A randomized open-label study of guideline-driven antiemetic therapy versus single agent antiemetic therapy in patients with advanced cancer and nausea not related to anticancer treatment

Hardy, Janet, Skerman, Helen, Glare, Paul, Philip, Jennifer, Hudson, Peter, Mitchell, Geoffrey, Martin, Peter, Spruyt, Odette, Currow, David and Yates, Patsy 2018, A randomized open-label study of guideline-driven antiemetic therapy versus single agent antiemetic therapy in patients with advanced cancer and nausea not related to anticancer treatment, BMC cancer, vol. 18, no. 1, doi: 10.1186/s12885-018-4404-8.

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Title A randomized open-label study of guideline-driven antiemetic therapy versus single agent antiemetic therapy in patients with advanced cancer and nausea not related to anticancer treatment
Author(s) Hardy, Janet
Skerman, Helen
Glare, Paul
Philip, Jennifer
Hudson, Peter
Mitchell, Geoffrey
Martin, PeterORCID iD for Martin, Peter orcid.org/0000-0002-1214-5149
Spruyt, Odette
Currow, David
Yates, Patsy
Journal name BMC cancer
Volume number 18
Issue number 1
Article ID 510
Total pages 9
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2018-05-02
ISSN 1471-2407
Keyword(s) Antiemetic
Guidelines
Nausea
Palliative care
Vomiting
Science & Technology
Life Sciences & Biomedicine
Oncology
FAR-ADVANCED CANCER
QUALITY-OF-LIFE
MANAGEMENT
HALOPERIDOL
EFFICACY
Summary BACKGROUND: Nausea/vomiting (N/V) not related to anti-cancer treatment is common in patients with advanced cancer. The standard approach to management is to define a dominant cause, and treat with an antiemetic selected through pathophysiologic knowledge of emetic pathways. High rates of N/V control have been reported using both etiology-based guideline-driven antiemetic regimens and an empiric approach using single agents in uncontrolled studies. These different approaches had never been formally compared. METHODS: This randomized, prospective, open label, dose-escalating study used readily available antiemetics in accordance with etiology-based guidelines or single agent therapy with haloperidol. Participants had a baseline average nausea score of ≥3/10. Response was defined as a ≥ 2/10 point reduction on a numerical rating scale of average nausea score with a final score < 3/10 at 72 h. RESULTS: Nausea scores and distress from nausea improved over time in the majority of the 185 patients randomized. For those who completed each treatment day, a greater response rate was seen in the guideline arm than the single agent arm at 24 h (49% vs 32%; p = 0.02), but not at 48 or 72 h. Response rates at 72 h in the intention to treat analysis were 49 and 53% respectively, with no significant difference between arms (0·04; 95% CI: -0·11, 0·19; p = 0·59). Over 80% of all participants reported an improved global impression of change. There were few adverse events worse than baseline in either arm. CONCLUSION: An etiology-based, guideline-directed approach to antiemetic therapy may offer more rapid benefit, but is no better than single agent treatment with haloperidol at 72 h. CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ANZCTRN12610000481077 .
Language eng
DOI 10.1186/s12885-018-4404-8
Field of Research 1112 Oncology and Carcinogenesis
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2018, The Authors
Persistent URL http://hdl.handle.net/10536/DRO/DU:30122082

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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