OnCo
ideasIdea

Low-dose olanzapine and generic antiemetic bundles in every guideline and formulary

A cheap, old antipsychotic at a low dose is one of the best anti-sickness drugs for chemotherapy. Make sure every cancer unit in the world uses it.

Olanzapine 5 to 10 mg reduces chemotherapy-induced nausea and vomiting in randomised trials, including with highly emetogenic regimens, at a cost of pennies. Uptake is uneven, and in many low-income settings even standard 5-HT3 antagonists and dexamethasone are inconsistently available. The proposal is a global implementation programme: inclusion of olanzapine-based bundles in national essential medicines lists and guidelines, pre-printed order sets, and audit of complete response rates as a quality indicator.

Hypothesis
Implementation raises complete control of nausea and vomiting in highly emetogenic chemotherapy above 70% in participating units and reduces emergency visits for vomiting and dehydration.
Rationale
The evidence is done; the gap is diffusion. Nausea is among the most feared toxicities and among the cheapest to control.
What would test it
Before-and-after audit with a randomised implementation-support arm across cancer units in three middle-income countries; primary endpoint complete response rate in cycle 1.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks

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