Background： Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting （CINV） at a national level in China or to assess how treatment regimens adhere to current...Background： Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting （CINV） at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods： We searched the China Health Insurance Research Association （CHIRA） Database to identify patients with cancer who were 〉 18 years old and received either moderately or highly emetogenie chemotherapy （MEC and HEC, respectively） between 2008 and 2012. Patients＇ characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results： Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC （59.4% vs. 81.3 %; P〈0.001）. The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group （P〈0.012）; however, a higher proportion received a mixed regimen containing eorticosteroids （P≤0.007）. Although more than half of the patients in the HEC group took three antiemeties to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group （both P〈0.001）. Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions： These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.展开更多
BACKGROUND A new,oral fixed dose combination of highly selective neurokinin-1 receptor antagonist,netupitant with 5HT3 receptor antagonist,netupitant and palonosetron(NEPA)was approved in India for prevention of chemo...BACKGROUND A new,oral fixed dose combination of highly selective neurokinin-1 receptor antagonist,netupitant with 5HT3 receptor antagonist,netupitant and palonosetron(NEPA)was approved in India for prevention of chemotherapy induced nausea and vomiting(CINV).AIM To assess effectiveness of NEPA in real-world scenario.METHODS We retrospectively assessed the medical records and patient dairies of adult patients who received highly emetogenic or moderately emetogenic chemotherapy(HEC/MEC)and treated with NEPA(Netupitant 300 mg+Palanosetron 0.50 mg)for prevention of CINV.Complete response(CR)was defined as no emesis or no requirement of rescue medication in overall phase(0 to 5 d),acute phase(0-24 h)and delayed phase(2 to 5 d).RESULTS In 403 patients included in the analysis,mean age was 56.24±11.11 years and 55.09%were females.Breast cancer(25.06%)was most common malignancy encountered.HEC and MEC were administered in 54.6%and 45.4%patients respectively.CR in overall phase was 93.79%whereas it was 98.01%in acute CINV and 93.79%in delayed CINV.Overall CR in HEC and MEC groups was 93.63%and 93.98%respectively.CR was more than 90%in different chemotherapy cycles except in group of patients of cycle 4 where CR was 88.88%.CONCLUSION NEPA is a novel combination that is effective in preventing CINV in up to 93%cases treated with highly emetogenic or moderately emetogenic chemotherapy.This study brings the first real-life evidence of its effectiveness in India population.展开更多
Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinica...Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinical studies on NK1-RAs have shown mixed results in reducing CINV risk. Most studies focused on the use of aprepitant (APR) and casopitant (CAS) in breast cancer patients receiving AC-type (doxorubicin and cyclophosphamide) chemotherapy. In this study, we compared the study design and clinical efficacies of these NK1-RAs in reducing CINV risk. Among the selected eight studies, 4 APR Randomized Controlled Trials (RCTs), 2 APR Observational Studies (OSs) and 2 CAS RCTs were identified. Patient-related characteristics such as the proportion of females (60.0% - 100.0%), age (46.5 - 59.5 years), histories of motion (5.6% - 47.0% in NK1-RA arms) and morning sicknesses (14.2% - 45.0% in NK1-RA arms) and types of antiemetic regimens;as well as chemotherapy-related characteristics such as the proportion of patients on AC chemotherapy (15.0% - 100.0%) varied greatly. In terms of efficacies, both APR and CAS improved overall CR and vomiting in majority of the studies. None of the studies, however, demonstrated that NK1-RA could provide adequate nausea control. To conclude, NK1-RAs are effective in improving vomiting and overall CR, but not useful in controlling nausea or attaining CC, the ideal CINV endpoint. A shift in paradigm is needed for future CINV research. As healthcare providers continue to strive for optimum CINV control in their patients, we hope this review can help them make better informed clinical decisions.展开更多
目的比较3种工具在肿瘤静脉化疗患者急性化疗相关恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)风险评估中的预测价值。方法采用便利抽样法,选取2022年1月至2022年12月在浙江省肿瘤医院肝胆胰肿瘤内科住院化疗的626例肿瘤...目的比较3种工具在肿瘤静脉化疗患者急性化疗相关恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)风险评估中的预测价值。方法采用便利抽样法,选取2022年1月至2022年12月在浙江省肿瘤医院肝胆胰肿瘤内科住院化疗的626例肿瘤患者为研究对象。应用Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型分别预测患者急性CINV发生,绘制受试者操作特征曲线,计算曲线下面积、敏感度、特异性和约登指数以比较其预测效能。结果最终纳入研究的患者有622例,有效率为99.36%。发生CINV的患者有318例,占比51.13%:其中2级及以上急性期CINV者18.17%(113/622)。使用3种工具对急性期CINV风险评估:Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型AUC分别为0.591、0.616、0.558,Dranitsaris评分系统敏感度最高、George团队的CINV风险预测工具特异性最高。结论肿瘤患者化疗后CINV发生率处于较高水平,Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型预测对国内肿瘤患者急性期CINV预测准确度略低,需构建本土化的、适用于多病种的标准化CINV风险评估模型。展开更多
目的探讨微信小程序在结直肠癌化疗患者出院后化疗相关性不良反应(chemotherapy–induced nausea and vomiting,CINV)自我管理及延续性护理中的应用与体会。方法采用非同期对照研究设计,选取2018年10月至2019年12月在中国科学院大学附...目的探讨微信小程序在结直肠癌化疗患者出院后化疗相关性不良反应(chemotherapy–induced nausea and vomiting,CINV)自我管理及延续性护理中的应用与体会。方法采用非同期对照研究设计,选取2018年10月至2019年12月在中国科学院大学附属肿瘤医院化疗的结直肠癌患者200例,2018年10月至2019年5月,采用传统纸质问卷随访,发放问卷162份,以回收有效问卷100例患者作为对照组,断档2019年8月~12月,采用微信小程序随访,系统推送问卷124份,以回收有效问卷100例患者作为观察组。比较两组患者CINV的发生情况及对医务人员的满意度情况。结果使用微信小程序随访后,患者CINV记录准确率及对医务人员的满意度均有提高,差异均有统计学意义(P<0.05)。结论通过微信小程序随访,能更准确、及时地了解患者对于CINV的发生情况,若发生严重不良反应,医护能通过私信进行指导干预,提高患者化疗后的生活质量及对医务人员的满意度,微信小程序随访更容易被患者接受,特别是年轻患者,值得临床应用。展开更多
基金supported by MSD Holding Co.,Ltd.The funding was only for the payment of using CHIRA database
文摘Background： Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting （CINV） at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods： We searched the China Health Insurance Research Association （CHIRA） Database to identify patients with cancer who were 〉 18 years old and received either moderately or highly emetogenie chemotherapy （MEC and HEC, respectively） between 2008 and 2012. Patients＇ characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results： Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC （59.4% vs. 81.3 %; P〈0.001）. The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group （P〈0.012）; however, a higher proportion received a mixed regimen containing eorticosteroids （P≤0.007）. Although more than half of the patients in the HEC group took three antiemeties to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group （both P〈0.001）. Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions： These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.
文摘BACKGROUND A new,oral fixed dose combination of highly selective neurokinin-1 receptor antagonist,netupitant with 5HT3 receptor antagonist,netupitant and palonosetron(NEPA)was approved in India for prevention of chemotherapy induced nausea and vomiting(CINV).AIM To assess effectiveness of NEPA in real-world scenario.METHODS We retrospectively assessed the medical records and patient dairies of adult patients who received highly emetogenic or moderately emetogenic chemotherapy(HEC/MEC)and treated with NEPA(Netupitant 300 mg+Palanosetron 0.50 mg)for prevention of CINV.Complete response(CR)was defined as no emesis or no requirement of rescue medication in overall phase(0 to 5 d),acute phase(0-24 h)and delayed phase(2 to 5 d).RESULTS In 403 patients included in the analysis,mean age was 56.24±11.11 years and 55.09%were females.Breast cancer(25.06%)was most common malignancy encountered.HEC and MEC were administered in 54.6%and 45.4%patients respectively.CR in overall phase was 93.79%whereas it was 98.01%in acute CINV and 93.79%in delayed CINV.Overall CR in HEC and MEC groups was 93.63%and 93.98%respectively.CR was more than 90%in different chemotherapy cycles except in group of patients of cycle 4 where CR was 88.88%.CONCLUSION NEPA is a novel combination that is effective in preventing CINV in up to 93%cases treated with highly emetogenic or moderately emetogenic chemotherapy.This study brings the first real-life evidence of its effectiveness in India population.
文摘Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinical studies on NK1-RAs have shown mixed results in reducing CINV risk. Most studies focused on the use of aprepitant (APR) and casopitant (CAS) in breast cancer patients receiving AC-type (doxorubicin and cyclophosphamide) chemotherapy. In this study, we compared the study design and clinical efficacies of these NK1-RAs in reducing CINV risk. Among the selected eight studies, 4 APR Randomized Controlled Trials (RCTs), 2 APR Observational Studies (OSs) and 2 CAS RCTs were identified. Patient-related characteristics such as the proportion of females (60.0% - 100.0%), age (46.5 - 59.5 years), histories of motion (5.6% - 47.0% in NK1-RA arms) and morning sicknesses (14.2% - 45.0% in NK1-RA arms) and types of antiemetic regimens;as well as chemotherapy-related characteristics such as the proportion of patients on AC chemotherapy (15.0% - 100.0%) varied greatly. In terms of efficacies, both APR and CAS improved overall CR and vomiting in majority of the studies. None of the studies, however, demonstrated that NK1-RA could provide adequate nausea control. To conclude, NK1-RAs are effective in improving vomiting and overall CR, but not useful in controlling nausea or attaining CC, the ideal CINV endpoint. A shift in paradigm is needed for future CINV research. As healthcare providers continue to strive for optimum CINV control in their patients, we hope this review can help them make better informed clinical decisions.
文摘目的比较3种工具在肿瘤静脉化疗患者急性化疗相关恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)风险评估中的预测价值。方法采用便利抽样法,选取2022年1月至2022年12月在浙江省肿瘤医院肝胆胰肿瘤内科住院化疗的626例肿瘤患者为研究对象。应用Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型分别预测患者急性CINV发生,绘制受试者操作特征曲线,计算曲线下面积、敏感度、特异性和约登指数以比较其预测效能。结果最终纳入研究的患者有622例,有效率为99.36%。发生CINV的患者有318例,占比51.13%:其中2级及以上急性期CINV者18.17%(113/622)。使用3种工具对急性期CINV风险评估:Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型AUC分别为0.591、0.616、0.558,Dranitsaris评分系统敏感度最高、George团队的CINV风险预测工具特异性最高。结论肿瘤患者化疗后CINV发生率处于较高水平,Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型预测对国内肿瘤患者急性期CINV预测准确度略低,需构建本土化的、适用于多病种的标准化CINV风险评估模型。
文摘目的探讨微信小程序在结直肠癌化疗患者出院后化疗相关性不良反应(chemotherapy–induced nausea and vomiting,CINV)自我管理及延续性护理中的应用与体会。方法采用非同期对照研究设计,选取2018年10月至2019年12月在中国科学院大学附属肿瘤医院化疗的结直肠癌患者200例,2018年10月至2019年5月,采用传统纸质问卷随访,发放问卷162份,以回收有效问卷100例患者作为对照组,断档2019年8月~12月,采用微信小程序随访,系统推送问卷124份,以回收有效问卷100例患者作为观察组。比较两组患者CINV的发生情况及对医务人员的满意度情况。结果使用微信小程序随访后,患者CINV记录准确率及对医务人员的满意度均有提高,差异均有统计学意义(P<0.05)。结论通过微信小程序随访,能更准确、及时地了解患者对于CINV的发生情况,若发生严重不良反应,医护能通过私信进行指导干预,提高患者化疗后的生活质量及对医务人员的满意度,微信小程序随访更容易被患者接受,特别是年轻患者,值得临床应用。
