Guidelines for Complications of Cancer Treatment Vol VIII Part B

Management of refractory and breakthroughNausea and vomitingThough there are no clear guidelines for this type of CINV,combination antiemetic therapy consisting of different classesof antiemetic drugs is one approach that can be used in somepatients. The addition of dopamine-receptor antagonists(metoclopramide), and agents such as benzodiazepines orneuroleptics (Olanzapine) to the standard treatment can beconsidered. (Level V, D)Multiple Day Chemotherapy5HT 3receptor antagonist and dexamethasone during each dayof chemotherapy followed by Dexamethasone for delayedemesis after the last day of chemotherapy is the standard ofcare. The role of Aprepitant in this setting is not yet proven(Level II, A).1. Evidence-Based Recommendations for CancerNausea and VomitingArash N, Sydney MD, Karl AL, et al. J Clin Oncol 2008;26: 3903-10The experience of patients living with cancer and being treatedwith chemotherapy often includes the symptoms of nauseaand vomiting. To provide a framework for high-qualitymanagement of these symptoms, we developed a set of keytargeted evidence-based standards through an iterative processof targeted systematic review, development, and refinementof topic areas and standards and consensus ratings by amultidisciplinary expert panel as part of the RAND CancerQuality–Assessing Symptoms Side Effects and Indicators ofSupportive Treatment Project. For nausea and vomiting, keyclinical standards included screening at the initial outpatientand inpatient visit, prophylaxis for acute and delayed emesisin patients receiving moderate to highly emetic chemotherapy,400