Background: Moderately emetogenic chemotherapy has a broad definition which encompasses rates of chemotherapy induced nausea and vomiting of 30–90% attributed to moderately emetogenic chemotherapy regimens. Cancer Care Ontario published recommendations for single day use of dexamethasone in moderately emetogenic chemotherapy regimens in 2014 which not all hospitals adopted. We conducted a retrospective analysis comparing patients receiving FOLFOX and multiple day dexamethasone at Odette Cancer Centre (n = 154) with patients receiving FOLFOX and single-day dexamethasone at Cambridge Memorial Hospital (n = 56) to determine whether there were differences in rates of chemotherapy induced nausea and vomiting between the two institutions.

Results/Key findings: Patient demographics in the two cohorts were well balanced. The adherence to single day dexamethasone in FOLFOX regimens as outlined by Cancer Care Ontario was 100% in the Cambridge Memorial Hospital cohort of patients compared to 0% in the Odette Cancer Centre patients. Overall patient reported rates of chemotherapy induced nausea and vomiting were 19% at OCC and 42% at Cambridge Memorial Hospital which was a statistically significant difference (p=0.013). Risk of CTCAE Grade 2 nausea was significantly reduced in the Odette Cancer Centre patients compared to the Cambridge Memorial Hospital patients (RR 0.33, p = 0.0084).

Conclusion/Recommendations: Multiple day dexamethasone appears to be more protective against chemotherapy induced nausea and vomiting in patients on FOLFOX. A prospective trial is needed to validate these findings.