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Supportive Care in Cancer

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01-07-2014 | Original Article

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

Authors: Mary Lou Affronti, Susan M. Schneider, James E. Herndon II, Susan Schlundt, Henry S. Friedman

Published in: Supportive Care in Cancer | Issue 7/2014

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.

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Title: Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice
Authors: Mary Lou Affronti
Susan M. Schneider
James E. Herndon II
Susan Schlundt
Henry S. Friedman
Publication date: 01-07-2014
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 7/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-014-2136-0

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