ArticleSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2019
Characterizing and assessing antiemetic underuse in patients initiating highly emetogenic chemotherapy.
Article in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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11 citing papers in PubMed, 19 citations in OpenAlex.
- Structural Inequalities in Ambulatory Care: A Scoping Review of Access and Quality and the Neglected Dimension of Patient Safety.International journal of environmental research and public health · 2026Article
- Psychosocial predictors of chemotherapy-induced nausea and vomiting among chemotherapy-naïve cancer patients: a prospective multicenter cohort study.Journal of cancer survivorship : research and practice · 2026Article
- Infusion therapy patient outcomes are similar at reduced costs in alternative sites of care compared with hospital outpatient departments: A matched cohort analysis of infusion therapy across multiple chronic conditions.Journal of managed care & specialty pharmacy · 2026Article
- Real-World Determinants of Olanzapine Prescribing for Antiemetic Prophylaxis in Adults Receiving Highly-Emetogenic Chemotherapy.Hospital pharmacy · 2025Article
- Prior Authorization, Quantity Limits, and Step Therapy for Patient-Administered Antiemetics.JAMA network open · 2025Article
- Assessing the Validity of the Centers for Medicare & Medicaid Services Measure in Identifying Potentially Preventable Emergency Department Visits by Patients With Cancer.JCO oncology practice · 2025Article
- Serious Gaming for Chemotherapy-Induced Nausea and Vomiting in Older Adults With Cancer: Protocol for a Randomized Clinical Trial.JMIR research protocols · 2024Article
- Financial Burden of Drugs Prescribed for Cancer-Associated Symptoms.JCO oncology practice · 2022Review
- Effectiveness of a phone-based nurse monitoring assessment and intervention for chemotherapy-related toxicity: A randomized multicenter trial.Frontiers in oncology · 2022Article
- Unplanned emergency department visits and hospital admissions of older adults under treatment for cancer in the ambulatory/community setting.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2021Article
- Emergency Department Visits for Emesis Following Chemotherapy: Guideline Nonadherence, OP-35, and a Path Back to the Future.The oncologist · 2021Article
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPatients initiating highly emetic chemotherapy (HEC) are at a 90% risk of chemotherapy-induced nausea and vomiting (CINV). Despite guideline-concordant antiemetic prescribing preventing CINV in up to 80% of patients, studies suggest that guideline-concordant antiemetic regimen use by patients initiating HEC is sub-optimal. However, these studies have been limited to single-site or single-cancer type with limited generalizability. The objective of this study was to describe antiemetic fill regimens and to assess predictors of underuse in the USA.
methodsOur study population was adult patients under the age of 65 with cancer initiating intravenous HEC between 2013 and 2015 with employer-sponsored insurance in the IBM Watson/Truven MarketScan Commercial Claims database (N = 31,923). Descriptive statistics were used to explain antiemetic prescribing patterns, including antiemetic underuse. Modified Poisson regression was used to identify factors associated with antiemetic underuse.
resultsAmong individuals initiating HEC, 49% underused guideline-concordant antiemetics. Most classified as under-using lacked an NK1 fill. While dexamethasone and 5HT3A uptake was over 80%, olanzapine use was minimal. Having lower generosity for prescription and medical benefits (paying more versus less than 20% out-of-pocket) increased the underuse risk by 3% and 4% (RR,1.03; 95% CI,1.01-1.05; P = 0.01 and RR,1.04; CI, 1.00-1.09; P = 0.03), respectively. Additionally, compared to receiving chemotherapy in the physician office setting, patients were at a 28% (RR, 1.28; 95% CI, 1.25-1.30; P < 0.0001) higher underuse risk in the outpatient hospital setting.
conclusionAntiemetic underuse is high in patients initiating HEC, potentially leading to avoidable CINV events. We found that insurance generosity has a minimal effect on antiemetic guideline concordance in this population, suggesting discordance may be the result of site of care as well as gaps in provider knowledge or accountability.
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