of vomiting in patients with treatment regimens classed as HL 1–3 was 100% in acute phase and 91.7% in the delayed phase; nausea was reported by 27% in the acute phase and 31% in the delayed phase. The factors that contributed the most to the presence of vomiting and nausea were the emetogenic potential of the treatment regimen (P<.05), vomiting in the previous cycle (P<.05) and age younger than 50 years (P<.002).
DiscussionThe proposed antiemetic protocol is effective for controlling vomiting in chemotherapy regimens with an HL of 1–3. For highly emetogenic regimens, the antiemetic protocol is also effective, but protection is not complete. This protocol seems less effective for controlling nausea, although this is a subjective symptom which is difficult to assess and not routinely measured in clinical trials.
Analizar la efectividad de un protocolo antiemético en pacientes que reciben quimioterapia.
MétodoEstudio prospectivo en pacientes con tumores sólidos con quimioterapia en el hospital de día de Oncología entre enero 2006–2007.
Se realizó una revisión bibliográfica analizando las recomendaciones de guías de práctica clínica. Se calculó el potencial emetógeno según nivel Hesketh (NH), estableciendo la premedicación antiemética de cada esquema. Se evaluó la efectividad de un protocolo antiemético mediante una encuesta como método de medida de episodios eméticos y náuseas en fase aguda y retardada.
ResultadosCiento setenta y dos pacientes cumplimentaron la encuesta, 13,4% vomitaron en fase aguda y 16,9% en retardada, mediana número de veces 2 (1–8) y 1 (1–5) respectivamente. Con esquemas NH 4–5 18,5% experimentaron vómitos en fase aguda y 20,2% en retardada; náuseas en fase aguda 46% y 38,4% en retardada. El control de vómitos en pacientes con esquemas NH=1–3 fue del 100% en fase aguda y de 91,7% en retardada; notificaron náuseas un 27% en fase aguda y 31% en retardada. Los factores que más contribuyeron a la presencia de vómitos y náuseas fueron potencial emetógeno (p<0,05), vómitos en ciclo anterior (p<0,05) y edad < 50 (p<0,002).
DiscusiónLa pauta propuesta es eficaz en el control de vómitos para esquemas NH = −3. En esquemas altamente emetógenos, el protocolo antiemético es también eficaz aunque la protección no es completa. Este protocolo parece no ser tan efectivo en el control de náuseas, aunque éste es un síntoma subjetivo de valoración compleja que no se mide de forma sistemática en ensayos clínicos.
This work has been partially presented as a brief presentation (poster) to the Spanish Society of Hospital Pharmacists (SEFH). Málaga, September 28th, 2006.
