TRANSFERABILITY TO CLINICAL-PRACTICE OF THE RESULTS OF CONTROLLED CLINICAL-TRIALS - THE CASE OF ANTIEMETIC PROPHYLACTIC TREATMENT FOR CANCER CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING

Background: There is convincing evidence from randomized clinical tria ls that the use of 5-HT3 antagonists has brought about a substantial i mprovement in the control of chemotherapy-induced nausea and vomiting. However, no data exist to indicate how this new research evidence can be applied to the individual patient. Patients and methods. We carrie d out a prospective, observational study on the use and effectiveness of antiemetic drugs in patients undergoing cancer chemotherapy in 33 I talian oncology departments. Results: A total of 1,956 consecutive pat ients entered the study; 1,238 of them underwent a one-day chemotherap y and 718 a chemotherapy fractionated over several consecutive days. T he 5-HT3 antagonists, used either alone or in combination with a corti costeroid, have almost completely supplanted all other types of antiem etic regimens for preventing cancer chemotherapy-induced emesis. In fa ct, 80% of patients, irrespective of whether their emesis was acute or delayed, or of the emetogenic potential of the cancer chemotherapy th ey received, have been treated with these compounds. However, the prac tice of participating oncologists with respect to prescriptions has be en far from consistent with the evidence provided by randomized contro lled trials. Both overtreatment and undertreatment have occurred in ma ny patients, creating unjustified costs and placing the patients at gr eater risk for emesis. However, when antiemetics are properly used the ir effectiveness is similar to that seen in randomized controlled tria ls. Conclusions: Powerful barriers exist between the evidence provided by sound research and clinical practice, and this issue hampers progr ess toward the optimal use of antiemetic drugs.