1. Presented By: Julie Hoffman, ADN, RN, OCN Sylvia Wentzky, ADN, RN Bon Secours St. Francis Health System Greenville, South Carolina

2. The purpose of this Evidence Based Project was to compare the cost effectiveness of two anti-nausea medications: ALOXI and ZOFRAN for patients receiving highly emetogenic chemotherapy regimens, such as Cisplatin.

3.  Bon Secours St. Francis Health System Outpatient Infusion Center  Retrospective 3 month chart review  Solid tumor types  100 adult patients

4.  Gender  Age  Diagnosis  Types of Lung Cancer Treatments  Antiemetics in Cisplatin Protocols

10. ALOXI- 8% Total Cost Savings Increased Patient Satisfaction Decreased Nursing Time ZOFRAN- Lower Patient Satisfaction Increased Clinic Visits Increased Nursing Time Aloxi:  IV push 1 dose day of chemo  Nursing time - 5 minutes  Supplies – needle & syringe Zofran:  IVPB treatment day  2 extra days of IV fluids and daily Zofran IVPB  Nursing time – 6.5 hours  Supplies – IV tubing

11. The cost analysis demonstrated that selecting Aloxi on Day 1 of the chemotherapy treatment impacted:  Cost  Patient Satisfaction  Nurse Time Limitations of this study included a small sample size, retrospective nature, and selective diagnosis of Lung Cancer.

12.  Product Availability  Provider Changes & Preferences  Protocol Changes ◦ Dexamethasone 10 mg IVP ◦ Zofran 8 mg IVP ◦ Emend 150 mg IVPB  3 Month Retrospective Analysis (2014) ◦ 12 Lung Cancer Patients – Cisplatin Treatment ◦ 1 Patient Needed Hydration

13. DeLeon, A. (2006, October). Palonosetron (Aloxi): A Second Generation 5HT3 Receptor Antagonist for Chemotherapy-Induced Nausea and Vomiting. Baylor University Medical Center Proceeding, 19(4),413-416. Retrieved from http:///www.medscapecom/viewarticle/512796 http:///www.medscapecom/viewarticle/512796 Feinberg, B.A., Gilmore, J., Haislip, S., Gondesen, T., Saleh, N., Lenz, W. (2009, February). Data-Driven Medical Decision-Making in Managing Chemotherapy-Induced Nausea and Vomiting, Community Oncology, 62-67. Retrieved from http://www.CommunityOncology.nethttp://www.CommunityOncology.net National Comprehensive Cancer Network. (2011). NCCN Clinical Practice Guilelines in Oncology (NCCN Guidelines) Antiemesis (Version 1.2012). Fort Washington, PA: Ettinger, David S., et al. Tarricone, R., & Girolami, F. (2005). Economic Evaluation of a New Antiemetic Drug – Palonosetron Versus Ondansetron, Clinical Drug Investiation, 25 (9), 597-608 Retrieved from http://www.nci.nlm.nih.gov/pmc/articles/PMC1618755 http://www.nci.nlm.nih.gov/pmc/articles/PMC1618755

14. Bon Secours St. Francis Health System Outpatient Infusion Center Greenville, South Carolina JULIE HOFFMAN, ADN, RN, OCN JULIANA_HOFFMAN @BSHSI.ORG SYLVIA WENTZKY, ADN, RN SYLVIA_WENTZKY@BSHSI.ORG TRACY FASOLINO, PhD, FNP, ACHPN TRACY_FASOLINO@BSHSI.ORG