Appropriate use of antiemetics to prevent chemotherapy-induced nausea and vomiting

Overuse of low-value oncology services has received increasing attention recently. National campaigns such as “Choosing Wisely” have prompted medical specialty societies to identify areas for reducing low-value utilization. The use of antiemetic drugs to prevent chemotherapy-induced nausea and vomiting (CINV) exemplifies an area with high potential for overuse, and was targeted in the American Society of Clinical Oncology (ASCO)’s 2013 set of Choosing Wisely recommendations. Specifically, providers were cautioned not to use potent antiemetics (i.e., neurokinin-1 receptor antagonists [NK1-RAs]), which are intended for use among patients receiving chemotherapy with a high risk of CINV, for patients initiating chemotherapy with a low or moderate risk of CINV

Concurrent prescribing of opioids with other sedating medications after cancer diagnosis: a population-level analysis

Purpose: Cancer is a major reason for concurrent prescription of opioids with other sedating medications—particularly benzodiazepines and gabapentinoids—yet population-based assessments of the extent and predictors of concurrent prescribing among clinically and demographically diverse patients with cancer are lacking. Methods: We conducted a retrospective cohort study of patients with non-metastatic cancer using North Carolina cancer registry data linked with Medicare and private insurance claims (2013–2016). We used modified Poisson regression to assess associations of patient characteristic with adjusted relative risk (aRR) of new concurrent prescribing of opioids with benzodiazepines or gabapentinoids after diagnosis. Results: Overall, 15% of patients were concurrently prescribed opioids with benzodiazepines or gabapentinoids. Characteristics independently associated with an increased risk of concurrent prescribing included cancer type (e.g., aRR cervical vs. colorectal cancer: 1.55, 95% CI: 1.12–2.14); prior use of opioids (aRR: 2.43, 95% CI:2.21–2.67), benzodiazepines (aRR: 4.08, 95% CI: 3.72–4.48), or gabapentinoids (3.82, 95% CI: 3.31–4.39), and premorbid mental health conditions, including substance use disorder (aRR: 1.27, 95% CI: 1.05–1.54). Black and Hispanic patients were less likely to experience concurrent prescribing (aRR, Black vs. White: 0.35, 95% CI: 0.15–0.83; aRR, Hispanic vs. White: 0.75, 95% CI: 0.66–0.85). Conclusion: Approximately 1 in 7 patients with cancer was concurrently prescribed opioids with other sedating medications. Associations between patient characteristics and risk of concurrent prescribing highlight predictors of concurrent prescribing and suggest a rationale for systematic assessment of substance use history at diagnosis. Future research could explore inequitable pain and symptom management and investigate risk of adverse medication-related events