Key Points
ÎThe rates of nausea and vomiting secondary to chemotherapy and radiation therapy are often underestimated.
ÎPatient response to antiemetic treatment may change during treatment, requiring ongoing assessments and modification to antiemetic strategies. To ensure optimal symptom management, clinicians should assess symptoms throughout therapy.
ÎChecklists can facilitate collection of direct patient reporting of symptom presence and severity. For example, the National Cancer Institute is developing a Patient-Reported Outcomes version of its Common Terminology Criteria for Adverse Events (PRO-CTCAE), which includes two items to assess nausea:
1. In the last 7 days, how OFTEN did you have NAUSEA? (Never / Rarely / Occasionally / Frequently / Almost constantly)
2. In the last 7 days, what was the SEVERITY of your NAUSEA at its WORST? (None / Mild / Moderate / Severe / Very severe)
ÎThe same type of questions can be used to assess vomiting.
ÎPatient-provider communication is relevant to decision-making about selection of antiemetic therapy.
ÎClinicians are encouraged to provide patients with prescriptions for rescue therapy before the patient leaves on the first day of treatment.
Abbreviations
AC, anthracylcine and cyclophosphamide; CINV, chemotherapy-induced nausea and vomiting; d, days; h, hours; IV, intravenous; RCT, randomized controlled trial; RINV, radiation-induced nausea and vomiting; XRT, radiation therapy
Source Basch E, Prestrud AA, Hesketh PJ, Kris MG, Feyer PC, Somerfield MR, Chesney M, Clark- Snow RA, Flaherty AM, Freundlich B, Morrow G, Rao KV, Schwartz RN, and Lyman GH. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. JCO Sep 26, 2011 published online on September 26, 2011.
Disclaimer This resource is a practice tool for physicians based on an ASCO®
guideline and this tool are not intended to substitute for the independent professional judgment of the treating physician. Practice guidelines do not account for individual variation among patients and may not reflect the most recent evidence. This tool does not recommend any particular product or course of medical treatment. Use of the practice guideline and this resource is voluntary. The full practice guideline and additional information are available at http://www.asco.org/guidelines. Copyright © 2012 by American Society of Clinical Oncology ®
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