Impact of Evolving Antiemetic Prophylaxis on Chemotherapy-Induced Nausea and Vomiting (CINV): A Five-Year Comparative Study in Sichuan, China (2018–2023)

Weijie Xiong,1,* Weiwei Zhang,1,* Quande Zhao,2,* Yuzhu Zheng,3,* Ke Xie,4,* Jidong Miao,5 Li Chen,6 Ting Li,7 Wei Cao,8 De Zhu,9 Mengjun Huang,10 Cheng Li,11 Youhua Wang,12 Yan Gui,13 Qingcong Li,14 Chun Cao,15 Yunxiao Yang,16 Chi Du,17 Yan Gao,18 Yangang Zhou,19 Huiling Zhang,20 Xiaoyan Le,21 Ping Chen,22 Ming Jiang,23 Peng Li,24 Jinping Yang,25 Yang Wang,26 Jiang Zhu,27 Lang He1 1Department of Oncology, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Cancer Prevention and Treatment Institute of Chengdu, Chengdu, Sichuan Province, People’s Republic of China; 2Department of Oncology, Langzhong People’s Hospital, Nanchong, Sichuan Province, People’s Republic of China; 3Department of Oncology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan Province, People’s Republic of China; 4Department of oncology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People’s Republic of China; 5Department of Oncology, The Fourth People’s Hospital of Zigong, Zigong, Sichuan Province, People’s Republic of China; 6Department of Oncology, Wusheng People’s hospital, Guang’an, Sichuan Province, People’s Republic of China; 7Department of Oncology, The Second People’s Hospital of Yibin, Yibin, Sichuan Province, People’s Republic of China; 8Department of Oncology, the People’s Hospital of Jianyang City, Chengdu, Sichuan Province, People’s Republic of China; 9Department of Oncology, Bazhong Central hospital, Bazhong, Sichuan Province, People’s Republic of China; 10Department of Oncology, Du Jiang Yan Medical Center, Chengdu, Sichuan Province, People’s Republic of China; 11Department of Oncology, Guang’an People’s Hospital, Guang’an, Sichuan Province, People’s Republic of China; 12Department of Oncology, Gulin People’s hospital, Luzhou, People’s Republic of China; 13Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People’s Republic of China; 14Department of Oncology, Ya’an People’s Hospital, Chengdu, Sichuan Province, People’s Republic of China; 15Department of Oncology, Zigong First People’s Hospital, Zigong, Sichuan Province, People’s Republic of China; 16Department of Oncology, The Affiliated Hospital of Panzhihua University, Panzhihua, Sichuan, People’s Republic of China; 17Department of Oncology, The Hospital of Zizhou, Neijiang, Sichuan Province, People’s Republic of China; 18Department of Oncology, Pidu District People’s Hospital, Chengdu, Sichuan Province, People’s Republic of China; 19Department of Oncology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, People’s Republic of China; 20Department of Oncology, Ziyang Central Hospital, Chengdu, Sichuan Province, People’s Republic of China; 21Department of Oncology, Chengdu Shi Wenjiang Qu Renmin Yiyuan, Chengdu, Sichuan Province, People’s Republic of China; 22Department of Oncology, Chengdu Seventh People’s Hospital, Chengdu, Sichuan Province, People’s Republic of China; 23Head & Neck Oncology Ward, Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People’s Republic of China; 24Department of Oncology, Dayi People’s Hospital, Chengdu, Sichuan Province, People’s Republic of China; 25Department of Oncology, People’s Hospital of Guangyuan, Chengdu, Sichuan Province, People’s Republic of China; 26Department of Oncology, China Aviation Industry Chengdu 363 Hospital, Chengdu, Sichuan Province, People’s Republic of China; 27Department of Thoracic Oncology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiang Zhu, Department of Thoracic Oncology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People’s Republic of China, Email [email protected] Lang He, Department of Oncology, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, Sichuan province, People’s Republic of China, Email [email protected]: A baseline study conducted in 2018 revealed suboptimal guideline adherence and high chemotherapy-induced nausea and vomiting (CINV) burden in Sichuan, China. Since then, concerted efforts have been made to enhance CINV management through guideline promotion and physician education. This study aimed to evaluate temporal changes in CINV incidence and antiemetic prophylaxis patterns by comparing 2023 real-world data with the 2018 baseline.Methods: In this prospective, multicenter study, we enrolled 1985 cancer patients receiving moderately or highly emetogenic chemotherapy (MEC/HEC) across Sichuan in 2023. We employed methodologies consistent with the baseline study to ensure direct comparability. Primary endpoints were the overall, acute, and delayed CINV incidence. Secondary endpoints included complete control (CC) rates and antiemetic regimen adherence.Results: Compared with the 2018 baseline, significant improvements were observed in 2023. The overall CINV incidence decreased from 82.97% to 57.3% (P < 0.001). Acute CINV decreased from 55.3% to 43.9%, and delayed CINV showed the most substantial decline from 62.3% to 30.4% (P < 0.001 for both). For patients receiving HEC, CC rates in the overall, acute, and delayed phases increased from 30.1% to 58.4%, from 52.8% to 64.1%, and from 60.6% to 75.6%, respectively. For MEC patients, CC rates in the overall, acute, and delayed phases increased from 32.1% to 68.5%, from 47.5% to 83.4%, and from 55.4% to 91.9%, respectively (P < 0.001 for all comparisons). Guideline-concordant antiemetic prophylaxis increased from 21.5% to 52%. The most notable increase was observed in the utilization of neurokinin-1 receptor antagonists (NK-1 RAs) for HEC. Regarding NCDs, guideline-compliant management resulted in significantly more CINV-free days compared with non-compliant management (19.88 days vs. 17.05 days, P < 0.0001), highlighting the critical role of standardized antiemetic prophylaxis in improving patient outcomes.Conclusion: Over the five-year period, CINV management in Sichuan has demonstrated significant, measurable progress, evidenced by a notable decline in incidence and substantially improved complete control rates, especially in high-risk HEC patients. This positive trend is strongly associated with the increased implementation of evidence-based antiemetic guidelines. However, the persistent CINV burden underscores the need for continued quality improvement efforts to fully translate guideline recommendations into universal best practice.Keywords: chemotherapy-induced nausea and vomiting, CINV, no CINV days, NCDs, guideline adherence, real-world evidence, China