National Comprehensive Cancer Network. (2016). NCCN Clinical Practice Guidelines in Oncology: Antiemesis [v.2.2016]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf

Purpose & Patient Population

PURPOSE: To provide guidance in the prevention and management of nausea and vomiting in patients with cancer
 
TYPES OF PATIENTS ADDRESSED: It is unclear if recommendations are intended to apply to pediatric as well as to adult patients

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: Expert panel reviews selected evidence from literature to update guidelines.   
 
DATABASES USED: PubMed
 
INCLUSION CRITERIA: Clinical trials, guidelines, systematic reviews, meta-analysis, English language
 
EXCLUSION CRITERIA: Not specified

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Results Provided in the Reference

One hundred seventy-one articles were retrieved via aPubMed search. No information was provided regarding which articles were selected as relevant to these guidelines, and no discussion of any method used for rating the quality of included evidence exists.

Guidelines & Recommendations

For high emetic risk (HEC) and moderate risk (MEC), recommendations include a standard triple drug antiemetic regimen, a NEPA-containing regimen, or a olanzapine-based triple drug regimen in which olanzapine is used in place of an NK1 and no dexamethasone is given after day 1.
 
For breakthrough treatment, recommendations suggest olanzapine, benzodiazepine, cannabinoid, phenothiazine, 5HT3, dexamethasone, haloperidol, metoclopramide, or a scopolamine transdermal patch. Recommendations include using a regimen for higher level emetogenicity prior to subsequent cycles or changing between aprepitant-based and olanzapine-based regimens.
 
For anticipatory CINV, recommendations suggests relaxation, hypnosis, guided imagery, music therapy, acupuncture, acupressure, or anxiolytics.

Limitations

Limited database used. Recommendations are a combination of evidence- and consensus-based suggestions, and most nonpharmacologic interventions are by consensus.

Nursing Implications

Provides multiple evidence- and consensus-based recommendations for prophylaxis and the management of nausea and vomiting due to chemotherapy or radiation therapy. Recommendations provide a list of chemotherapy agents, including oral agents and categorization as to emetic potential.