Electronic medical record (EMR) order sets, counseling, and complementary therapy for chemotherapy induced nausea/vomiting (CINV) control.

Abstract

e20698 Background: EMR order sets entry can standardize CINV therapy and reduce errors. EMR CINV control, impact of counseling and use of complementary therapies for nutrition and control of CINV are rarely reported. Methods: Patient interview regarding CINV, nutrition education, weight change, and use of other therapies for nutrition and nausea control. Patients initially medicated with parenteral short T1/2 5HT3 antagonist and dexamethasone and oral prochlorperazine. Antiemetics changed at physician discretion. Medical records review for chemotherapy, antiemetics, and weights. Interviews conducted by a research coordinator who did not counsel, prescribe, or treat the patients. Results: 79 patients participated after minimum 2 and maximum 6 cycles of chemotherapy, 24 males and 55 females, age range 38-87 years. 76/79 received moderately or highly emetogenic chemotherapy. 78/79 reported good control of CINV at the time of interview. 38/79 reported decrease in appetite or dysgeusia associated with chemotherapy. 7 patients had change short to long T1/2 5HT3 antagonist. 9 patients had oral aprepitant added. All patients were prescribed oral prochlorperazine and ondansetron, but home use was not assessed as part of the study. 77/79 recalled dietary counsel, but recollection of source and content was not consistent with curriculum or medical record. 8 patients had weight loss >10 pounds, 4 patients had weight gain >10 pounds during chemotherapy. 18 patients reported weight change at least 10 pounds different from measured change. 28/79 patients used calorie and/or protein supplements. 24/79 used ginger related products. 7/79 reported improvement in dysgeusia or appetite with use of plastic utensils. Conclusions: CINV control can be achieved for most patients with combination antiemetics prescribed by EMR order set. Some patients require additional or alterative therapy. A substantial number of patients access nutritive or complementary therapy for CINV control. Patients’ recall of dietary counseling was poor, possibly related to timing of education. Patient reports and possibly perception of chemotherapy associated weight changes are frequently inaccurate.