Naeim, A., Dy, S.M., Lorenz, K.A., Sanati, H., Walling, A., & Asch, S.M. (2008). Evidence-based recommendations for cancer nausea and vomiting. Journal of Clinical Oncology, 26, 3903–3910.

Databases searched were MEDLINE, Cochrane Database of Abstracts of Reviews and Effects, Cochrane Register of Clinical Trials, hand searching from previous systematic reviews, National Guideline Clearinghouse, National Quality Measures Clearinghouse, and Web sites of professional organizations.

Search keywords were extensive and provided in an appendix. 

A panel of nine experts reviewed evidence to identify minimum standards of care. 

This report was part of the RAND Cancer Quality Assessing Symptoms Side Effects and Indicators of Supportive Treatment Project to develop evidence-based tools to evaluate aspects of supportive cancer care practice. The work was supported by a grant from Amgen to RAND.

• Assess for nausea and vomiting at each outpatient visit and within 24 hours of an inpatient visit.
• Evaluate emetogenic risk of every chemotherapy regimen for prevention.
• For highly emetogenic chemotherapy (HEC) and patients with breast cancer on anthracycline with aprepitant, use a three-drug regimen for acute and a two-drug regimen for delayed chemotherapy-induced nausea and vomiting (CINV) prevention.
• For MEC, use 5-HT₃ receptor antagonists and dexamethasone for acute and one of these for delayed CINV prevention.
• For low emetogenic chemotherapy (LEC), use dexamethasone if clinically appropriate.
• Consider electroacupuncture if the technique is available by a capable operator.
• Present alternative treatment options to patients with persistent symptoms within one month in an outpatient setting and within 48 hours in an inpatient setting.

• Minor differences are recommended here in the area of low emetogenic potential compared to some other guidelines, as prophylaxis is suggested here.
• Use of a one-month cutoff for presenting alternatives to people with persistent nausea and vomiting seems like a long time to wait for better symptom control.
• As noted, many pharmacologic options for antiemesis are available; however, in trials, often substantial proportions of patients still do not achieve symptom control. This points to the continuing need for research in this area, as well as individualization of regimens in clinical practice.
• The authors suggest that results of a 2005 systematic review of the effects and costs of 5-HT₃ receptor antagonists for delayed nausea cast doubt on the cost-effectiveness of this approach.