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Evidence-Based Recommendations for Cancer Nausea and Vomiting

Arash Naeim, Sydney M. Dy, Karl A. Lorenz, Homayoon Sanati, Anne Walling, Steven M. Asch

From the David Geffen School of Medicine at University of California at Los Angeles; VA Greater Los Angeles Healthcare System, Los Angeles; RAND Health, Santa Monica; University of California, Irvine, Irvine, CA; and Johns Hopkins University, Baltimore, MD

Corresponding author: Arash Naeim, MD, PhD, 10945 LeConte Ave, Ste 2333, Los Angeles, CA 90095; e-mail: anaeim{at}mednet.ucla.edu

The experience of patients living with cancer and being treated with chemotherapy often includes the symptoms of nausea and vomiting. To provide a framework for high-quality management of these symptoms, we developed a set of key targeted evidence-based standards through an iterative process of targeted systematic review, development, and refinement of topic areas and standards and consensus ratings by a multidisciplinary expert panel as part of the RAND Cancer Quality–Assessing Symptoms Side Effects and Indicators of Supportive Treatment Project. For nausea and vomiting, key clinical standards included screening at the initial outpatient and inpatient visit, prophylaxis for acute and delayed emesis in patients receiving moderate to highly emetic chemotherapy, and follow-up after treatment for nausea and vomiting symptoms. In addition, patients with cancer and small bowel obstruction were examined as a special subset of patients who present with nausea and vomiting. The standards presented here for preventing and managing nausea and vomiting in cancer care should be incorporated into care pathways and should become the expectation rather than the exception.

Supported by a grant from Amgen Inc to the RAND Corporation.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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