TABLE 2
Classification and characteristics of CINV
Classification Characteristics
Acute
Occurs within the first 24 hours of treatment, possibly
between 3 and 16 hours
Delayed
Occurs after 24 hours, usually for around three days,
but can persist for up to five days
Anticipatory
A conditioned response occurring before each treatment
episode; factors include previous poor emetic control
Breakthrough Nausea and vomiting that occurs despite recommended
CINV prophylaxis
Refractory
CINV that occurs during subsequent treatment cycles
when antiemetic prophylaxis and/or rescue have failed
in earlier cycles
abnormal tastes and smells), and
the vestibular apparatus.
Classification of CINV
CINV can be classified into five
categories: 6–8
• Acute
• Delayed
• Anticipatory
• Breakthrough
• Refractory.
Each class has a different
profile, which is a factor in
deciding which antiemetic drugs
are most appropriate for its
management (Table 2).
Acute CINV is described as
that occurring within 24 hours
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of chemotherapy administration,
although some agents may induce
emesis within a few hours.
Delayed CINV generally
occurs more than 24 hours after
chemotherapy and commonly
lasts for up to three days, although
this may extend to up to five days.
Optimal emetic control in the
acute phase is essential to prevent
delayed CINV in the delayed
phase and failure to achieve the
former is a strong predictor for
the latter.
Anticipatory CINV is a
conditioned response and is
most commonly associated with
previous experience of poor