Transferring scientific evidence to oncological practice: a trial on the impact of three different implementation strategies on antiemetic prescriptions

Abstract

Goals

In 1996, a gap between the literature evidence for the prevention of chemotherapy-induced emesis and the prescription pattern in clinical practice was demonstrated in a drug utilization study. This study, carried out in 103 Italian oncological centers (77 new; 26 old that participated in the previous study) evaluates three different intervention strategies to implement these guidelines.

Patients and methods

In cancer patients submitted to chemotherapy, prescriptions of antiemetics were prospectively monitored for 2 consecutive weeks in 1999. Simple diffusion of guidelines was evaluated in an observational study in the 77 new centers, while the double combination of simple diffusion and “audit and feedback” strategy was randomly compared in the old centers with the triple combination of the same two strategies plus an “educational outreach visit.”

Main results

Simple diffusion of guidelines improved the prescription but only for acute and delayed emesis induced by high-moderate emetogenic chemotherapy. No significant difference was detected in the prescriptions against cisplatin-induced emesis. The inappropriate use of 5-HT₃ antagonists for prophylaxis of low emetogenic chemotherapy was found most frequently. Similar poor results were achieved by the audit and feedback strategy, while the educational outreach visit significantly increased the prescription of the optimal prophylaxis for cisplatin-induced acute and delayed emesis.

Conclusions

A combination of interventions, including an educational outreach visit, seems to be a good strategy for transferring the results of antiemetic research to oncological practice.

Appendix

Principal Investigators: Medical Oncology Division, Policlinico Hospital, Perugia: Fausto Roila, Verena De Angelis, Maurizio Tonato; Dept. of Internal Medicine and Oncological Sciences, University, Perugia: Lucio Patoia, Albano Del Favero; Medical Statistics Unit, Dept. of Internal Medicine and Public Health, University, L’Aquila: Enzo Ballatori.

Investigators and collaborating centers: Division of Medical Oncology B, National Cancer Institute of Naples: S. Pignata, R. Tambaro, E. Barletta, E. De Maio, M. Di Maio, A. Ottaiano; CRO—Aviano, National Cancer Institute, Aviano, Pordenone: R. Sorio, M. Berretta, M. Libra, S. Del Tin, D. Favero; Medical Oncology Division, Perugia: G. Ciccarese, M.A. Palladino, S. Porrozzi, R. Cherubini, M. Betti, C. Basurto; Unit of Medical Oncology, Ospedali Riuniti, Bergamo: R. Labianca, A. Quadri, M.A. Pessi, A. Galizzi, P. Savoldi, C. Caldara; Medical Oncology Division, Ragusa: C. Iacono, P. Amendola, G. Occhipinti, G. Iacono, G. Lo Presti; Medical Oncology Division, San Giovanni Rotondo, Foggia: G. Lelli; Medical Oncology Division B, ‘Regina Elena’ Institute, Roma: M. Lopez, A. Amodio, F. Conti, G. Di Lauro, S. Carpano; Medical Oncology Division, University of Verona: G.L. Cetto, R. Sabbioni, R. Nortilli, C. Griso, A.P. Fraccon; Medical Oncology Dpt., University of Modena and Reggio Emilia, Modena: R. Sabbatini, R. Depenni, M. Federico, V. Silingardi ; Oncologic Centre “M. Santo”, Cosenza: S. Palazzo, A. Rovito, A. Roa, C. Mastroianni; Medical Oncology Division A, Regina Elena Institute, Roma: F. Cognetti, A. Savarese, A. Fabi, V. Pacetti; Medical Oncology Division, Castelfranco Veneto: P. Manente, G. Vicario, E. Scolzi, G. Sgarbossa; Institute of Oncology, Medical Oncology University of Palermo: I. Carreca, R. Agueli, S, Cucciarrè; Department of Oncology, ASO Alessandria Hospital, Alessandria: G. Bottero, V. Fusco, M. Rossi, G. Bellotti; 2nd Division of Medical Oncology “A. Businco” Hospital, Cagliari: S. Pasqualucci, M.G. Aste, M.C. Cherchi, C. Floris; Medical Oncology Division, Casale Monferrato: M. Botta, D. Degiovanni, A. Muzio, B. Castagneto; Medical Oncology Unit, “S. Carlo” Hospital, Potenza: G. Rosati, A. Rossi, L. Manzione; Medical Oncology Division, General Hospital Rovigo: E. Ferrazzi, M. Gusella, C. Bolzonella ; Medical Oncology Division, ‘S. Bortolo’ Hospital, Vicenza: V. Fosser, S. Schiavon; Medical Oncology Division, Hospital, Benevento: G.P. Ianniello, V. Tinessa; Clinical Oncology Division, Ferrara: P. Malacarne, D. Donati, R Maccaferri, G. Margutti; Preventive Oncological Service, Fondazione S. Maugeri, Pavia: G. Bernardo, M. R. Strada, G. Villani, A. Bernardo; Medical Oncology Service, Galliera Hospital, Genova: L. Gallo, C. Caroti, L. Merlini; Medical Oncology, University of L’Aquila: P. Marchetti, C. Ficorella, G. Porzio; Medical Oncology Division, San Giovanni A.S., Torino: C. Bumma; Hematology and Clinical Oncology Division, Catanzaro: A. Peta, D. Magro, M.G. Kropp; Medical Oncology Division, Cardarelli Hospital, Napoli: L. Campanella; Medical Oncology Dept, Morgagni-Pierantoni Hospital, Forlì: M. Fabbri, L. Ridolfi, D. Amadori; Medical Oncology Service, Morgagni Hospital, Catania: O. Marino; Medical Oncology Division, Desio, Milano: M. Cazzaniga; Medical Oncology Division, “S. Maria Goretti” Hospital, Latina: M. D’Aprile, F. Cardillo, F. Angelini; Gynecologic Oncology Service, Sant’Anna Hospital, Torino: S. Danese, E. Bertone, G. Richiardi; Medical Oncology Service, Sassari: A. Contu, A. Pazzola, G. Baldino; Medical Oncology Division, San Carlo Borromeo Hospital, Milano: M.C. Locatelli, A. D’Antona, C. Ganzinelli; Medical Oncology Service, A.O. Umberto I, Siracusa: S. Spada, M.G. Bonaiuto, M. Spada; Medical Oncology Service, Regina Elena Institute, Roma: E. Terzoli; Medical Oncology Division C, National Cancer Institute, Napoli: A. de Matteis, V. Labonia, G. Landi; Medical Oncology, Poliambulanza Brescia: A. Zaniboni, F. Meriggi; Medical Oncology Division, San Gennaro Hospital, Napoli: L. Maiorino; Medical Oncology Division, San Giovanni di Dio, Salerno: S. Cariello, G. Di Giulio; Cancer Center, University of Trieste: G. Mustacchi, R. Ceccherini; 5th Unit of Pulmonary—Oncology, Forlanini Hospital, Roma: F. De Marinis, S. Ramponi; Medical Oncology Division, Negrar Hospital, Verona: E. Recaldin, M. Nicodemo; Medical Oncology Service, Livorno: M. Bertuccelli; Medical Oncology Division, San Lazzaro Hospital, Alba, Cuneo: G. Porcile, A. Dalla Mola ; Medical Oncology Division, Ospedale Civile, Asti: F. Testore, R. Manfredi; Medical Oncology Service, Como: M. Giordano, G. Luchena, C. Epifani; Medical Oncology Department, ‘Luigi Sacco’ Hospital, Milano: M.T. Cattaneo, S. Ferrario; Dpt. of Internal Medicine and Oncological Sciences, University, Perugia: M.S. Dionisi, L. Patoia; Medical Oncology Unit, “G. Di Maria” Hospital, Avola, Siracusa: P. Tralongo, A. Di Mari; 3rd Medical Oncology Division, A. Businco Hospital, Cagliari: V. Mascia; Medical Oncology Unit, “S. Croce” Hospital, Fano: R. Mattioli, V. Casadei; Medical Oncology, Department of Experimental Medicine, University “La Sapienza”, Roma: E. Cortesi, R. Saltarelli; Medical Oncology Service, ‘S. Maria’ Hospital, Terni: F. Di Costanzo, B. Farmush; Department of Human Pathology, Surgical Oncology, Messina: F. M. Gioffré, A. Venuti, P. Scarfò; Oncology Unit, Civil Hospital “Umberto I°” Lugo, Ravenna: G. Cruciani; Satellite Unit Messina, National Cancer Institute Genova, Messina: R. Maisano, M. Mare; Medical Oncology, Policlinico University, Messina: R.A. Samiani, P. Spadaro; Unit of Medical Oncology, Umberto I Hospital, Enna: R. Carroccio; Department of Internal Medicine, University Federico II, School of Medicine, Napoli: S. Cigolari, V. Angelini; Medical Oncology Unit, University of Bari, Bari: G. Troccoli, I. Lolli; Medical Oncology, Department of Experimental Medicine, University ‘La Sapienza’, Roma: P. Marchei, B. Di Girolamo; Medical Oncology Division, Santa Maria Hospital, Castellanza, Varese: C. Verusio, I. Rampinelli, U. Scaglietti; Oncology Unit, S. Croce General Hospital, Cuneo: M. Merlano, P. La Ciura; Medical Oncology Service, Hospital, Lamezia Terme, Catanzaro: P. Molinaro; Department of Oncology and Hematology, Medical Oncology Unit, Pesaro: P. Alessandroni, M. Ceccolini; Medical Oncology Division, ‘S. Luigi’ Hospital, University, Torino: L. Dogliotti, P. Sperone; Medical Oncology Service, San Giovanni di Dio Hospital, Olbia, Cagliari: S. Ortu; Medical Oncology Service, Rossano Scalo, Cosenza: G. Cicero; Day Hospital Oncology-Senology, Lucera, Foggia: R. Laricchiuta, A. Suriano; Medical Oncology Division, Fatebenefratelli Hospital, Benevento: T. Pedicini, A. Febbraro, C. Corbo; Medical Oncology Division, Policlinico Universitario, Cagliari: G. Mantovani, C. Mulas; Mayor Hospital of Carity, Medical Oncology Division, Novara: C. Volta, L.Forti; Medical Oncology Service, San Giovanni e Paolo Hospital, Venezia: A. Paccagnella, P. D’Amanzo; Gynecology Institute, ‘Careggi’ Hospital, Firenze: G. Amunni, A. Villanucci; Medical Oncology Service, “Di Venere” Hospital, Bari-Carbonara: G. Palmiotti, G. Garofalo; Oncologic Center, ‘V. Fazzi’ Hospital, Lecce: S. Mazzotta; Medical Oncology Service, “A. Cardarelli” Hospital, Campobasso: S. Vecchiarelli, F. Carrozza, G. Giglio; Medical Oncology Division, H. Casalpusterlengo, A.S.L. della Provincia di Lodi: G. Sbalzarini, R. Franchi, P. Costa, A. Signaroldi, G. Tansini; Oncological Day Hospital of “S. Pertini” Hospital, Roma: C. Narduzzi, M. Pesce, A. Toto; National Cancer Institute of Genova, Unit of Roma, Roma: S. Tomao, A. Romiti; Medical Oncology Service, Vittorio Veneto, Treviso: L. Salvagno, V. Palmisano; Medical Oncology Unit, “A. Murli” Hospital, Jesi, Ancona: V. Pieroni, G. Giacomini, G. Rossi; Medical Oncology Service, Crotone: T. Prantera; 5th Medical Oncology Division, Monaldi Hospital, Napoli: L. Brancaccio; Internal Medicine and Medical Oncology University and IRCCS, Policlinico S. Matteo, Pavia: A. Riccardi, A. Bovio; Medical Oncology Service, “G. Da Procida” Hospital, Salerno: G. De Cataldis; Medical Oncology Division, University, Catanzaro: S. Venuta; Medical Oncology Service, “Macchiarella” Hospital, Palermo: T. Sciacchitano; Medical Oncology Division, “E. Agnelli” Hospital, Pinerolo, Torino: V. Sidoti; Ematological Division, Taranto: P. Mazza; Internal Medicine Division, Voghera, Pavia: P. Cardellini; Medical Oncology Service, “Vecchio Pellegrini” Hospital, Napoli: L. De Luca; Internal Medicine Division, “S. S. Antonio e Margherita” Hospital, Tortona, Alessandria: S. Roveta, P.P.Chiusso, F. Bennicelli; Medical Oncology Dpt., 2nd University, Napoli: F. De Vita; Internal Medicine Division, Castellammare di Stabia, Napoli: P. Villari; Department of Obstetrics and Gynaecology, Breast Unit and Chemotherapy, “Ascoli-Tomaselli” Hospital, Catania: G. Maugeri; Medical Oncology Unit, “La Sapienza” University, II Faculty, Sant’Andrea Hospital, Roma: S. Lauro, L. Trasatti, E. Bria, G. La Rosa; Radiotherapy Oncology Division, Barletta, Bari: M. Serlenga, A.M. Barracchia; Surgical and Oncology Division, Hospital Buccheri La Ferla F.B.F., Palermo: M. Valdesi, M. Pavone, S. Madonia; Department of Pharmacology, Ginecology and Obstetrics, Sassari: P.L. Cherchi, F. Fattorini, A.M. Canetto; Medical Oncology Service, Teramo: V. Di Virgilio; Internal Medicine Division, Borgomanero, Novara: G. Massara; Urology Division, Oncology Service, Civil Hospital, Caserta: P. Prudenzano, S. Caggiano.