Abstract

Chemotherapy-induced nausea and vomiting (CINV) is a common, but now often overlooked side effect of cancer treatment, and one that can be largely prevented through the implementation of international evidence-based guidelines. The European CINV Forum, comprising nurses from France, Germany, Portugal, Spain and the UK, discussed the use of CINV preventive strategies in routine practice, and the factors that affect optimal delivery of antiemetic therapies. Based on these discussions, they developed a series of recommendations for optimal, evidence-based management of CINV. These state that all patients receiving chemotherapy should undergo full assessment of their risk of CINV and receive appropriate prophylactic treatment based on guidelines from the Multinational Association of Supportive Care in Cancer (MASCC) and the National Comprehensive Cancer Network (NCCN), which were both updated in 2011. Other recommendations, aimed at raising awareness of CINV and its management, include timely updates of relevant local practice guidelines and protocols, translation of the MASCC and NCCN guidelines into all European languages and their dissemination through accessible articles in nursing journals and newsletters and via nursing conferences and study days, improved training for nurses on CINV, collaboration between the European Oncology Nursing Society and national nursing organisations to promote consistent practice, the development of a CINV toolkit, information provision for patients, local audits of CINV management, and a survey of CINV management between and within European countries.

Highlights

  • Chemotherapy-induced nausea and vomiting (CINV) is a recognised adverse effect of cytotoxic cancer treatment, and one that is consistently cited by patients as one of their greatest fears before embarking on a treatment course [1]

  • It has been reported that patients with haematological malignancies who receive less than 90% of their planned chemotherapy dose intensity are at a significant survival disadvantage compared with those who receive ≥90% dose intensity [5,6,7]

  • The latest international guidelines—2011 updates to recommendations from the Multinational Association of Supportive Care in Cancer (MASCC) [10] and the National Comprehensive Cancer Network (NCCN) [2]—set out a multi-drug approach to CINV prophylaxis for patients receiving highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) regimens (Tables 1 and 2)

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Summary

Introduction

Chemotherapy-induced nausea and vomiting (CINV) is a recognised adverse effect of cytotoxic cancer treatment, and one that is consistently cited by patients as one of their greatest fears before embarking on a treatment course [1]. The latest international guidelines—2011 updates to recommendations from the Multinational Association of Supportive Care in Cancer (MASCC) [10] and the National Comprehensive Cancer Network (NCCN) [2]—set out a multi-drug approach to CINV prophylaxis for patients receiving HEC and MEC regimens (Tables 1 and 2). All patients receiving HEC or MEC should undergo a full assessment of their risk of CINV, taking account of the emetogenicity of the planned chemotherapy regimen and patient factors such as sex, age and history of nausea and vomiting, and the appropriate prophylactic treatment indicated in the 2011 MASCC or NCCN guidelines should be implemented [2,10]. A survey of CINV management at local level between and within European countries would provide a snapshot of current practices and a focus for change

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