Annals of African Medicine

: 2022  |  Volume : 21  |  Issue : 2  |  Page : 124--131

Chemotherapy-Associated nausea and vomiting: A cross-sectional survey of occurrence and management patterns at jos university teaching hospital, Nigeria

Kelvin Mogesa Manyega, Benjamin Nasara Joseph, Okunlola Charity Rotkangmwa, Maxwell P Dapar 
 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Jos, Jos, Nigeria

Correspondence Address:
Kelvin Mogesa Manyega
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Jos, Jos


Background: The management patterns for chemotherapy-associated nausea and vomiting (CANV) in Sub-Saharan African settings have not been previously reported. The objectives of this study were to describe the prescribing pattern of antiemetics for CANV, to assess their adherence to guidelines, and to determine the occurrence of CANV. Subjects and Methods: This was a cross-sectional study, with data extracted from the records of adult patients who received chemotherapy from 2015 to 2018 at Jos University Teaching Hospital, Nigeria. The National Comprehensive Cancer Network Harmonized Guidelines™ for Sub-Saharan Africa for Antiemesis Version 3.2018 was used to determine the extent of guideline adherence. Results: Records of 165 patients were analyzed. Majority of the patients (76.4%, n = 126) received moderate-to-high emetic risk intravenous (IV) chemotherapy. Out of 129 antiemetic prescriptions for acute-phase prophylaxis, ondansetron (75.2%), corticosteroids (61.2%), and promethazine (24.8%) were the most prescribed agents. In the delayed phase, 50 patients received prophylactic antiemetics in the order of corticosteroids, ondansetron, and promethazine at 74%, 34%, and 26%, respectively. Guideline adherence was low for the acute-phase (23.6%), delayed-phase (20.6%), and overall period (17.6%). Among inpatients (n = 85), occurrences of nausea were negligible, whereas acute vomiting (9%) and delayed vomiting (15%) levels were considerable. Not receiving highly emetogenic IV chemotherapy was associated with significantly lower odds for nausea or vomiting occurrence, odds ratio 0.228 (95% confidence interval 0.054–0.967). Conclusions: Antiemetic guideline adherence was low due to antiemetic under-prescribing. A few nausea and vomiting events were recorded predominantly among patients who received highly emetogenic IV chemotherapy.

How to cite this article:
Manyega KM, Joseph BN, Rotkangmwa OC, Dapar MP. Chemotherapy-Associated nausea and vomiting: A cross-sectional survey of occurrence and management patterns at jos university teaching hospital, Nigeria.Ann Afr Med 2022;21:124-131

How to cite this URL:
Manyega KM, Joseph BN, Rotkangmwa OC, Dapar MP. Chemotherapy-Associated nausea and vomiting: A cross-sectional survey of occurrence and management patterns at jos university teaching hospital, Nigeria. Ann Afr Med [serial online] 2022 [cited 2022 Oct 5 ];21:124-131
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Full Text


Chemotherapy-associated nausea and vomiting (CANV) is a commonly occurring adverse event[1] that negatively impacts patients' quality of life.[2] CANV occurs in the acute phase within 24-h postadministration of cancer chemotherapy or in the delayed phase, 2–5 days afterward.[3] If poorly managed, CANV could lead to dehydration, electrolyte disturbances,[4] and subsequent treatment delays with accumulating healthcare costs.

Depending on their emesis-inducing capacity, anticancer agents are classified into four categories namely highly emetogenic chemotherapy (HEC), moderately emetogenic chemotherapy (MEC), low emetogenic chemotherapy (LEC), and minimal emetic risk chemotherapy.[5] Studies indicate that more than 90% of patients experience acute vomiting with HEC in the absence of antiemetic prophylaxis.[5] Similarly, for MEC, LEC, and minimal emetic risk chemotherapy, the proportions of acute vomiting reported ranged from 30% to 90%, 10% to 30%, and <10%, respectively.[5]

The overarching goal of CANV control is prevention. Antiemetic agents used for CANV prophylaxis include neurokinin-1 receptor antagonists (NK-1RAs) exemplified by aprepitant, 5-hydroxytryptamine 3 receptor antagonists (5-HT3RAs) like ondansetron, the atypical antipsychotic drug olanzapine, and corticosteroids.[6] Guideline-recommended management of CANV entails administration of a three-drug combination of a 5-HT3RA, a corticosteroid, and an NK-1RA or olanzapine as acute-phase prophylaxis before administration of HEC.[7] A two-drug combination of a 5-HT3RA and a corticosteroid is considered sufficient acute-phase prophylaxis for MEC,[8] while a single antiemetic agent (5-HT3RA or corticosteroid) is adequate for LEC.[6] Acute-phase regimens may be augmented by the administration of prophylactic antiemetics for 2 or more days in the delayed phase for patients receiving HEC, MEC,[7],[8] or multiday chemotherapy regimens.[6]

Research evidence suggests that guideline-recommended antiemetic management results in significantly better CANV control.[9] Despite this, a considerable proportion of patients at risk of CANV do not receive optimal antiemetic management. Nonadherence to antiemetic-prescribing guidelines appears to be widespread. While a European multicenter prospective study reported under-prescribing of antiemetic agents,[10] an American multicenter retrospective study reported overprescribing of antiemetic agents.[11] There is a paucity of literature on adherence to CANV management guidelines in Nigeria. Findings of a survey of oncology professionals suggest that inadequate facilities and complexity of guideline information were barriers to implementation of guidelines.[12] Therefore, the objectives of this study were to describe the prescribing pattern of antiemetics for CANV, to assess their adherence to guidelines, and to determine the occurrence of CANV.

 Subjects and Methods

Study design

A cross-sectional study was carried out at Jos University Teaching Hospital (JUTH), Jos, Plateau State, Nigeria.


Ethical clearance (Ref: JUTH/DCS/ADM/127/XXVIII/1265) was obtained from the Institutional Health Research Committee of JUTH.


Records of all adult patients (≥18 years) who received at least one cycle of intravenous (IV) or oral chemotherapy from January 1, 2015, to December 31, 2018, were eligible for inclusion.

Data collection

Data were manually abstracted from the medical records into a data collection pro forma. Data collected included patients' demographic data, baseline cancer clinical data, details of the chemotherapy regimen, antiemetic regimen, as well as occurrences of nausea and vomiting.

Chemotherapy agents prescribed were classified into IV single-day, IV multiday, or per-oral (PO) multiday, depending on the route and schedule of administration. Anticancer agents prescribed were classified according to the emetic risk classes following the criteria of the National Comprehensive Cancer Network (NCCN) Harmonized Guidelines™ for Sub-Saharan Africa for Antiemesis Version 3.2018 [Appendix 1].[6]

Outcome assessment

Study definition of guideline adherence closely followed the NCCN Harmonized Guidelines™ for Sub-Saharan Africa for Antiemesis version 3.2018[Appendix 2].[6] Prescribing specific antiemetic doses was not required for guideline adherence in line with the practice established in previous research and to allow for comparison with the past studies.[9],[10] Prescriptions with the recommended antiemetics for the recommended days were considered guideline adherent. Patients for whom there was no indication for antiemesis and did not receive antiemetics were also counted as guideline adherent. Prescriptions lacking recommended antiemetics for the recommended days or those containing nonrecommended antiemetics were considered guideline nonadherent. Excessive antiemetic prescribing, defined as prescribing of antiemetics without indication, prescribing more antiemetic agents than recommended or prescribing antiemetics for longer than the recommended period, was considered guideline nonadherence. Overall period guideline adherence was achieved when a patient received guideline adherent antiemetic prescriptions on the recommended days of both the acute and delayed phases.

Nausea and/or vomiting were considered to have occurred only when they were recorded in the patient's file.

Data analysis

The sample size formula for proportions with a finite population correction was used to calculate sample size. Assuming the prevalence of antiemetic guideline adherence to be 50%, with a precision of 7.5% and 95% confidence level, a minimum sample size of 153 was required.[13]

The Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corporation, Armonk, New York, United States) was used for data management.

The prescribing pattern of antiemetics was determined by counting the number of patients who received specific antiemetics and their combinations for prophylaxis. Antiemetics prescribed were matched with emetic risk of chemotherapy prescribed to show the indications for the antiemetics.

Guideline adherence was determined by counting the number of patients who received guideline adherent antiemetic prescriptions as prophylaxis for the acute-phase, delayed-phase, and overall period.

The number of patients who experienced nausea and/or vomiting was counted for inpatients only. Outpatients were excluded from this analysis because they were not available for observation; thus, records of CANV occurrence in the hours following chemotherapy administration could not be found.

Corresponding percentages were computed for all the frequencies.

The association between the emetic risk of chemotherapy prescribed and CANV occurrence (any nausea or vomiting event) was determined. Association between guideline adherence and CANV occurrence was also determined. The Pearson's Chi-square test for independence or the Fisher's exact test was used as appropriate. A multivariate logistic regression model was built with CANV occurrence as the dependent variable, whereas overall period antiemetic guideline adherence (dichotomous), IV HEC (dichotomous), sex, and age were included as the independent variables. Statistical significance was achieved at a two-sided P < 0.05.


A total population of 1418 patients had a presumed or confirmed cancer diagnosis, according to the records of the hospital within the study period. All of these were potential chemotherapy recipients. However, records of 706 patients could not be retrieved and only 712 records were available and assessed for eligibility. Of these, 547 did not receive chemotherapy and therefore were ineligible for inclusion in the study. Records of 165 patients who received chemotherapy were analyzed. [Table 1] shows demographic and clinical characteristics of the study participants.{Table 1}

Prophylactic antiemetic prescribing pattern

Out of the 165 patients analyzed, 129 patients (78.2%) and 50 patients (30%) received at least one prophylactic antiemetic agent in the acute-phase and delayed-phase, respectively. [Figure 1] shows the percentage distribution of individual antiemetic agents prescribed.{Figure 1}

The combination of ondansetron and a corticosteroid was prescribed to 50 patients (38.8%) as antiemetic prophylaxis for the acute phase. Promethazine was prescribed with a corticosteroid to 21 patients (16.3%), whereas a three-drug combination of promethazine, a corticosteroid, and ondansetron was prescribed to five patients (3.9%) as acute-phase prophylaxis.

Among patients who received delayed-phase antiemetics (n = 50), the combination of promethazine and a corticosteroid was prescribed to 11 patients (22%) while five patients (10%) were prescribed for ondansetron with a corticosteroid.

Guideline adherence for chemotherapy-associated nausea and vomiting prophylaxis

The proportion of patients who received guideline adherent antiemetic prescriptions for prophylaxis was 23.6% (n = 39) for the acute-phase period, 20.6% (n = 34) for the delayed-phase period, and 17.6% (n = 29) for the overall period. Excessive antiemetic prescribing was observed in four patients (2.4%) in the acute phase and in three patients (1.8%) in the delayed phase. A total of 87 (64.0%) out of 136 patients who had an indication for delayed-phase antiemetic prophylaxis (single-day IV MEC or HEC; multiday IV MEC/HEC, minimal/LEC; multiday PO MEC/HEC) did not receive any antiemetics. Guideline adherence was high among patients who received IV or PO chemotherapy of minimal-to-low emetogenicity and low among patients who received IV or PO chemotherapy of moderate-to-high emetogenicity [Figure 2].{Figure 2}

Overall guideline adherence was 12.9% for the inpatient subgroup (n = 85) and 22.5% for the outpatient subgroup (n = 80).

The major reasons for guideline nonadherence in the acute phase were nonprescribing of NK-1RAs for patients who received single-day IV HEC or multiday IV MEC/HEC (n = 103, 62.4%); nonprescribing of corticosteroids for patients who received single-day IV MEC/HEC, multiday IV MEC/HEC (52 patients, 31.5%); nonprescribing of 5-HT3RAs for patients who received single-day IV HEC or MEC, IV multiday MEC/HEC, or multiday PO MEC/HEC (41 patients, 24.8%).

In the delayed phase, guideline nonadherence was majorly due to nonprescribing of NK-1RAs for 86 patients (52.1%) who received single-day IV HEC; nonprescribing of corticosteroids for patients who received single-day IV HEC or multiday IV MEC/HEC (73 patients, 44.2%); nonprescribing of 5-HT3RAs for patients who received multiday IV MEC/HEC or multiday PO MEC/HEC (n = 23, 13.9%); nonprescribing of either a corticosteroid or a 5-HT3RAs for 18 patients (10.9%) who received single-day IV MEC.

Chemotherapy-associated nausea and vomiting occurrence

Only inpatients (n = 85) were included for analysis of CANV occurrence. Seventeen patients (20%) experienced at least one episode of nausea or vomiting. Acute nausea occurred in four patients only (5%), while acute vomiting occurred in eight patients (9%). Delayed nausea occurred in two patients (2%), while delayed vomiting was present in 13 patients (15%). [Figure 3] shows the pattern of occurrence of various CANV categories. Receiving highly emetogenic IV chemotherapy was associated with higher CANV occurrence than receiving chemotherapy of other emetic risk classes (χ2 [1, N = 73] =5.0, P = 0.025). No association was found between overall guideline adherence and nonoccurrence of nausea or vomiting (P = 0.110, Fisher's exact test). On multivariate analysis, not receiving IV HEC was associated with significantly lower odds for CANV occurrence – odds ratio 0.228 (95% confidence interval 0.054–0.967; P = 0.045). Overall period guideline nonadherence was not significantly associated with CANV occurrence on multivariate analysis.{Figure 3}


In this study, the most prescribed antiemetic agents were ondansetron (75.2%), corticosteroids (61.2%), and promethazine (24.8%) for acute-phase prophylaxis; as well as corticosteroids (74%), ondansetron (34%), and promethazine (26%) for delayed-phase prophylaxis. Antiemetic guideline adherence was low for the acute-phase (23.6%), delayed-phase (20.6%), and overall periods (17.6%). Vomiting occurred in 9% and 15% of patients in the acute and delayed phases, respectively, while nausea occurrence both in the acute and delayed phases was very low (≤5%).

Despite the frequent prescribing of ondansetron and corticosteroids, a large proportion of patients did not receive these agents for acute- or delayed-phase prophylaxis, leading to low antiemetic guideline adherence and hence suboptimal CANV management. Observational studies carried out in India and South Korea have also reported higher prescribing rates for 5-HT3RAs and corticosteroids,[14],[15] than those observed in the current study. Inadequate clinician knowledge on antiemetic prescribing is thought to have contributed to this difference. Promethazine prescribing in the current study was high despite lack of guideline recommendations to support its use for prophylaxis.[6] Literature on prescribing of promethazine and other phenothiazines for CANV prophylaxis is scarce. Promethazine prescribing might have been high due to its relative low cost and availability as compared to other antiemetics.

The level of guideline adherence (17.6%) was low, indicating that transfer of guideline recommendations to practice was inadequate. Higher levels of guideline adherence ranging from 29% to 71% have been reported in the United States, Europe, and Iran.[9],[10],[16],[17] Prescribing of NK-1RAs was relatively high in these studies and could have contributed to the observed difference in guideline adherence with the current study.

For patients who received single-day IV HEC or multiday IV MEC/HEC, guideline adherence and hence protection from CANV were very low because none of them were prescribed for NK-1RA or olanzapine. Aprepitant prescribing has been observed to be low in studies from Indian and Saudi Arabian tertiary centers, probably due to its high cost.[18],[19] Olanzapine has also been reported to be infrequently prescribed.[18] From a general perspective, the cost of olanzapine at the study site was relatively high and could have contributed to its low prescribing rate.

Conversely, guideline adherence for patients who received chemotherapy of minimal or low emetogenicity, who have little or no requirement for antiemetic prescribing, was very high. Tavernier et al. reported similar findings from a prospective study conducted in France.[16] Excessive prescribing of antiemetics in the current study was negligible unlike in reports from Japan and the United States where costly antiemetics were prescribed for patients who were receiving chemotherapy of low and minimal emetogenicity.[11],[20] Resources at the study site like other public hospitals in Sub-Saharan Africa tend to be scarce, hence the need to avoiding wasteful prescribing.

The proportion of patients who did not receive any antiemetic agent in the delayed phase despite having a clear indication for antiemesis was disproportionately high as compared to the acute phase. This shows that antiemetic prophylaxis for the delayed phase was neglected. A similar observation was made in an Italian multicenter prospective study where 30% of patients who needed antiemetics in the delayed phase did not receive any.[21]

The occurrence of both acute and delayed nausea was very low (≤5%). Previous research has shown that nausea is highly occurring (42%) in patients receiving MEC and higher emetic risk chemotherapy who constituted the majority of patients in the current study.[22] This study depended on archival records of clinicians' assessment notes to pick out nausea events. It is therefore possible that clinicians may have not probed for the presence of nausea in their patients, leading to under-reporting. A prospective study where nausea events will be recorded in real-time is required to confirm this observation.

In contrast to nausea, the occurrence of vomiting in both the acute and delayed phases was considerable and shows the extent of patient suffering as a result of CANV. Previous studies report similar levels of vomiting.[22],[23] As compared to nausea, vomiting was identified more frequently in the current study although literature shows that nausea is in fact more frequently occurring,[22],[23],[24] further supporting the hypothesis that nausea was under-reported.

Patients receiving IV HEC experienced significantly more CANV than patients receiving other types of chemotherapy underscoring the need for appropriate antiemetic prophylaxis for this patient population. This observation is consistent with what has been reported in the past research.[25]

Findings from this study suggest that antiemetic guideline adherence does not offer protection from CANV. However, prospective studies have shown that guideline adherence is associated with a significant reduction in CANV.[9],[10] This difference in findings could be explained by the retrospective cross-sectional design used in the current study, in which a large number of CANV events could have been missed precluding a proper assessment of the effect of guideline adherence. A prospective study is required to shed light on the effect of antiemetic guideline adherence on nausea and vomiting occurrence in a similar setting as the current study.

Strengths and weaknesses

This study shows a real-world picture of antiemetic management practices among patients receiving chemotherapy of all emetic risk classes used in practice including chemotherapy of low emetogenicity and PO chemotherapy which have not received adequate research attention. A weakness of this study was the inability to accurately determine the occurrence of nausea which could be attributed to the cross-sectional retrospective design. Prospective studies are needed to address this shortcoming.


The levels of guideline adherence in antiemetic management were low due to under-prescribing of 5-HT3RAs and corticosteroids, nonprescribing of NK-1RAs and olanzapine, and a neglect of antiemetic prophylaxis in the delayed phase. Notably, promethazine prescribing was frequent while excessive antiemetic prescribing was negligible. While vomiting occurrences were substantial, occurrences of acute and delayed nausea may have been under-reported. Strategies to enhance transfer of guideline recommendations to practice which include clinician education and use of chemotherapy order templates with prespecified antiemetics are needed to help improve management of CANV.


We acknowledge Mrs. Rifkatu Incham and Mr. Joro Christopher of the Health Records Department of JUTH for facilitating data collection. Pharm. Isaac Abah (Department of Pharmacy, JUTH) provided methodological support. The Faculty of Pharmaceutical Sciences headed by Prof. Ikoni Ogaji provided administrative support. Dr. Achei Beryl of the Ministry of Health, Kenya, is appreciated for assisting in reviewing and copy editing the final manuscript. Financial support in the form of research funds and university fees for Kelvin Manyega was provided by the Africa Centre of Excellence in Phytomedicine Research and Development (ACEPRD), University of Jos, Nigeria.

Financial support and sponsorship

This research was supported by a postgraduate studentship grant from the World Bank Sponsored ACEPRD, University of Jos, Nigeria.

Conflicts of interest

There are no conflicts of interest.






1Belachew SA, Erku DA, Mekuria AB, Gebresillassie BM. Pattern of chemotherapy-related adverse effects among adult cancer patients treated at Gondar University Referral Hospital, Ethiopia: A cross-sectional study. Drug Healthc Patient Saf 2016;8:83-90.
2Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J. Delayed nausea and vomiting continue to reduce patients' quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol 2006;24:4472-8.
3Kris MG, Gralla RJ, Clark RA, Tyson LB, O'Connell JP, Wertheim MS, et al. Incidence, course, and severity of delayed nausea and vomiting following the administration of high-dose cisplatin. J Clin Oncol 1985;3:1379-84.
4Laszlo J. Nausea and vomiting as major complications of cancer chemotherapy. Drugs 1983;25 Suppl 1:1-7.
5Jordan K, Chan A, Gralla RJ, Jahn F, Rapoport B, Warr D, et al. 2016 Updated MASCC/ESMO consensus recommendations: Emetic risk classification and evaluation of the emetogenicity of antineoplastic agents. Support Care Cancer 2017;25:271-5.
6Referenced with Permission From the NCCN Clinical Practice Guidelines in Oncology: Harmonized Guidelines™ for Sub-Saharan Africa for Antiemesis V.3.2018. © National Comprehensive Cancer Network, Inc. 2018. All Rights Reserved. To View the Most Recent and Complete Version of the Guideline, Go Online to NCCN Makes no Warranties of Any Kind Whatsoever Regarding Their Content, Use or Application and Disclaims any Responsibility for Their Application or Use in Any Way; March 18, 2020.
7Navari RM, Qin R, Ruddy KJ, Liu H, Powell SF, Bajaj M, et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting. N Engl J Med 2016;375:134-42.
8Lofters WS, Pater JL, Zee B, Dempsey E, Walde D, Moquin JP, et al. Phase III double-blind comparison of dolasetron mesylate and ondansetron and an evaluation of the additive role of dexamethasone in the prevention of acute and delayed nausea and vomiting due to moderately emetogenic chemotherapy. J Clin Oncol 1997;15:2966-73.
9Gilmore JW, Peacock NW, Gu A, Szabo S, Rammage M, Sharpe J, et al. Antiemetic guideline consistency and incidence of chemotherapy-induced nausea and vomiting in US community oncology practice: INSPIRE Study. J Oncol Pract 2014;10:68-74.
10Aapro M, Molassiotis A, Dicato M, Peláez I, Rodríguez-Lescure Á Pastorelli D, et al. The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): The Pan European Emesis Registry (PEER). Ann Oncol 2012;23:1986-92.
11Encinosa W, Davidoff AJ. Changes in antiemetic overuse in response to choosing wisely recommendations. JAMA Oncol 2017;3:320-6.
12Ismaila N, Salako O, Mutiu J, Adebayo O. Oncology guidelines usage in a low- and middle-income country. J Glob Oncol 2018;4:1-6.
13Naing L, Winn T, Rusli TN. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci 2006;1:9-14.
14Baburaj G, Abraham AM, George L, Shetty V, Thempalangad RM, Rajesh KS, et al. A study on utilization and evaluation of antiemetics in chemotherapy-induced nausea and vomiting. Indian J Med Paediatr Oncol 2017;38:334-9.
15Lee MA, Cho EK, Oh SY, Ahn JB, Lee JY, Thomas B, et al. Clinical practices and outcomes on chemotherapy-induced nausea and vomiting management in South Korea: comparison with Asia-pacific data of the pan Australasian chemotherapy induced emesis burden of illness study. Cancer Res Treat 2016;48:1420-8.
16Tavernier J, Jouannet-Romaszko M, Bertucat H, Marchiset N, Bahadoor M, Chevrier R. Region-wide professional practice evaluation with regards to antiemetic prescription into chemotherapy-induced nausea and vomiting. Bull Cancer 2016;103:622-31.
17Vazin A, Eslami D, Sahebi E. Evaluating the antiemetic administration consistency to prevent chemotherapy-induced nausea and vomiting with the standard guidelines: A prospective observational study. Ther Clin Risk Manag 2017;13:1151-7.
18Patil VM, Noronha V, Joshi A, Ramaswamy A, Gupta S, Sahu A, et al. Adherence to and Implementation of ASCO Antiemetic Guidelines in Routine Practice in a Tertiary Cancer Center in India. J Oncol Pract 2017;13:e574-81.
19Alamri A, Alawlah YA, Qiao Y, Wang J. A retrospective review of treatment patterns of antiemetic agents for chemotherapy-induced nausea and vomiting. SAGE Open Med 2018;6:1-6.
20Okuyama A, Nakamura F, Higashi T. Prescription of prophylactic antiemetic drugs for patients receiving chemotherapy with minimal and low emetic risk. JAMA Oncol 2017;3:344-50.
21Drug Utilization Review Team in Oncology (DURTO). Antiemetic prescription in Italian breast cancer patients submitted to adjuvant chemotherapy. Support Care Cancer 2003;11:785-9.
22Escobar Y, Cajaraville G, Virizuela JA, Álvarez R, Muñoz A, Olariaga O, et al. Incidence of chemotherapy-induced nausea and vomiting with moderately emetogenic chemotherapy: ADVICE (Actual Data of Vomiting Incidence by Chemotherapy Evaluation) study. Support Care Cancer 2015;23:2833-40.
23Nawa-Nishigaki M, Kobayashi R, Suzuki A, Hirose C, Matsuoka R, Mori R, et al. Control of nausea and vomiting in patients receiving anthracycline/cyclophosphamide chemotherapy for breast cancer. Anticancer Res 2018;38:877-84.
24Gadisa DA, Assefa M, Tefera GM, Yimer G. Patterns of anthracycline-based chemotherapy-induced adverse drug reactions and their impact on relative dose intensity among women with breast cancer in Ethiopia: A prospective observational study. J Oncol 2020;2020:2636514.
25Osoba D, Zee B, Pater J, Warr D, Latreille J, Kaizer L. Determinants of postchemotherapy nausea and vomiting in patients with cancer. Quality of Life and Symptom Control Committees of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1997;15:116-23.