healthcare utilisation and costs,
and enables physicians to integrate
the latest clinical research into
their daily practice, 7 uptake is low
for a variety of physician-linked
or institutional reasons. It seems
that providing recommendations
to oncology practices alone is
not an effective way to increase
antiemetic guideline utilisation,
and a combination of educational
strategies is more effective. 8
Furthermore, what the antiemetic
guidelines do not do is to well
identify and define those patients
at an increased risk for developing
nausea and vomiting during
cancer treatments (patient risk
factors are described in detail
in other sections of this pocket
guide). Other effective
methods include
patient feedback
to clinicians or
a multifaceted
pharmacist-led
intervention
that includes
guideline
dissemination,
use of opinion
leaders, interactive
educational workshops,
therapeutic reminders
in the form of preprinted
orders, clinical interventions
by pharmacists for the event of
inappropriate antiemetic orders,
and physician audit and feedback. 7
Furthermore, a multitude of
personal, sociodemographic and
clinical characteristics are risk
factors for nausea and vomiting. 9
Anxiety, history of nausea/
vomiting, and patient expectations
of nausea are important predictors
for some phases and cycles of
treatment but not consistently
across the nausea/vomiting
pathway. 9 Also, antiemetic
guidelines are all based on the first
cycle of chemotherapy; hence,
there are no recommendations for
treating patients in subsequent
cycles, particularly if patients in
the first cycle have failed ‘optimal’
treatment. The strength of
evidence in antiemetic guidelines
is weak in several areas of
nausea/vomiting management,
including breakthrough nausea/
vomiting, multiple
day chemotherapy
(including in the
haematology
setting),
radiotherapy,
and in LEC/
MEC. Finally,
guidelines can
also become out
of date quickly,
particularly in a
rapidly evolving field
such as CINV management,
and these need to have
mechanisms to bring new data into
the existing recommendations and
be updated regularly. Finally, a tool
to help clinicians make appropriate
clinical decisions is available (www.
riskcinv.org) based on work
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