Type: Original Article Adherence to antiemetic guidelines in solid cancer patients receiving highly emetogenic chemotherapy in Korea

Abstract Background: Highly emetogenic chemotherapy (HEC) is known to induce nausea and vomiting (CINV) in approximately 90% of cancer patients undergoing this regimen unless proper prophylactic antiemetics are administered. To mitigate these side effects, the National Comprehensive Cancer Network (NCCN) guidelines recommend a prophylactic antiemetic regimen comprising three or four drugs with different mechanisms for patients receiving HEC. This study aimed to analyze the use of prophylactic antiemetics during the first cycle of chemotherapy and assess the compliance rate with the NCCN guidelines. Methods: This study used data from the National Inpatient Sample database from 2016 to 2020 provided by the Health Insurance Review and Assessment Service, Korea. Patients with solid cancers treated with two HEC regimens, namely anthracycline + cyclophosphamide (AC) and cisplatin-based regimens, were selected as the study population. The use of prophylactic antiemetic drugs and compliance with guidelines were analyzed. Multiple logistic regression was conducted to estimate the influence of variables on guideline adherence. Results: The overall compliance rate with the NCCN guidelines for prophylactic antiemetics was 74.3%, with higher rates observed in the AC group (87.9%) and lower rates in the cisplatin group (60.4%). The AC group had a 6.37 times higher likelihood of receiving guideline-adherent antiemetics than the cisplatin group. The analysis revealed that, compared to 2016, the probability of complying with the guidelines in 2019 and 2020 was 0.72 times and 0.76 times lower, respectively. Conclusion: This study showed that a considerable proportion of HEC-treated patients received guideline-adherent antiemetic therapies. However, given the variations in adherence rates between different chemotherapy regimens (AC vs. cisplatin), efforts to improve adherence and optimize antiemetic treatment remain essential for providing the best possible care for patients experiencing CINV.