Antiemetic prescription in Italian breast cancer patients submitted to adjuvant chemotherapy

Goal. The aim of this study was to investigate if the Multinational Association of Supportive Care in Cancer (MASCC) antiemetic guidelines for the prevention of both acute and delayed emesis induced by highly-moderately emetogenic chemotherapy were transferred in daily clinical practice in Italy 2 years after their publication. Patients and methods. From 16 to 23 March 2000, all consecutive breast cancer patients referred to 87 Italian oncological centers to receive any cycle of adjuvant chemotherapy were monitored. Main results. Of 715 evaluable patients submitted to chemotherapy, 533 received cyclophosphamide, methotrexate, 5-fluorouracil (CMF) and 151 anthracyclines. Patients receiving taxanes or other experimental therapies (31) were not considered. The MASCC-recommended antiemetic prophylaxis against acute/delayed emesis was prescribed in 56.3/45.9% patients. Antiemetic prophylaxis against delayed emesis was not prescribed to 30.6% of patients. The MASCC-recommended prescription against acute emesis was more frequently followed in research centers, in Northern Italy, and in centers with experience on antiemetic research. Conclusions. Two years after the publication of the MASCC antiemetic guidelines, strong discrepancies between these and antiemetic prescriptions in daily clinical practice in Italy were observed. The similarity of these results with those obtained in our previous drug utilization study on antiemetics, carried out before the publication of the MASCC guidelines, leads us to conclude that the transferability of antiemetic guidelines to daily clinical practice in Italy has been modest. A great effort should be made in Italy by the National Health Service to accelerate the process of implementation of antiemetic guidelines.