Optimización de la terapia antiemética en pacientes oncológicos con tumores sólidos atendidos en el hospital de día de la Clínica Universidad de Navarra

Resumen

Optimization of antiemetic therapy in cancer patients receiving ambulatory chemotherapy at the University of Navarra Clinic María Ángeles García del Barrio. College of Pharmacy. University of Navarra. 2015 Chemotherapy-induced nausea and vomiting (CINV) is a major concern of antineoplastic treatment because of its high incidence, the patients¿ fear of experiencing them and clinicians¿ difficulty in assessing it properly, mainly in the delayed phase (days 2 to 5). The availability of new antiemetic drugs and the update of the Antiemesis Guidelines, has made imperative a review of the institutional protocols employed to prevent these effects. To analyze and promote changes, we have to establish the real efficacy of the protocol actually used. A prospective recruitment of 157 ambulatory patients showed a global incidence of emesis (nausea and/or vomiting-NV) of 28%. Only 11% of the patients suffered from vomiting; nausea was the major symptom (27%). Twenty one patients (13%) had NV in the first 24 hours after treatment and 43 (27%) at the delayed phase. The majority of them (98%) had received prophylaxis before chemotherapy, while health professionals underestimated the risk during days 2 to 5, with 22% of the patients without antiemetics. The apparition of acute symptoms was a main prognostic factor for delayed emesis, increasing the risk of NV at that period (OR 23). The emetogenicity level of the antineoplastic agents was relevant, with the highly emetogenic chemotherapy (HEC) as the principal cause of symptoms. The most implicated cytostatics were cisplatin, anthracycline-cyclophosphamide combination (AC) and irinotecan. Emetogenicity attributed to cisplatin was dose-depended and the patients who receive ≥ 50 mg/m² had more incidence of CINV. Irinotecan proved to be more emetogenic than its usual classification as moderate indicates. The results about AC combination were in consonance with its actual classification on the Antiemetic Guidelines as HEC. Some prognosis factors that remained at the multivariable regression model for emesis were: diagnosis of esophageal-gastric cancer, AC or irinotecan employment, patients¿ expectations regarding emesis ≥3, CINV antecedents and neoadjuvant intention of treatment. Patients¿ expectations of emesis were a good parameter to assess the impact of subjective factors, since it was related to others as individual susceptibility for emesis, insomnia, anxiety-depression level or NV related to meals. Seventy per cent of the patients with CINV felt this influenced their quality of life (iQoL) and nausea was the main symptom implicated (74% vs 50% cause by vomiting). The duration of the symptoms was relevant and the patients who had CINV for 2 days or more, demonstrated an increased risk of iQoL (OR 30). When nausea grade was ≥2, the probability for the patients to see affected their daily life activities was greater. Adverse events reported by the patients included fatigue, constipation, somnolence, insomnia and nervousness. Fatigue was probably related to the disease and the effect of chemotherapy treatment; constipation was linked to 5HT3-antagonist employ and insomnia-nervousness was an effect of corticosteroid therapy. With the results obtained it has been possible to establish some improvement proposals on antiemetic therapy.