Prevention of chemotherapy-induced nausea and vomiting - standards versus clinical practice

In patients' perception, chemotherapy-induced nausea and vomiting (CINV) are the main treatment-related adverse events of anti-cancer treatment. The probability of CINV incidence depends on the treatment regimen, dose, administration route, and patient-dependent factors. According to the current guidelines, a combination of setrons, neurokinin-1 receptor antagonists, and glucocorticoids results in control of acute emesis in 80-90% of patients and delayed emesis in 60-80%. Despite the availability of recommendations for prophylaxis CINV, the level of adherence to the guidelines in clinical practice is lower than observed in trials. Only half of the patients with highly and moderately emetogenic chemotherapy receive prophylaxis consistent with recommendations. Overuse of 5-hydroxytryptamine-3 receptor antagonists, incorrect dosing of corticosteroids, and overuse of metoclopramide in prophylaxis of delayed emesis are the main issues of non-adherence. Possible reasons for non-adherence are: insufficient knowledge of the guidelines, inappropriate CINV risk assessment, underestimation of symptoms reported by the patients, and difficulties in communication between a patient, medical personnel, and physician. To improve adequate control of CINV and adherence to the guidelines repetitive educational, administrative, and scientific actions need to be taken.