Prophylactic use of antiemetics for prevention of opioid-induced nausea and vomiting: a web based online survey among Italian experts on supportive care in cancer

Abstract

Background: Antiemetics are being used both for the treatment and prophylaxis of opioid-induced nausea and vomiting (OINV) in clinical practice, despite the lack of evidence for the prophylactic benefit. Studies among Japanese physicians trained in cancer pain management demonstrated over 80% prescribe antiemetics, with neuroleptic antipsychotics (prochlorperazine 88%) as the most commonly prescribed drugs. The objective of this study was to evaluate the practice among Italian experts on supportive care in cancer of the prophylactic use of antiemetics when starting opioids prescription for OINV prevention. Material and methods: From January to March 2017, we carried out a web-based cross sectional national survey. The survey was created with the GoogleDocsTM online surveys maker (https://docs.google.com). All invited participants received e-mail with the 12-items electronic questionnaire that was only accessible through a direct link. The questionnaire assessed the physicians' practice and beliefs regarding the prophylactic antiemetics prescription when they start opioids in patients with cancer pain (7 items) and other demographics data (5 items). According to the exploratory intent of the survey, we did not predefine any formal statistical hypothesis or sample size. Results: 112/256 responded to the electronic questionnaire (ORR 43.7%): 54 medical oncologists, 16 anesthesiologists, 11 radiation/clinical oncologists, 5 internists, 2 geriatrics, 1 infectivologist, 1 general surgeon. 22 physicians declared no formal medical specialization. Responders were geographically evenly distributed among Italian areas and came from palliative care units (61), community hospitals (21), education hospitals (20) and comprehensive cancer centers (10). 45% prescribed prophylactic antiemetics at the beginning of opioid prescription, and the most commonly prescribed drug for this purpose were prokinetics such as metoclopramide and domperidone (84%), followed by 5-HT3 antagonists (8%), neuroleptic antipsychotics (6%), corticosteroids (2%). Among physicians who prescribed prophylactic antiemetics, 41 (82%) also prescribed antiemetics (prokinetics as well) for use as treatment at the occurrence of OINV. Conclusion: Italian physicians do not commonly prescribe prophylactic antiemetics for OINV. Unlike previous reported evidences, dopamine antagonists resulted the most commonly prescribed drugs. Prospective clinical trials are necessary to evaluate the real efficacy of this practice.