Evaluation of anti-emetic use in chemotherapy-induced nausea and vomiting in a third-world country (Lebanon).

Rationale: In Lebanon, the appropriateness of anti-emetic use is questionable in large measure because of the absence of published multicentre trials.

Aim And Objectives: To evaluate the extent of appropriateness of anti-emetic use in patients on chemotherapy among several Lebanese hospitals. Appropriateness of chemotherapy-induced nausea and vomiting (CINV) prophylaxis was determined as per National Comprehensive Cancer Network guidelines.

Methods: A multicentre, cross-sectional study was conducted over a 3-month period. Data were collected from medical charts of cancer patients. The main outcome measure was to evaluate the appropriateness of prophylactic use of anti-emetics in CINV in terms of selected drug regimen, dosage and route of administration, and to investigate the role of several pre-specified variables (including hospital type and size, type of insurance coverage and patient-related factors) in influencing the appropriateness of anti-emetic practice.

Results: A total of 493 patients' forms were analysed. The median age was 58.8 ± 13.9 years, 290 (58.8%) patients were female. Around 211 (42.8%) patients received inappropriate anti-emetic regimen, and only 17 (6%) patients of those receiving appropriate regimen received the appropriate dose, and just 55 (19.5%) patients were treated for the appropriate duration. Factors that may affect the relative effectiveness of treatment were identified.

Conclusion: This study reflected substantial flaws in CINV prophylaxis practice in Lebanon which should alert health care professionals of the adverse consequences resulting from non-adherence to guidelines. Our study also highlighted areas for improvement and suggested recommendations in order to minimize patient risk and optimize safe and effective CINV management.