antiemesis.pdf

Purpose & Patient Population

PURPOSE: To provide recommendations for antiemesis in patients with cancer

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Consensus-based guideline

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results Provided in the Reference

No detailed information about literature searching or evidence grading was provided, and most recommendations were based on low-level evidence and consensus. A panel developed the recommendations.

Guidelines & Recommendations

For highly-emetogenic chemotherapy, the guideline recommends either:

Triple drug therapy with NK1, 5HT3, and dexamethasone
Netupitant-containing regimen
Olanzapine, palonosetron, and dexamethasone for the acute phase and olanzapine for the delayed phase

For moderately-emetogenic chemotherapy, the guideline recommends either:

5HT3 and dexamethasone with or without NK1 and either dexamethasone monotherapy, 5HT3, or NK1 plus dexamethasone for the delayed phase
Netupitant-containing regimen
Olanzapine regimen

For low-emetogenic chemotherapy, the guideline recommends metoclopramide, prochlorperazine, haloperidol, or 5HT3.

For breakthrough emesis, the guideline recommends olanzapine, lorazepam, cannabinoid, and multiple other drugs. It notes some evidence that olanzapine was more effective in one study than metoclopramide.

Limitations

Limited provision of the evidence base for recommendations
Much of the guideline is consensus-based.

Nursing Implications

This guideline provides a good resource for identifying the emetogenicity of various oral and IV chemotherapy agents, and it provides recommendations for radiation-related nausea and vomiting. The guideline is limited in that the full evidence base for all adjuvant recommendations is not provided, and the full strategy for the search and review of evidence is not stated.