Antiemetic drugs overused prophylactically in low-risk chemo patients

Last Updated: 2016-11-09

By Anne Harding

NEW YORK (Reuters Health) - Prophylactic antiemetic drugs are widely prescribed to patients receiving chemotherapy that carries only a low risk of emesis, a new study shows.

While the study was conducted in Japan, overuse of these medications is likely a problem in the U.S. as well, Dr. Ayako Okuyama of the National Cancer Center in Tokyo told Reuters Health by email.

She noted that the American Society of Clinical Oncology recommends against using antiemetics when chemotherapy has a low or minimal risk of causing vomiting, and instead reserving them for high-risk regimens.

As reported online November 3 in JAMA Oncology, Dr. Okuyama and her team looked at insurance claims data from 122 cancer hospitals between September 2010 and December 2012 for patients prescribed chemotherapy with either low (n=6,081) or minimal (n=8,545) risk of emesis.

While only 2.8% of the patients in the minimal emesis risk group were prescribed serotonin receptor antagonists and dexamethasone, 47.8% of patients in the low-risk group were prescribed the drugs. In the low-risk group, outpatients were more likely to be given the two drugs (53.1% of chemotherapy doses) than inpatients (33.7% of chemotherapy doses).

The study could have overestimated prophylactic use of the drugs, Dr. Okuyama and her team note, because antiemetic treatment prescribed on the same day as therapy could have been prescribed therapeutically. On the other hand, they add, because the study did not look at oral antiemetic drugs prescribed in the days before chemotherapy started, it could have underestimated prophylactic use.

The researchers estimate that excess use of antiemetic medications among patients in their study cost 170 million yen (US$1.6 million).

"Prescribing unnecessary antiemetic drugs not only exposes patients to the risk for adverse effects but also produces an economic burden on the patients and the society," Dr. Okuyama told Reuters Health. "Judicious use of these drugs is important."

The next step in the research, she added, should be to identify reasons for and consequences of antiemetic overuse. "We believe monitoring the trends of prescribing these drugs will be important."

SOURCE: http://bit.ly/2fDMoGW

JAMA Oncol 2016.