Care Excellence in England. 5
In the context of developing
guidelines for the prophylaxis
and treatment of CINV, a
multidisciplinary team must
be involved and include
representation from a clinician,
a nurse and a pharmacist. The
pharmacist has the training and
experience required to interpret
complex clinical information
from national and international
guidelines and clinical research
and translate this into practical
guidance and advice for daily use
in the clinic.
Once the guideline has been
written, it must be circulated to
other members of the team for
feedback and comments. The
purpose is to ascertain whether
other clinicians or healthcare
professionals would make
similar recommendations. 5 Once
finalised, the information must be
disseminated to the appropriate
clinicians and practitioners via
groups such as clinical governance
meetings. Agreed antiemetic
regimens can then be built into
electronic prescribing systems
to ensure compliance with
recommendations.
Approved clinical guidelines
must be used as best practice.
However, there might be
circumstances when individual
patients require a more tailored
treatment plan, in which case the
pharmacist can play a key role in
assessing the patient’s needs and
78 | 2018 | hospitalpharmacyeurope.com
should not be limited by clinical
guidelines, instead treating the
patient using a holistic approach.
Pharmacists can play a key
role in the pre-assessment
process for patients starting on
chemotherapy, which includes
an assessment of the factors that
affect the likelihood of the patient
experiencing CINV. Some of the
patient-related factors are shown
in Table 1. 6
Sekine et al 6 investigated risk
factors for CINV in both the
acute and delayed settings using
a number of randomised trials of
moderately and highly emetogenic
chemotherapy. They found various
factors, including female gender,
Table 1
Patient-related
risk factors
• Female gender
• History of nausea and vomiting
• History of morning sickness
(pregnant women)
• Occurrence of nausea and
vomiting after prior cycles of
chemotherapy
• Symptom distress (pain)
• High anxiety before the
chemotherapy session
• Less sleep during the night
prior to the chemotherapy session
• Use of non-prescription
antiemetic drugs at home
• Low alcohol consumption