Pharmacist-led program improves management of refractory chemo-induced nausea, vomiting

Implementing a clinical pharmacist-led service program has led to the standardization and streamlining of refractory chemotherapy-induced nausea and vomiting (CINV) management in adult haematology and oncology clinics, reports a study.

“Enrollment resulted in a measurable reduction in nausea and/or vomiting for patients with refractory CINV,” the authors said.

This program, implemented at University of Wisconsin, US, was open to adult outpatients with refractory CINV. Pharmacists performed baseline and follow-up assessments; provided patient educations; and initiated, discontinued, and/or adjusted antiemetics as clinically necessary for all enrolled patients.

The authors conducted a retrospective chart review to describe the number of patients whose CINV improved through pharmacist intervention, effect of the program on antiemetic adherence, categorization of pharmacist interventions, and duration of patient enrollment.

Of the 46 patients enrolled between February 2019 and January 2020, 41 (89.1 percent) had an overall reduction in their nausea and vomiting from baseline. Eleven patients (23.9 percent) met the criteria for nonadherence to prescribed antiemetics at baseline, while all were adherent at unenrollment.

Overall, 111 pharmacist interventions were carried out, of which the most common was the addition of new breakthrough antiemetic, while the least common was dose escalation of a previously prescribed antiemetic. The average number of interventions made was 2.5 per patient.

Patients were enrolled in the intervention program for an average of 16.6 days and met with a pharmacist three times.

“CINV is a common and potentially debilitating adverse effect of chemotherapy,” said the authors, noting that refractory CINV can be difficult to control.