American Society of Clinical Oncology Guideline for Antiemetics in Oncology: Update 2006

Kris, Mark G.; Hesketh, Paul J.; Somerfield, Mark R.; Feyer, Petra; Clark‐Snow, Rebecca; Koeller, James M.; Morrow, Gary R.; Chinnery, Lawrence W.; Chesney, Maurice; Gralla, Richard J.; Grunberg, Steven M.

doi:10.1200/jco.2006.06.9591

Cited by 676 publications

(681 citation statements)

References 92 publications

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“…ASCO for low as well as for moderate risk suggests prophylaxis with a 5-HT 3 antagonist or in some patients a dopamine receptor antagonist, without corticosteroids [27]. It seems like the oncologists have followed MASCC's emesis risk-classification (pelvis= low risk) but none of the antiemetic guidelines [27,31]. Eighty-eight of the nauseous patients (61%) did not take any antiemetics at all, which is not in concordance to any of the guidelines.…”

Section: Discussionmentioning

confidence: 97%

“…In some cases, a wish to reduce prescription cost [1] may result in the choice of a cheaper alternative. The low utilisation of 5-HT 3 antagonists is not in line with evidence-based suggestions for this patient group, both in older [19,21,35] and in more recently updated antiemetic guidelines based on randomised controlled studies [17,27,31]. During upper abdominal irradiation, it has been shown that a 5-HT 3 antagonist given prophylactic (43% had nausea) was more effective than placebo (58% had nausea) [28] and was more effective than corticosteroids only [40].…”

Section: Discussionmentioning

confidence: 99%

“…There are differences between the antiemetic guidelines regarding when and how 5-HT 3 antagonists should be prescribed. Abdominal and pelvic fields are classified as moderate risk for nausea by ASCO (American Association of Clinical Oncology) [27] but pelvic fields as low risk by MASCC (Multinational Association of Supportive Care in Cancer) [31]. MASCC for low risk suggests prophylaxis or rescue with 5-HT 3 antagonists and for moderate risk prophylaxis with 5-HT 3 antagonists, possibly combined with corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

“…MASCC for low risk suggests prophylaxis or rescue with 5-HT 3 antagonists and for moderate risk prophylaxis with 5-HT 3 antagonists, possibly combined with corticosteroids. ASCO for low as well as for moderate risk suggests prophylaxis with a 5-HT 3 antagonist or in some patients a dopamine receptor antagonist, without corticosteroids [27]. It seems like the oncologists have followed MASCC's emesis risk-classification (pelvis= low risk) but none of the antiemetic guidelines [27,31].…”

Section: Discussionmentioning

confidence: 99%

“…For radiotherapy-induced nausea and vomiting there are international antiemetic guidelines [17,27,31] but how they are transferred into daily clinical practice and how satisfied the patients are with their antiemetic treatment is not well investigated. Some clinics offer non-pharmacological methods such as acupuncture as a complement to antiemetics [14] but the interest in undergoing acupuncture treatment in patients with radiotherapy-induced nausea has not, to our knowledge, been studied.…”

Section: Introductionmentioning

confidence: 99%

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One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient

Enblom

Axelsson

Steineck

et al. 2008

Support Care Cancer

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Objective To describe the prevalence of nausea and vomiting during radiotherapy and to compare quality of life, psychological and functional status in patients experiencing or not experiencing nausea.Materials and methods A cross-sectional selection of 368 cancer patients treated with radiotherapy answered a questionnaire (=93% answering rate) regarding nausea, vomiting, actual use of and interest in antiemetic treatment, quality of life and psychological and functional status during the preceding week of radiotherapy. Mean age was 60 years and 66% were women. Main results Nausea was experienced by 39% (145) and vomiting by 7% (28) of patients in general, by 63% in abdominal or pelvic fields and by 48% in head/neck/brain fields. Abdominal/pelvic field (Relative risk (RR) 2.0), age ≤40 years (RR 1.9) and previous nausea in other situations (RR 1.8) implied an increased risk for nausea. Antiemetics were used by 17% and 78% were interested in or wanted more information about acupuncture treatment against nausea. Of the 145 nauseous patients only 25% felt that antiemetics had helped them and 34% would have liked additional treatment, although the nausea intensity was mild in 72%. The nauseous patients reported lower well-being and quality of life, lower satisfaction with aspects of daily living and more frequent anxiety and depressed mood than the patients without nausea. Conclusions Of all patients undergoing radiotherapy, 39% experienced nausea and one third of them would have liked more treatment against the nausea. This study stresses the importance to identify and adequately treat patients with increased risk for nausea related to radiotherapy.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient

Enblom

Axelsson

Steineck

et al. 2008

Support Care Cancer

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Literature Review and Global Consensus on Management of Acute Radiation Syndrome Affecting Nonhematopoietic Organ Systems

Dainiak¹,

Gent²,

Carr³

et al. 2011

Disaster med. public health prep.

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ABSTRACTObjectives:The World Health Organization convened a panel of experts to rank the evidence for medical countermeasures for management of acute radiation syndrome (ARS) in a hypothetical scenario involving the hospitalization of 100 to 200 victims. The goal of this panel was to achieve consensus on optimal management of ARS affecting nonhematopoietic organ systems based upon evidence in the published literature.Methods:English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to conferees in advance of and updated during the meeting. Published case series and case reports of ARS, publications of randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation system. In cases in which data were limited or incomplete, a narrative review of the observations was made.Results:No randomized controlled trials of medical countermeasures have been completed for individuals with ARS. Reports of countermeasures were often incompletely described, making it necessary to rely on data generated in nonirradiated humans and in experimental animals. A strong recommendation is made for the administration of a serotonin-receptor antagonist prophylactically when the suspected exposure is >2 Gy and topical steroids, antibiotics, and antihistamines for radiation burns, ulcers, or blisters; excision and grafting of radiation ulcers or necrosis with intractable pain; provision of supportive care to individuals with neurovascular syndrome; and administration of electrolyte replacement therapy and sedatives to individuals with significant burns, hypovolemia, and/or shock. A strong recommendation is made against the use of systemic steroids in the absence of a specific indication. A weak recommendation is made for the use of fluoroquinolones, bowel decontamination, loperamide, and enteral nutrition, and for selective oropharyngeal/digestive decontamination, blood glucose maintenance, and stress ulcer prophylaxis in critically ill patients.Conclusions:High-quality studies of therapeutic interventions in humans exposed to nontherapeutic radiation are not available, and because of ethical concerns regarding the conduct of controlled studies in humans, such studies are unlikely to emerge in the near future.(Disaster Med Public Health Preparedness. 2011;5:183–201)

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Management of Intractable Nausea and Vomiting in Patients at the End of Life

Wood¹,

Shega²,

Lynch³

et al. 2007

JAMA

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Mr Q is a 50-year-old electronics designer with metastatic esophageal cancer treated with third-line palliative chemotherapy. Recently, he has spent more than half of his time in bed due to a general lack of energy, although he walks without assistance or dyspnea. He was admitted to a university hospital in May 2006 for intractable nausea and vomiting.His medical history was remarkable for migraine headaches, depression, and ulcerative colitis during childhood. He was diagnosed with esophageal cancer by endoscopic biopsy in October 2005. Thoracic computed tomography (CT) scans at the time showed circumferential thickening of the distal esophagus and an enlarged gastrohepatic lymph node. In December 2005, he began presurgical chemotherapy with docetaxel and capecitabine. In February 2006, he underwent an exploratory laparotomy but the tumor was found to be unresectable. A 20 ϫ 20-mm stent was inserted in the gastroesophageal junction for impending obstruction and a jejunostomy feeding tube ( J-tube) was placed. In March 2006, CT scans showed evidence of liver metastases.Mr Q had experienced intermittent nausea and vomiting throughout his course of chemotherapy and reported a painful burning sensation in the chest and epigastrium since the esophageal stenting. Ten days before admission he had begun palliative chemotherapy with capecitabine. Afterwards, his nausea and vomiting worsened considerably, with vomiting episodes occurring up to 10 times a day, consisting of both dry heaves and emesis of bilious fluid. There was no apparent temporal relation of these symptoms to oral in-CME available online at www.jama.com Author Affiliations are listed at the end of this article.

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American Society of Clinical Oncology Guideline for Antiemetics in Oncology: Update 2006

Cited by 676 publications

References 92 publications

One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient

One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient

Literature Review and Global Consensus on Management of Acute Radiation Syndrome Affecting Nonhematopoietic Organ Systems

Management of Intractable Nausea and Vomiting in Patients at the End of Life

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