Data-driven medical decision-making in managing chemotherapy-induced nausea and vomiting

Chemotherapy-induced nausea and vomiting (CINV) remains a problem in the management of cancer patients. Although improved antiemetics are available, clinical inertia, cost concerns in community practices, and perceptions of agent equivalence within a class can hinder the adoption of a newer drug indicated for prevention of both acute and delayed CINV - a newer drug that may provide more healthcare value in terms of patient outcomes and management costs than an older agent whose efficacy is limited to acute CINV. Georgia Cancer Specialists (GCS) is a 30-site community-based group practice that uses electronic medical records (EMRs) to collect information that allows for continuous quality improvement of cancer care. Using EMRs and billing records, GCS examined retrospectively whether using palonosetron rather than ondansetron reduced the incidence of resource-consuming extreme CINV events, including rescue antiemetics and office visits for CINV treatment. Initial use of palonosetron to prevent CINV reduced the incidence of extreme CINV events over a 5-day period by 76% in moderately emetogenic chemotherapy and by 54% in highly emetogenic chemotherapy, compared with ondansetron. In more than 3,000 patients evaluated, the use of palonosetron versus ondansetron was associated with an estimated reduction in staff management time totaling approximately 4 work months.