Impact of Evolving Antiemetic Prophylaxis on Chemotherapy-Induced Nausea and Vomiting (CINV): A Five-Year Comparative Study in Sichuan, China (2018-2023).

BACKGROUND

A baseline study conducted in 2018 revealed suboptimal guideline adherence and high chemotherapy-induced nausea and vomiting (CINV) burden in Sichuan, China. Since then, concerted efforts have been made to enhance CINV management through guideline promotion and physician education. This study aimed to evaluate temporal changes in CINV incidence and antiemetic prophylaxis patterns by comparing 2023 real-world data with the 2018 baseline.

METHODS

In this prospective, multicenter study, we enrolled 1985 cancer patients receiving moderately or highly emetogenic chemotherapy (MEC/HEC) across Sichuan in 2023. We employed methodologies consistent with the baseline study to ensure direct comparability. Primary endpoints were the overall, acute, and delayed CINV incidence. Secondary endpoints included complete control (CC) rates and antiemetic regimen adherence.

RESULTS

Compared with the 2018 baseline, significant improvements were observed in 2023. The overall CINV incidence decreased from 82.97% to 57.3% (P < 0.001). Acute CINV decreased from 55.3% to 43.9%, and delayed CINV showed the most substantial decline from 62.3% to 30.4% (P < 0.001 for both). For patients receiving HEC, CC rates in the overall, acute, and delayed phases increased from 30.1% to 58.4%, from 52.8% to 64.1%, and from 60.6% to 75.6%, respectively. For MEC patients, CC rates in the overall, acute, and delayed phases increased from 32.1% to 68.5%, from 47.5% to 83.4%, and from 55.4% to 91.9%, respectively (P < 0.001 for all comparisons). Guideline-concordant antiemetic prophylaxis increased from 21.5% to 52%. The most notable increase was observed in the utilization of neurokinin-1 receptor antagonists (NK-1 RAs) for HEC. Regarding NCDs, guideline-compliant management resulted in significantly more CINV-free days compared with non-compliant management (19.88 days vs. 17.05 days, P < 0.0001), highlighting the critical role of standardized antiemetic prophylaxis in improving patient outcomes.

CONCLUSION

Over the five-year period, CINV management in Sichuan has demonstrated significant, measurable progress, evidenced by a notable decline in incidence and substantially improved complete control rates, especially in high-risk HEC patients. This positive trend is strongly associated with the increased implementation of evidence-based antiemetic guidelines. However, the persistent CINV burden underscores the need for continued quality improvement efforts to fully translate guideline recommendations into universal best practice.