The investigators reviewed 624 anonymized physician-completed questionnaires to profile antiemetic practice during anticancer therapy. Records were mapped to NCCN Antiemesis Version 2.2023 emetic-risk categories using the highest-risk principle, because regimen-level risk determines recommended prophylaxis. High-emetic-risk (HEC) regimens represented 389/624 (62.3%) records and moderate-emetic-risk (MEC) regimens 150/624 (24.0%). The study team noted that dose, specific agent timing, and delayed-phase continuation were not uniformly captured in the dataset; therefore, guideline implementation was evaluated with prespecified medication-class proxies based on the first antiemetic regimen rather than full regimen-detail adjudication.
Acute nausea was reported in 330/624 (52.9%) of records. Delayed nausea affected 238/624 (38.1%), and vomiting occurred less often than nausea across the cohort. Residual nausea—symptoms persisting after antiemetic treatment—was present in 143/624 (22.9%) of records. The data therefore indicate that nausea, particularly delayed and residual forms, remained common in routine clinical practice despite widespread antiemetic use.
Initial antiemetic regimens were overwhelmingly 5-HT3 receptor antagonist-based, documented in 555/624 (88.9%) records. To assess concordance with guideline-recommended, risk-adapted multidrug prophylaxis, the authors applied class-level proxy measures because full details (timing, dosing, delayed prophylaxis) were inconsistently available. Among HEC/MEC-classifiable records (539 total), the core class-level concordance proxy was met in 188/539 (34.9%). For HEC records specifically, a four-class documentation proxy intended to reflect a full HEC prophylactic strategy was observed in only 8/389 (2.1%). These findings indicate that, when judged by first-regimen medication classes, multidrug prophylaxis appropriate to high-risk therapy was incompletely implemented in this sample.
The study team performed multivariable analysis to evaluate associations with residual symptoms. Meeting the core class-level proxy was not significantly associated with fewer residual symptoms (adjusted OR, 1.40; 95% CI, 0.88–2.23) in this dataset. By contrast, a documented history of prior chemotherapy-induced nausea and vomiting (CINV) was independently associated with residual symptoms (adjusted OR, 2.53; 95% CI, 1.53–4.18). The authors therefore observed that patient history of prior CINV carried a stronger signal for persistent symptoms than did meeting the prespecified class-level prophylaxis proxy.
The dataset and the analytic approach carry explicit limitations that the authors acknowledged. Key regimen details—dose, exact antiemetic agents, timing of administration, and continuation into the delayed phase—were not uniformly recorded, so proxy measures were used to approximate guideline concordance. The records were physician-completed questionnaires and anonymized; there was no direct patient contact, no alteration of care, and no identifiable personal information. Ethics review was deemed unnecessary under those conditions, and no clinical trial number applies. The authors declared no competing interests.
Given the observed gap between widespread antiemetic prescribing and persistent nausea, the study team recommended several concrete clinical priorities. Clinicians should assess nausea separately from vomiting, since the two symptom domains showed different frequencies and patterns in the cohort. Prophylaxis should be tailored across the full emetic-risk window for the specific regimen rather than inferred from initial or single-dose choices. Reassessment across treatment cycles is necessary; prior CINV emerged as an independent predictor of residual symptoms and therefore should inform proactive adjustments in prophylaxis. The authors also identified considerations that can influence real-world effectiveness, including tolerability, patient adherence, and affordability—factors that were not fully captured in the questionnaire data.
This analysis documents measurable implementation gaps: initial regimens were commonly single-class 5-HT3 receptor antagonist–based, yet comprehensive, risk-adapted multidrug prophylaxis for HEC was rarely documented by the proxy measures. Meeting proxy-based core class recommendations did not correlate with statistically significant symptom reduction in adjusted models, whereas prior CINV did. These observations point to unanswered clinical questions that remain within the source material: whether more complete capture of dosing/timing and delayed-phase continuation would change the measured concordance rates, and whether cycle-by-cycle prophylaxis adjustments informed by prior CINV would reduce residual nausea rates. The authors concluded that improving supportive care will require separate measurement of nausea, appropriate prophylaxis across the emetic-risk period, and systematic reassessment across treatment cycles that accounts for prior CINV, tolerability, adherence, and affordability.