がん化学療法制吐剤の適正使用にむけた取り組み―新潟県立がんセンター新潟病院における急性期嘔吐対策の現状―

Abstract

We have been promoting proper antiemetic therapy for chemotherapy induced emesis based on antiemetic treatment guidelines.In doing this,we have formulated our own antiemetic usage criteria,and classified registered regimens according to emetic risk based on ASCO,MASCC and NCCN guidelines.We investigated the compatibility situation of currently registered regimens by assigning them either to a compatible group (antiemetic agent prescriptions for acute nausea and vomiting meeting the usage criteria) or a non-compatible group (prescriptions not meeting the usage criteria).Patients who had received chemotherapy were targeted for investigation of drug management and guidance records,and a comparison of the 2 groups was made regarding acute nausea and vomiting incidence.Regimens with a high emetic risk accounted for 57.3% of the total,the compatibility rate with the acute anti-emesis usage criteria was 36.3% and a large percentage of regimens with high emetic risk were in the non-compatible group (45.9%).Common deviations from the usage criteria in the non-compatible group were multiple doses of 5HT3 receptor antagonists and insufficient dosages of adrenal corticosteroids.Further,nausea and vomiting greater than grade 2 frequently occurred in this group,and this pattern became more evident as the emetic risk increased.We demonstrated that the improvement of antiemetic therapy based on the guidelines was effective in alleviating emetic risk and our findings indicated that there was a particular need for improvement of therapy for high emetic risk regimens.