strength of a recommendation,
such as patient values and
preferences. 3
Key issues
One of the key issues in
the development of CINV
is the emetogenicity of the
chemotherapy drugs. Not all
chemotherapy drugs have the same
level of emetogenicity. Antiemetic
guidelines provide a guide for
the clinician to understand the
particular level of emetogenicity,
dividing drugs into four distinct
categories. These include highly
emetogenic chemotherapy
(HEC), where more than 90% of
patients are likely to experience
nausea and vomiting if left
untreated; moderately emetogenic
chemotherapy (MEC), where 30–
90% of patients can develop nausea
and vomiting if left untreated;
low emetogenic chemotherapy
(LEC), where 10–30% of patients
can develop nausea and vomiting
if left untreated, and minimally
emetogenic chemotherapy
(MiEC), where less than 10% of
patients can develop nausea and
vomiting if left untreated. This
classification is very important, as
each level of drug emetogenicity
is linked with specific treatment
recommendations in the
guidelines.
Understanding of the levels
of emetogenicity can assist in
minimising variations among
clinicians in the way they
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