CHOOSING WISELY IN PROPHYLACTIC NEUROKININ-1 RECEPTOR ANTAGONIST USE AMONG WOMEN WITH BREAST CANCER: A RETROSPECTIVE COHORT STUDY

Breast cancer is the second most common cancer among women in the United States (US) with 297,790 new cases expected in 2023. Survival rates for breast cancer have significantly improved over the past decade due to effective screening, diagnosis, and advancement in multimodal therapy, including surgery, radiotherapy, and chemotherapy. In the US, the treatment cost for breast cancer increased substantially from $16.5 billion in 2010 to $23.8 billion in 2020. Moreover, in the US, female breast cancer contributes to 14% of all cancer treatment costs. Unnecessary use of certain oncology services increases the cost of cancer care without improving the quality and value of cancer care. In April 2012, the American Board of Internal Medicine (ABIM) Foundation launched a national campaign, “Choosing Wisely (CW)” to reduce the use of medical services that do not improve patient’s health. CW is a clinician-led campaign that began in the US but quickly spread to Canada, Australia, Japan, and most parts of Europe. As a part of the CW campaign, the American Society of Clinical Oncology (ASCO) issued the top five measures in 2012 to identify the areas of low-value utilization to promote cost reductions. Later, on October 29, 2013, ASCO issued another set of five measures, including the one focused on chemotherapy-induced nausea vomiting (CINV) and antiemetic use stating: “Don’t give patients starting on a chemotherapy regimen that has low or moderate risk of nausea and vomiting antiemetic drugs intended for use with a regimen that has a high risk of causing nausea and vomiting”. While chemotherapy has contributed substantially to improved health outcomes, certain chemotherapy regimens are associated with severe nausea and vomiting. Antiemetic prophylaxis is an effective treatment to prevent CINV in the majority of cancer patients. The main prophylactic antiemetics classes include corticosteroids, serotonin receptor antagonists (5HT3-RAs), and Neurokinin-1 receptor antagonists (NK1-RAs). NK1-RAs are clinically efficacious as evident from the clinical trials and were thus rapidly incorporated into antiemetic guidelines for CINV prophylaxis for patients who receive high emetogenic chemotherapy. To promote the appropriate use of antiemetics, several oncology organizations worldwide have developed clinical guidelines. In the US, these antiemesis guidelines published by ASCO and the National Comprehensive Cancer Network (NCCN) have categorized chemotherapy agents based on their emetogenic potential (high, moderate, or low risk). Both guidelines recommend against using NK1-RAs for low and moderate emetogenic chemotherapy regimens, particularly because these antiemetics are expensive and may not provide any additional

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.