Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice.

Abstract

PURPOSE:

A quality improvement project was implemented to improve adherence to evidence-based antiemetic guidelines for malignant glioma patients treated with moderately emetic chemotherapy (MEC). Poorly controlled chemotherapy-induced nausea and vomiting (CINV) reduce cancer treatment efficacy and significantly impair cancer patients' quality of life (QOL). A review of Duke University Preston Robert Tisch Brain Tumor Center (PRTBTC)'s usual practice demonstrates a high incidence (45%) of CINV, despite premedication with short-acting 5-HT3-serotonin-receptor antagonists (5-HT3-RAs). National Comprehensive Cancer Network (NCCN)'s evidence-based guidelines recommend the combination of the long-acting 5-HT3-RA palonosetron (PAL) and dexamethasone (DEX) for the prevention of acute and delayed CINV with MEC. Low adherence (58%) to antiemetic guidelines may have explained our high CINV incidence.

METHODS:

One-sample binomial test, quasi-experimental design, evaluated a combination intervention that included a provider education session; implementation of risk-assessment tool with computerized, standardized antiemetic guideline order sets; and a monthly audit-feedback strategy. Post-implementation adherence to evidence-based antiemetic order sets and patient outcomes were measured and compared to baseline and historical data. Primary outcome was the guideline order set adherence rate. Secondary outcomes included nausea/vomiting rates and QOL.

RESULTS:

Adherence to ordering MEC guideline antiemetics increased significantly, from 58% to a sustained 90%, with associated improvement in nausea/vomiting. In acute and delayed phases, 75 and 84% of patients, respectively, did not experience CINV. There was no significant change in QOL.

CONCLUSION:

Combination intervention and audit-feedback strategy to translate evidence into oncology practice improved and sustained adherence to antiemetic guidelines. Adherence corresponded with effective nausea/vomiting control and preserved QOL in patients with malignant gliomas.

• Authors: Mary Lou Affronti, Susan M Schneider, James E Herndon 2nd, Susan Schlundt, Henry S Friedman
• Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (Support Care Cancer) Vol. 22 Issue 7 Pg. 1897-905 (Jul 2014) ISSN: 1433-7339 [Electronic] Germany
• PMID: 24570103 (Publication Type: Journal Article)

Chemical References

• Antiemetics
• Antineoplastic Agents
• Isoquinolines
• Quinuclidines
• Serotonin 5-HT3 Receptor Antagonists
• Palonosetron
• Dexamethasone

Topics

• Adult
• Antiemetics (administration & dosage)
• Antineoplastic Agents (adverse effects, therapeutic use)
• Brain Neoplasms (drug therapy)
• Dexamethasone (administration & dosage)
• Female
• Glioblastoma (drug therapy)
• Humans
• Isoquinolines (administration & dosage)
• Male
• Medication Adherence
• Middle Aged
• Nausea (chemically induced, drug therapy, prevention & control)
• Neoplasms (drug therapy)
• Palonosetron
• Quality of Life
• Quinuclidines (administration & dosage)
• Serotonin 5-HT3 Receptor Antagonists (administration & dosage)
• Translational Research, Biomedical
• Treatment Outcome
• Vomiting (chemically induced, drug therapy, prevention & control)