/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/cpg/,/clinical/cckm-tools/content/cpg/nausea-and-vomiting/,

/clinical/cckm-tools/content/cpg/nausea-and-vomiting/name-97597-en.cckm

20170247

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Clinical Practice Guidelines,Nausea and Vomiting

Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting - Adult - Inpatient/Ambulatory

Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting - Adult - Inpatient/Ambulatory - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Nausea and Vomiting


1
Prevention and Treatment of
Chemotherapy-Induced Nausea and
Vomiting - Adult - Inpatient/Ambulatory
Clinical Practice Guideline
Note: Active Table of Contents – Click to follow link
Table of Contents
EXECUTIVE SUMMARY ........................................................................................................... 3
SCOPE ...................................................................................................................................... 4
METHODOLOGY ...................................................................................................................... 5
DEFINITIONS ............................................................................................................................ 5
INTRODUCTION ....................................................................................................................... 6
RECOMMENDATIONS .............................................................................................................. 6
UW HEALTH IMPLEMENTATION ............................................................................................12
REFERENCES .........................................................................................................................12
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

2
CPG Contact for Content:
Name: Mary Mably, RPh, BCOP - Pharmacy
Phone Number: (608) 263-1263
Email: mmably@uwhealth.org
CPG Contact for Changes:
Name: Philip Trapskin, PharmD, BCPS – Manager, Drug Policy Program
Phone Number: (608) 263-1328
Email: ptrapskin@uwhealth.org
Guideline Revision Author:
Sara Koth, PharmD – Pharmacy
Jason R. Jared, PharmD – Pharmacy
Original Guideline Author(s):
Mary Mably, RPh, BCOP; Kate Simondsen, PharmD; Daniel Mulkerin, MD; Michael Reed, RPh,
BCOP; Sarah Lentz, RPh, BCOP
Coordinating Team Members:
Mary Mably, RPh, BCOP - Pharmacy
Review Individuals/Bodies:
Daniel Mulkerin, MD – Medicine, Hematology/Oncology
Michael Fallon, PharmD, BCOP - Pharmacy
Michael Reed, RPh, BCOP - Pharmacy
Rena Gosser, PharmD, BCPS – Pharmacy, Drug Policy Program
Committee Approvals/Dates:
Original Approval: March 2012
Chemotherapy Council: September, 2015
Pharmacy & Therapeutics Committee: September, 2015
Release Date: September 2015 | Next Review Date: September 2018
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

3
Executive Summary
Guideline Overview
This clinical practice guideline is intended to guide the prescribing of anti-emetics to prevent and
treat chemotherapy induced nausea and vomiting. It is compiled from an extensive literature
review of current evidence and external clinical practice guidelines related to chemotherapy
induced nausea and vomiting.
Key Practice Recommendations
1. Emetogenic potential of single chemotherapy agents should be determined. (Class I, Level
A)
2. For multi-drug chemotherapy regimens, emetogenic potential should be based on the drug
with the highest emetic risk. (Class I, Level A)
3. Recommended prophylactic anti-emetic regimens should be administered based on
emetogenic potential of the chemotherapy regimen for low, moderate, and high emetic risk
regimens. (Class I, Level A)
4. An additional agent from a different drug class than any scheduled anti-emetics is
recommended for the treatment of breakthrough CINV. (Class I, Level A)
Companion Documents
1. Renal Function-based Dose Adjustments – Adult – Inpatient – Clinical Practice Guideline
Pertinent UW Health Policies & Procedures
1. UWHC Policy 8.59: Chemotherapy Processes: Informed Consent, Ordering, Verification,
Administration, Documentation and Patient/Family Education
Patient Resources
1. Health Fact ID 4700: Prochlorperazine/Phenothiazines for Nausea and Vomiting
2. Health Fact ID 6569: Controlling Your Nausea
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

4
Scope
Disease/Condition(s): Patients receiving chemotherapy who may develop or have
developed chemotherapy-induced nausea and vomiting (CINV)
Clinical Specialty: Bone marrow transplant, hematology, oncology, radiation oncology,
pharmacy, nursing
Intended Users: Physicians, advanced practice providers, pharmacists, registered nurses
Objective(s): Minimize morbidity by preventing and treating nausea and vomiting caused by
chemotherapy
Target Population: Patients greater than or equal to 18 years of age who are receiving
chemotherapy
Interventions and Practices Considered: This guideline provides
recommendations for anti-emetic pre-medication based on the emetic potential of chemotherapy
and for management of acute-onset, delayed-onset, anticipatory, breakthrough, and refractory
nausea and vomiting associated with chemotherapy. Non-medication therapies were not
considered
Major Outcomes Considered: Incidence and severity of nausea and vomiting with
chemotherapy
Guideline Metrics:
ξ Identification of emetogenic potential of chemotherapy regimens
ξ Initiation of prophylactic anti-emetic therapy based on emetogenic risk of the chemotherapy
regimen
ξ Ensuring availability of anti-emetics for breakthrough and refractory nausea and vomiting
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

5
Methodology
1. PUBMED was searched using the terms “antieme* AND chemotherapy AND NCCN,”
“antieme* AND chemotherapy AND ASCO”. References from identified articles were further
evaluated. Internal expert opinion was also incorporated into guideline development in
cases of a lack of evidence or conflicting evidence.
2. A modified Grading of Recommendations Assessment, Development, and Evaluation
(GRADE) developed by the American Heart Association and American College of
Cardiology Foundation has been used to assess the Quality and Strength of the Evidence in
this Clinical Practice Guideline (Figure1).1
Definitions
1. Types of nausea and vomiting:
1.1. Acute-onset: occurs within a few minutes to several hours after chemotherapy
administration and commonly resolves within 24 hours with peak intensity at 5-6
hours2-4
1.2. Delayed-onset: occurs more than 24 hours after chemotherapy administration and
commonly resolves within six or seven days with peak intensity at 48-72 hours2-4
1.3. Anticipatory: occurs before a patient receives the next chemotherapy treatment as a
conditioned response usually secondary to a negative experience with
chemotherapy2,4
1.4. Breakthrough: occurs despite prophylactic treatment, requiring rescue antiemetic
therapy2
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

6
1.5. Refractory: occurs during subsequent cycles when antiemetic prophylaxis and
rescue have failed in earlier cycles2,4
2. Emetogenic potential of chemotherapy2,4
2.1. High emetic potential: 90% or more of patients experience acute emesis in the
absence of anti-emetic medications
2.2. Moderate emetic potential: 30-90% of patients experience acute emesis in the
absence of anti-emetic medications
2.3. Low emetic potential: 10-30% of patients experience acute emesis in the absence of
anti-emetic medications
2.4. Minimal emetic potential: less than 10% of patients experience acute emesis in the
absence of anti-emetic medications
Introduction
Chemotherapy-induced nausea and vomiting (CINV) is a serious side effect of chemotherapy
that can significantly impact a patient’s quality of life.2 Additionally, uncontrolled emesis can
result in electrolyte imbalances, nutrient depletion, anorexia, decline in functional status, poor
compliance, and withdrawal from potentially beneficial chemotherapy treatment.2,4 Severe CINV
can prolong hospitalizations and increase health care costs. One review confirmed that the cost
associated with CINV prophylaxis was less than the cost of care for patients who did not receive
adequate CINV prophylaxis.5 The incidence and severity of CINV depends on a number of
factors including emetogenic potential of the drug, dosing and schedule of chemotherapy and/or
radiation therapy, and patient-specific characteristics such as age, gender, prior chemotherapy,
and alcohol use.2
The primary goal of anti-emetic therapy is to prevent nausea and vomiting completely, and
advances in medication therapy over the past decades have made this increasingly possible.4
More than 90% of patients receiving a highly emetogenic chemotherapy regimen will experience
episodes of emesis without anti-emetic therapy. This number falls to about 30% if patients
receive appropriate anti-emetic therapy prophylactically.2 If complete prevention of CINV is not
possible, the secondary goal is to minimize the morbidity associated with CINV as much as
possible.
Recommendations
1. Classification of emetogenic potential of select chemotherapy agents
1.1. Emetogenic potential of single chemotherapy agents should be determined based on
Tables 1 and 2. (Class I, Level A)2-4
1.2. For multi-drug chemotherapy regimens, emetogenic potential should be based on
the drug with the highest emetic risk. (Class I, Level A) 2,3
1.2.1. Risk level should be increased by one with addition of a moderate-risk agent.
(Class I, Level A)2
1.2.2. Risk level should not be increased with addition of a low- or minimal-risk
agent. (Class I, Level A)2
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

7
Table 1: emetogenic potential of select IV chemotherapy agents2-4
High Moderate Low Minimal
AC combination as defined as
either doxorubicin or
epirubicin with
cyclophosphamide
Carmustine > 250 mg/m2
Cisplatin a
Cyclophosphamide > 1500
mg/m2 a
Dacarbazine
Doxorubicin > 60 mg/m2 a
Epirubicin > 90 mg/m2
Ifosfamide > 2 g/m2 per dose
Mechlorethamine
Streptozosin
Aldesleukin > 12-15 million
IU/m2
Amifostine > 300mg/m2
Arsenic trioxide
Azacitidine
Bendamustine
Busulfan
Carboplatin a*
Carmustine ≤ 250 mg/m2 *
Clofarabine
Cyclophosphamide < 1500
mg/m2 a
Cytarabine > 200 mg/m2
Dactinomycin*
Daunorubicin*
Doxorubicin < 60 mg/m2 a*
Epirubicin < 90 mg/m2
Idarubicin
Ifosfamide <2 g/m2 *
Interferon alfa ≥ 10 million
IU/m2
Irinotecan*
Melphalan
Methotrexate ≥ 250 mg/m2*
Oxaliplatin
Temozolamide
Ado-trastuzumab emtansine
Aldesleukin ≤ 12 million IU/m2
Amifostine ≤ 300 mg/m2
Belinostat
Blinatumomab
Brentuximab vedotin
Cabazitaxel
Carfilzomib
Cytarabine (low dose) 100-
200 mg/m2
Docetaxel
Doxorubicin (liposomal)
Eribulin
Etoposide
Floxuridine
Fluorouracil (5-FU)
Gemcitabine
Interferon alfa 5-10 million
IU/m2
Ixabepilone
Methotrexate 50-250 mg/m2
Mitomycin
Mitoxantrone
Omacetaxine
Paclitaxel
Paclitaxel-albumin
Pemetrexed
Pentostatin
Pralatrexate
Romidepsin
Thiotepa
Topotecan
Ziv-aflibercept
Alemtuzumab
Asparaginase
Bevacizumab
Bleomycin
Bortezomib
Cetuximab
Cladribine
Cytarabine <100 mg/m2
Decitabine
Denileukin diftitox
Dexrazoxane
Fludarabine
Interferon alfa <5 million IU/m2
Ipilimumab
Methotrexate ≤ 50mg/m2
Nelarabine
Nivolumab
Obinutuzumab
Ofatumumab
Panitumumab
Pegasparaginase
Peginterferon
Pembrolizumab
Pertuzumab
Ramucirumab
Rituximab
Siltuximab
Temsirolimus
Trastuzumab
Valrubicin
Vinblastine
Vincristine
Vincristine (liposomal)
Vinorelbine
a
Commonly associated with delayed nausea and vomiting
* May be highly emetogenic in some patients
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

8
Table 2: emetogenic potential of select oral chemotherapy agents2
Moderate to High Minimal to Low
Altretamine
Busulfan > 4 mg/day
Ceritinib
Crizotinib
Cyclophosphamide > 100
mg/m2/day
Estramustine
Etoposide
Lenvantanib
Lomustine (single day)
Mitotane
Olaparib
Panobinostat
Procarbazine
Temozolomide > 75 mg/m2/day
Vismodegib
Afatinib
Axitinib
Bexarotene
Bosutinib
Busulfan < 4 mg/day
Cabozantanib
Capecitabine
Chlorambucil
Cyclophosphamide < 100
mg/m2/day
Dasatinib
Dabrafenib
Erlotinib
Everolimus
Fludarabine
Gefitinib
Hydroxyurea
Ibrutinib
Idelalisib
Imatinib
Lapatinib
Lenalidomide
Melphalan
Mercaptopurine
Methotrexate
Nilotinib
Palbociclib
Pazopanib
Pomalidomide
Ponatinib
Regorafenib
Ruxolitinib
Sorafenib
Sunitinib
Temozolomide ≤ 75 mg/m2/day
Thalidomide
Thioguanine
Topotecan
Trametinib
Tretinoin
Vandetanib
Vemurafenib
Vorinostat
2. Selection and administration of prophylactic anti-emetic therapy
2.1. Recommended prophylactic anti-emetic regimens are listed in Tables 3 through 6
and should be administered based on emetogenic potential of the chemotherapy
regimen for low, moderate, and high emetic risk regimens. (Class I, Level A)2,4
2.1.1. No routine prophylaxis is recommended for minimal emetogenic
chemotherapy. (Class I, Level A)2-4
2.2. All prophylactic anti-emetics should be administered 30 minutes prior to
administration of chemotherapy unless otherwise specified. For continuous infusion
chemotherapy, the anti-emetics should be given 30 minutes prior to the start of
therapy and every 24 hours while the infusion is running. (Class I, Level A)2
2.3. The oral route is the recommended route of therapy, as intravenous and oral
formulations have been found to be equally safe and effective. (Class I, Level A)2-4
2.3.1. Ondansetron orally disintegrating tablets (ODT) are recommended for
patients who have difficulty swallowing the tablet formulation. (Class I, Level
A)3
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

9
2.4. For patients who experience CINV—especially delayed CINV—despite maximized
doses of ondansetron or for patients unable to tolerate oral therapy, palonosetron is
recommended for subsequent cycles of chemotherapy. (Class I, Level A)2-4
2.5. Granisetron is indicated for patients who are unable to tolerate ondansetron due to
side effects. (Class I, Level A)2,4
2.6. Patients who experience refractory CINV should receive a higher level of
prophylactic anti-emetic therapy with subsequent chemotherapy cycles. (Class I,
Level A)2,3
Table 3: anti-emetics for high emetic risk IV chemotherapy2-4
High risk IV chemotherapy
Able to tolerate oral therapy Unable to tolerate oral therapy
1. Preferred regimen
Day 1: ondansetron 24 mg PO + dexamethasone
12 mg PO + aprepitant* 125 mg PO 30 minutes
prior to chemotherapy
Days 2-4: aprepitant* 80 mg PO daily on days 2
and 3 + dexamethasone 8 mg PO daily on days
2, 3 and 4
2. Alternative regimen
Day 1: olanzapine 10 mg PO + ondansetron 24
mg + dexamethasone 12 mg PO 30 minutes prior
to chemotherapy
Days 2-4: olanzapine 10 mg PO daily on days 2,
3 and 4
1. Preferred regimen
Day 1: fosaprepitant 150 mg IV + ondansetron 12
mg IV + dexamethasone 10 mg IV 30 minutes
prior to chemotherapy
Days 2-4: dexamethasone 8 mg IV daily on days
2, 3 and 4
* Fosaprepitant 150 mg IV on day 1 only is an acceptable alternative to oral aprepitant
Table 4: anti-emetics for moderate emetic risk IV chemotherapy2-4
Moderate risk IV chemotherapy
Able to tolerate oral therapy Unable to tolerate oral therapy
1. Preferred regimen
Day 1: ondansetron 16 mg PO + dexamethasone
8-12 mg PO 30 minutes prior to chemotherapy*
Days 2-3: ondansetron 8 mg PO BID for 2 days
after completion of chemotherapy (preferred) OR
dexamethasone 8 mg PO daily for 2 days after
completion of chemotherapy
2. Alternative regimen
Day 1: olanzapine 10 mg PO + ondansetron 8
mg + dexamethasone 20 mg PO 30 minutes prior
to chemotherapy
Days 2-3: olanzapine 10 mg PO daily for 2 days
after completion of chemotherapy
1. Preferred regimen
Day 1: ondansetron 8 mg IV + dexamethasone
10 mg IV 30 minutes prior to chemotherapy
Days 2-4: ondansetron 8 mg IV daily for 3 days
after completion of chemotherapy (preferred) OR
dexamethasone 8 mg IV daily for 2 days after
completion of therapy
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

10
* For patients at high-risk for CINV, consider adding aprepitant 125 mg PO on day 1, aprepitant 80 mg
PO daily on days 2 and 3 OR fosaprepitant 150 mg IV once on day 1. If fosaprepitant is used, ±
dexamethasone 8 mg PO/IV on days 2 and 3.
Table 5: anti-emetics for low emetic risk IV chemotherapy2-4
Low risk IV chemotherapy
Able to tolerate oral therapy Unable to tolerate oral therapy
1. Preferred regimen: ondansetron 8 mg PO 30
minutes prior to chemotherapy
2. Alternative regimens:
Dexamethasone 10 mg PO 30 minutes prior to
chemotherapy
OR
Prochlorperazine 10 mg PO 30 minutes prior to
chemotherapy
OR
Metoclopramide 10-40 mg PO 30 minutes prior
to chemotherapy
1. Preferred regimen: ondansetron 8 mg IV 30
minutes prior to chemotherapy
2. Alternative regimens:
Dexamethasone 10 mg IV 30 minutes prior to
chemotherapy
OR
Prochlorperazine 10 mg IV 30 minutes prior to
chemotherapy
OR
Metoclopramide 10-40 mg IV 30 minutes prior
to chemotherapy
* Repeat doses daily for multiday chemotherapy regimens
Table 6: anti-emetics for oral chemotherapy2
Moderate to high risk Minimal to low risk
Start before chemotherapy and continue daily
1. Preferred regimen: ondansetron 16-24 mg PO
daily (dose may be split)
2. Alternative regimen:
Granisetron 1-2 mg PO daily if unable to
tolerate ondansetron
1. Preferred regimen: ondansetron 8-16 mg PO
daily PRN
2. Alternative regimens:
Prochlorperazine 10 mg PO, then every 6
hours PRN (maximum 40 mg / day)
OR
Metoclopramide 10-40 mg PO, then every 4-6
hours PRN
OR
Haloperidol 1-2 mg PO every 4-6 hours PRN
3. Selection of anti-emetic therapy for breakthrough CINV
3.1. Rescue anti-emetics for breakthrough CINV are reasonable for all patients receiving
chemotherapy. (Class IIa, Level C)
3.2. An additional agent from a different drug class than any scheduled anti-emetics is
recommended for the treatment of breakthrough CINV. (Class I, Level A)2-4
3.3. Doses of all anti-emetic medications should be maximized for the treatment of
breakthrough CINV. (Class I, Level A)4
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

11
3.4. Anti-emetics found to be effective for a patient should be scheduled for the duration
of the emetic risk and incorporated into the anti-emetic regimen for subsequent
cycles of chemotherapy. (Class I, Level A)2
3.5. Multiple concurrent agents, listed in Table 7, are indicated for the management of
breakthrough CINV. (Class I, Level A)2,4
3.6. Antacid therapy with ranitidine should be considered if the patient has dyspepsia
(Class I, Level A)2
Table 7: anti-emetics for breakthrough CINV2-4
Breakthrough CINV (order does not imply preference)
Medication Suggested dose
Atypical antipsychotic
Olanzapine 10 mg PO daily for 3 days
Benzodiazepine
Lorazepam 0.5 – 2 mg PO/SL/IV every 6 hours
Antihistamines
Diphenhydramine 12.5 – 50 mg PO/IV every 4-6 hours PRN
Phenothiazines
Prochlorperazine 10 mg PO/IV every 6 hours
25 mg PR every 12 hours
Promethazine 12.5-25 mg PO/IV every 4-6 hours (central line only)
25 mg PR every 6 hours
Butyrophenones
Haloperidol 0.5-2 mg PO/IV every 4-6 hours
5-HT3 Antagonists
Ondansetron 16 mg PO/IV daily
Miscellaneous
Dronabinol 5-10 mg PO every 3-6 hours
Dexamethasone 12 mg PO/IV daily
Metoclopramide 10-40 mg PO/IV every 4-6 hours
Scopolamine transdermal patch 1 patch every 72 hours
4. Selection of anti-emetic therapy for anticipatory CINV
4.1. Effective emetic control with initial cycles of chemotherapy should be a priority, as
this is the major factor in preventing anticipatory CINV. (Class I, Level A)2-4
4.2. In patients with a history of anticipatory nausea and vomiting, pre-treatment with
lorazepam 0.5 – 2 mg PO the night prior to chemotherapy and the morning of
treatment is reasonable. (Class IIa, Level A)2,4
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

12
UW Health Implementation
Potential Benefits:
The primary benefit of implementation of this guideline is the standardization of identifying the
emetogenic risk of chemotherapy regimens and initiation of prophylactic anti-emetics with the
goal of preventing CINV.
Potential Harms:
The risks of implementing this guideline and administering anti-emetic medications include side
effects such as constipation, headache, extrapyramidal effects and QT prolongation.
Qualifying Statements
The above recommendations are based on national consensus guidelines, current evidence
and expert opinion. Patient-specific characteristics and experiences may require deviation from
these recommendations. Furthermore, the recommendations included in this guideline are
subject to change with publication of additional evidence.
Implementation Plan/Tools
1. Guideline will be housed on U-Connect in a dedicated folder for CPGs.
2. Links to this guideline will be updated and/or added in appropriate Health Link or equivalent
tools.
3. Beacon treatment protocols will be created with anti-emetic regimens consistent with these
CPGs.
Disclaimer
CPGs are described to assist clinicians by providing a framework for the evaluation and
treatment of patients. This Clinical Practice Guideline outlines the preferred approach
for most patients. It is not intended to replace a clinician’s judgment or to establish a
protocol for all patients. It is understood that some patients will not fit the clinical
condition contemplated by a guideline and that a guideline will rarely establish the only
appropriate approach to a problem.
References
1. Tricoci P, Allen JM, Kramer JM, Califf RM, Smith SC, Jr. Scientific evidence
underlying the ACC/AHA clinical practice guidelines. JAMA. Vol 301. United
States2009:831-841.
2. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in
Oncology: antiemesis version 1.2015. 2015.
3. Basch E, Prestrud AA, Hesketh PJ, Kris MG, Somerfield MR, Lyman GH.
Antiemetic Use in Oncology: Updated Guideline Recommendations from ASCO.
Am Soc Clin Oncol Educ Book. 2012:532-540.
4. Roila F, Herrstedt J, Aapro M, et al. Guideline update for MASCC and ESMO in
the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting:
results of the Perugia consensus conference. Ann Oncol. 2010;21 Suppl 5:v232-
243.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org

13
5. Carlotto A, Hogsett VL, Maiorini EM, Razulis JG, Sonis ST. The economic
burden of toxicities associated with cancer treatment: review of the literature and
analysis of nausea and vomiting, diarrhoea, oral mucositis and fatigue.
Pharmacoeconomics. 2013;31(9):753-766.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2015CCKM@uwhealth.org