Assuring the optimal use of serotonin antagonist antiemetics: The process for development and implementation of institutional antiemetic guidelines at Memorial Sloan-Kettering Cancer Center Journal Article


Authors: Nolte, M. J.; Berkery, R.; Pizzo, B.; Baltzer, L.; Grossano, D.; Lucarelli, C. D.; Kris, M. G.
Article Title: Assuring the optimal use of serotonin antagonist antiemetics: The process for development and implementation of institutional antiemetic guidelines at Memorial Sloan-Kettering Cancer Center
Abstract: Purpose: The need to foster the appropriate and cost-effective use of serotonin-antagonist antiemetic drugs spurred the creation of guidelines. The process by which institution-wide guidelines at Sloan-Kettering were developed, implemented, assessed, and modified is described. Methods: A multidisciplinary group working with disease-specific management teams assigned the emetic potential of chemotherapy programs to one of five categories. Antiemetic regimens, including a specified dose and schedule of a seratonin-antagonist and dexamethasone, were assigned to each emetic category. The information was collated by disease site and chemotherapy program into hospital-wide antiemetic regimen recommendations. Quality assessment was conducted initially and repeated each time the guidelines were modified. Results: Patient surveys demonstrated a high level of satisfaction with emetic control, which was similar to reported results. Data from the latest survey showed zero emetic episodes in 93% and 87% of participants given moderate and highly emetogenic chemotherapy, respectively. Compliance with the guidelines, initially in 73%, has been improved using a standardized chemotherapy order 'check box' labeled, 'Antiemetics as per Guidelines.' Antiemetic drug expenditures decreased from a projected $2.8 million to $1.3 million annually. Conclusion: The guidelines became an educational tool that ensured the delivery of optimal antiemetic therapy chosen by professionals with the greatest knowledge of both the particular chemotherapy regimen and cancer site. Implementation of the guidelines resulted in substantial savings while treating more patients. The guidelines were easily modified as new chemotherapeutic agents and antiemetic drugs became available.
Keywords: cancer chemotherapy; treatment planning; antineoplastic agents; cancer patient; nausea; vomiting; dexamethasone; health care policy; cost effectiveness analysis; quality assurance, health care; serotonin antagonist; granisetron; ondansetron; antiemetic agent; antiemetics; guideline adherence; drug utilization; drug use; practice guidelines; serotonin antagonists; cancer; humans; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 16
Issue: 2
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1998-02-01
Start Page: 771
End Page: 778
Language: English
PUBMED: 9469369
PROVIDER: scopus
DOI: 10.1200/JCO.1998.16.2.771
DOI/URL:
Notes: Article -- Export Date: 12 December 2016 -- Source: Scopus
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MSK Authors
  1. Mark Kris
    603 Kris
  2. Barbara Pizzo
    31 Pizzo