Identifying Current Practice Patterns for the Treatment of Nausea in Advanced Cancer Patients in the Hospice Setting (GP128)

Outcomes 1. Participants will self-report the ability to identify appropriate pharmacological nausea therapies for hospice patients with advanced care. 2. Participants will self-report the ability to describe the key factors that affect prescribing patterns for nausea medications in the hospice setting. Key Message Nausea is common in advanced cancer and significantly impacts quality of life. We conducted a cross-sectional survey of all hospice physicians and nurse practitioners across Missouri to identify provider practice patterns for the treatment of nausea in hospice patients with advanced cancer. We also assessed factors influencing antiemetic selection. Importance Nausea affects as many as 68% of patients with advanced cancer and is associated with anxiety, loss of appetite, and reduced quality of life. Despite this, few studies have examined current provider practices in the hospice setting. Objective(s) To determine current practice patterns among hospice providers for the treatment of nausea in patients with advanced cancer and the factors influencing treatment selection. Scientific Methods Utilized We conducted a cross-sectional survey of full and part-time hospice physicians and nurse practitioners actively licensed in Missouri in 2021. Results Ninety-three of the 124 hospice providers (75%) completed the entire survey. 62 providers selected ondansetron as first-line antiemetic (67%), followed by haloperidol and olanzapine selected by 12 (13%) and 8 (9%) providers, respectively. Haloperidol, dexamethasone, metoclopramide, and olanzapine were the most commonly selected second and third-line antiemetic medications. Forty-six out of the 93 respondents (49%) reported having prescribed olanzapine for the treatment of nausea in the past 12 months. Providers rated effectiveness with high levels of importance (mean=4.8 on a scale from 1 to 5) for antiemetic selection, while the side effect profile (mean=4.3), formulary availability (mean=4.0), and cost (mean=3.5) were also rated as important factors when selecting treatment. Conclusion(s) Ondansetron was the most widely utilized first-line antiemetic followed by haloperidol and olanzapine. Efficacy, side effect profiles, and formulary were rated by hospice providers as important factors when selecting antiemetics. Impact This may be the first survey in the United States to examine provider practice patterns for the treatment of nausea in advanced cancer patients specifically in the hospice setting.