Chemotherapy Induced Nausea and Vomiting (CINV) in the Αsia-Pacific (ΑΡ) Region – The Australian Perspective from the Ρan-Australasian Chemotherapy Induced Emesis Study (PrACTICE) (#104)
Background: There are limited data on CINV in AP, which had diverse healthcare systems and standards of care. This prospective, observational study of highly and moderately emetogenic chemotherapy (HEC/MEC) in 648 chemotherapy-naive adults from 6 AP countries enrolled 74 Australian subjects with mean age 60.8 years and 74.3% female (other countries, 54.9 years and 57%).
Methods: Primary objective was to estimate country-specific percentages of patients with complete response (CR): no emesis and no rescue medication use in overall phase (0-120 hours) during cycle 1 by regimen emetogenicity. Most common regimens included AC (26/42; 61.9%) for HEC, and carboplatin-based (18/32; 56.3%) for MEC. Australian results are presented.
Results: CR was 55.4% (CI:43.4,67.0) for Australia for overall phase (78.4% in other countries). Significant differences between countries were observed for overall and delayed phase (each p<0.001) and not for acute phase (p=0.855).
During overall phase, ‘no emesis’ significantly differed between countries (p<0.001). Australia had highest emesis control with 91.9% (68/74). In both HEC and MEC, incidence of anticipatory nausea was the same (9.1%) with similar incidence of clinically significant anticipatory nausea (5.0%,4.5%, respectively). Australia had the fewest non-drinkers (35.1%) vs. other countries (86.9%).
Chemotherapy was only given on an outpatient basis in Australia and Singapore. In China, 85.0% was given on inpatient basis. Highest usage of rescue medication was in Australia and Singapore (41.9%, 28.1%,respectively). 34.4% Australian patients receiving MEC required rescue medication. Unlike others, the majority of Australian patients received a rescue medication prescription.
Antiemesis guidelines were widely consulted. Australia’s adherence to guidelines was higher (83.3%) vs. other countries (China:0%; India:37.2%; Singapore:55.0%; South Korea:57.5%; Taiwan:26.8%).
Conclusions: Australia demonstrated: outpatient chemotherapy administration, fewest non-drinkers vs. other countries, highest adherence to guidelines and optimal emesis control. There is considerable room to improve CINV outcomes and use of recommended antiemetic prophylaxis in AP.