Real-world nausea/vomiting control during anticancer therapy: a cross-sectional survey

To characterize real-world antiemetic prescribing, nausea/vomiting control, and implementation gaps in supportive care during anticancer therapy.

We analyzed 624 anonymized physician-completed questionnaire records. Anticancer regimens were mapped to NCCN Antiemesis Version 2.2023 emetic-risk categories using the highest-risk principle. Because dose, agent, timing, and delayed-phase continuation were not uniformly captured, guideline implementation was assessed using prespecified medication-class proxies based on the first antiemetic regimen.

High- and moderate-emetic-risk regimens accounted for 389/624 (62.3%) and 150/624 (24.0%) records, respectively. Acute nausea (330/624, 52.9%) and delayed nausea (238/624, 38.1%) were more common than vomiting. Residual nausea persisted in 143/624 (22.9%) records after antiemetic treatment. Initial regimens were predominantly 5-HT₃ receptor antagonist-based (555/624, 88.9%). Among HEC/MEC-classifiable records, the core class-level concordance was met in 188/539 (34.9%), and the four-class documentation proxy for HEC was observed in only 8/389 (2.1%). In multivariable analysis, meeting the core proxy was not significantly associated with fewer residual symptoms (adjusted OR, 1.40; 95% CI, 0.88-2.23), whereas prior CINV was independently associated with residual symptoms (adjusted OR, 2.53; 95% CI, 1.53-4.18).

Antiemetic use was common, yet nausea, particularly delayed and residual nausea, remained frequent, and risk-adapted multidrug prophylaxis for high-risk therapy was incompletely implemented. Improving care will require separate assessment of nausea, appropriate prophylaxis throughout the emetic-risk window, and reassessment across treatment cycles that considers prior CINV, tolerability, adherence, and affordability.