de Las Penas, R., Blasco, A., De Castro, J., Escobar, Y., Garcia-Campelo, R., Gurpide, A., . . . Virizuela, J.A. (2016). SEOM Clinical Guideline update for the prevention of chemotherapy-induced nausea and vomiting (2016). Clinical and Translational Oncology, 18, 1237–1242.
DOI Link
Purpose & Patient Population
PURPOSE: To provide an update of the previously published guideline of the SEOM, published to improve supportive care of patients with cancer
TYPES OF PATIENTS ADDRESSED: Patient undergoing chemotherapy of any emetogenicity
Type of Resource/Evidence-Based Process
RESOURCE TYPE: Evidence-based guideline
PROCESS OF DEVELOPMENT: Not mentioned; update for previous guidelines
DATABASES USED: Not mentioned
INCLUSION CRITERIA: Not mentioned
EXCLUSION CRITERIA: Not mentioned
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Elder care, palliative care
Results Provided in the Reference
Guidelines & Recommendations
Highly emetogenic chemotherapy (HEC) prophylaxis consists of administering a triplet containing 5-HT3 receptor antagonists (0.25 mg of palonosetron is the most efficacious) (level II evidence, recommendation B), NK1 receptor antagnoist (125 mg apprepitant on day 1 and 80 mg on day 2, or fosaprepitant [150 mg IV] on day 1), and steroids (level I evidence, recommendation A). Netupitant plus palonosetron (NEPA) is efficacious in patients receiving HEC and moderately emetogenic chemotherapy (MEC) (level B evidence, recommendation A). For low emetogenic chemotherapy (LEC), a single antiemetic like dexamethasone, a dopamine receptor antagonist (metoclopramide), or a 5-HT3 receptor antagonist (level II evidence, recommendation B) is recommended. Patients with multiple-day MEC or HEC should receive a 5-HT3 receptor antagonist plus dexamethasone for acute nausea and vomiting, and dexamethasone for delayed nausea and vomiting (level II evidence, recommendation A). Patients receiving minimally emetic radiation therapy should receive a dopamine receptor antagonist or a 5-HT3 receptor antagonist (level IV evidence, recommendation D). Steroids (dexamethasone) are administered PO/IV at various doses depending on the schedule used. Physicians should consider the prescription of a combination of the different antiemetic drugs considering the emetogenicity of the chemotherapy regimen, patient situation, and individual responses to treatment. Prophylactic antiemetic is as important as the postchemotherapy treatment.
Limitations
Nothing has been listed regarding the updated antiemetic guidelines and the used databases.
Nursing Implications
Nurses should know about pharmaceutical antiemetics advancement, assess patients' nausea and vomiting, and discuss the efficacy of the antiemetics with physicians if it is not within the recommended guidelines. Although some differences across guidelines exist, evidence and most guidelines support triplet therapy for HEC. It is unclear in these guidelines why multiday HEC recommendations do not include an NK1.