Evaluation of Antiemetic Drugs use in Chemotherapy Breast Cancer Patients at Sawanpracharak Hospital
Keywords:
Chemotherapy-induced nausea and vomiting, Adverse event severity assessment criteria, Antiemetic drugsAbstract
Objective: To evaluate the effectiveness of antiemetic regimens not aligned with the guidelines of the National Comprehensive Cancer Network (NCCN) compared to guideline-recommended regimens in breast cancer patients receiving chemotherapy.
Methods: This prospective cohort study was conducted on breast cancer patients undergoing chemotherapy with a regimen containing cyclophosphamide and doxorubicin. The study assessed the occurrence of acute (0–24 hours) and delayed (24–120 hours) nausea and vomiting post-chemotherapy. The severity of nausea and vomiting was evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Patients were divided into two groups: the study group, receiving non-guideline antiemetic regimens, and the control group, receiving NCCN Guideline version 1.2024 recommended regimens. Data were collected from patient records from September 2023 to February 2024. Descriptive statistics, including mean, standard deviations, and percentage were used alongside inferential statistics such as Independent t-test, Chi-square test and Fisher’s exact test to compare outcomes between groups. Statistical significance was set at a p-value of less than 0.05.
Results: The study group demonstrated significantly higher rates of acute nausea (100%), acute vomiting (92%), delayed nausea (92%), and delayed vomiting (88%) compared to the control group, which showed rates of 76%, 48%, 8%, and 4%, respectively (p-values: 0.02, <0.01, <0.01, <0.01). The cumulative incidence of nausea over the 0–120-hour period was 100% in the study group and 76% in the control group (p-value <0.01). Similarly, the cumulative incidence of vomiting was 92% in the study group compared to 52% in the control group (p-value <0.01). Among the study group, 17 patients experienced grade 2 acute nausea, while 12 and 5 patients experienced grade 2 and grade 3 acute vomiting, respectively. No grade 2 or grade 3 symptoms were observed in the control group.
Conclusion: Antiemetic regimens recommended by NCCN guidelines were more effective in preventing both acute and delayed nausea and vomiting compared to non-guideline-based regimens.
Keywords: Chemotherapy-induced nausea and vomiting, Adverse event severity assessment criteria, Antiemetic drugs
References
สถาบันมะเร็งแห่งชาติ. ทะเบียนมะเร็งระดับโรงพยาบาล พ.ศ.2565 [อินเตอร์เน็ต]. กรุงเทพฯ: สถาบันมะเร็ง; 2567 [เข้าถึงเมื่อ 4 ต.ค.2567]. เข้าถึงได้จาก: https://www.nci.go.th/th/cancer_record/download/Hosbased-2022-1.pdf
ทักษิณ จันทร์สิงห์. 50 ปี กับยาต้านอาเจียนที่ใช้ในคลื่นไส้อาเจียนจากยาเคมีบำบัด. วารสารเภสัชศาสตร์อีสาน. 2562;15(1):1-20.
สุธาร จันทะวงศ์. การป้องกันภาวะคลื่นไส้อาเจียนจากยาเคมีบำบัด. ศรีนครินทร์เวชสาร. 2562;34(1):115-26.
National Comprehensive Cancer Network [Internet]. Antiemesis (Version 1.2024). [cited 2024 Jan 16]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf
Yeo W, Ngai NT, Yip CC, Mo FK, Yeo VA, Ko JW, et al. Risk Factors Associated with Chemotherapy-Induced Nausea and Vomiting Among Women with Breast Cancer Receiving Highly Emetogenic Chemotherapy: Individual Patient-Based Analysis of Three Prospective Antiemetic Trials. Cancer Manag Res. 2024;16:283-97.
ทักษิณ จันทร์สิงห์, ปิยชาติ ไวทยกุล, สุธีรา ประเสริฐทรัพย์, วรรณคล เชื้อมงคล. ผลการใช้ยาป้องกันอาการคลื่นไส้อาเจียนแบบเฉียบพลัน ในผู้ป่วยที่ได์รับยาเคมีบําบัด ณ โรงพยาบาลสวรรค์ประชารักษ์. วารสารไทยเภสัชศาสตร์และวิทยาการสุขภาพ. 2557;4(1):52-9.
National Cancer Institute [Internet]. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. [cited Jul 16]. Available from: https://www.eortc.be/services/doc/ctc/ctcae_4.03_2010-06-14_quickreference_5x7.pdf
Sukudom A. Comparison among 3 Antiemetics in Preventing Acute Vomit Symptom of Breast Cancer Patients Treated with FAC Regimen Chemotherapy in Chaiyaphum Hospital. Chaiyaphum medical journal. 2015;35:19-30.
G*power [Internet]. Germany: Heinrich-Heine-Universität Düsseldorf; c2023 [cited 2023 Sep 1]. Available from: https://www.psychologie.hhu.de/arbeitsgruppen/allgemeine-psychologie-und-arbeitspsychologie/gpower
Tienchaianada P, Nipondhkit W, Maneenil K, Sa-nguansai S, Payapwattanawong S, Laohavinij S, A randomized, double-blind, placebo-controlled study evaluating the efficacy of combination olanzapine, ondansetron and dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients receiving doxorubicin plus cyclophosphamide. Ann Palliat Med. 2019;8(4):372-80.
ItimakinS, Theeratrakul P, Laocharoenkiat A, Nimmannit A, Akewanlop C, Soparattanapaisarn N. Randomized, double-blind, placebo-controlled study of aprepitant versus two dosages of olanzapine with ondansetron plus dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients receiving high-emetogenic chemotherapy. Support Care Cancer. 2020;28:5335-42.
Clemons M, Dranitsaris G, Sienkiewicz M, Sehdev S, Ng T, Robinson A, et al. A randomized trial of individualized versus standard of care antiemetic therapy for breast cancer patients at high risk for chemotherapy-induced nausea and vomiting. The Breast. 2020;54:278-85.
Navari RM, Qin R, Ruddy KJ, Liu H. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med. 2016; 375:134-42.
Aapro M, Molassiotis A, Dicato M, Peláez I, Rodríguez-Lescure Á, Pastorelli L, et al. The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER). Ann Oncol. 2012;23(8):1986-92.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Region 3 Medical and Public Health Journal - วารสารวิชาการแพทย์และสาธารณสุข เขตสุขภาพที่ 3
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
