Chemotherapy-induced nausea and vomiting (CINV) is a serious problem that can negatively impact a cancer patient’s quality of life and affect the timely deliver and ability to give the most effective doses of the chemotherapy treatment. The risk for CINV in any given patient is dependent on patient-related factors, and most importantly, the innate emetogenicity of the chemotherapy agents themselves. If left untreated, agents classified as highly emetogenic will likely cause CINV in more than 90% of patients, and moderately-emetogenic regimens have a 30% to 90% frequency of emesis. Prevention of emesis is key, and evidence-based guidelines exist to direct healthcare practitioners in the proper use of the most effective regimens recommended for each level of chemotherapy emetogenicity. These regimens typically include a serotonin antagonist, a neurokinin-1 antagonist, and dexamethasone. These medications must cover both the acute and delayed period of time after chemotherapy is given. If breakthrough nausea or emesis occurs despite optimal prophylaxis, then appropriate antiemetics must be given, typically from a class of drugs that is different from what was originally administered. Anticipatory nausea may occur prior to chemotherapy in patients whose symptoms were not well controlled in a previous cycle of chemotherapy and should be treated preventively.
The goal of this activity is to provide guidance in the use of antiemetic regimens for prevention of nausea and vomiting that is associated with moderately and highly emetogenic chemotherapy, according to evidence-based guidelines. Despite appropriate prophylaxis, the principles of treatment for breakthrough nausea and vomiting will also be described.
This activity is designed for oncology healthcare providers (oncologists, oncology nurses, and oncology physician assistants) who care for patients with CINV. No prerequisites required.
After participating in this activity, the participant will demonstrate the ability to:
- RECOGNIZE the impact untreated CINV has on chemotherapy adherence and overall patient outcomes.
- ASSESS patient-specific and therapy-specific CINV risk factors.
- IDENTIFY current and emerging antiemetics used as single agents or in combination therapy for CINV.
- APPLY evidence-based strategies to prevent and manage CINV in patients receiving moderately or highly emetogenic chemotherapy regimens.
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As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine Office of Continuing Medical Education (OCME) to require signed disclosure of the existence of financial relationships with industry from any individual in a position to control the content of a CME activity sponsored by OCME. Members of the Planning Committee are required to disclose all relationships regardless of their relevance to the content of the activity. Faculty are required to disclose only those relationships that are relevant to their specific presentation.
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It is the policy of the Institute for Johns Hopkins Nursing to require our continuing nursing education faculty and planning committee members to disclose any financial relationships with companies providing program funding or manufacturers of any commercial products discussed in the educational activity.
The following relationships have been reported for this activity:
Chair and Planner
David S. Ettinger, MD
Alex Grass Professor in Oncology
Sidney Kimmel Comprehensive Cancer Center
Rebecca Barshick, RN, MSN
The Institute for Johns Hopkins Nursing
Susan Urba, MD
Professor of Internal Medicine
Division of Hematology/Oncology
Medical Director, Symptom Management and Supportive Care Program
University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan
MiKaela Olsen, APRN-CNS, MS, AOCNS
Oncology and Hematology Clinical Nurse Specialist
Sidney Kimmel Comprehensive Cancer Center
Johns Hopkins Hospital and Greenspring Oncology
Participating Faculty Disclosures
No faculty author has indicated that they have any financial interests or relationships with a commercial entity whose products or services are relevant to the content of their presentation(s).
Dr. Ettinger reports serving as a principal investigator for Golden Biotechnology Corp; serving on the data monitoring committee for ARIAD Pharmaceuticals Inc; and serving as a consultant for Boehringer Ingelheim, Bristol-Myers Squibb Company, Eli Lilly and Company, EMD Serono Inc, Genentech Inc. and Helsinn Therapeutics, Inc.
Grants to investigators at The Johns Hopkins University are negotiated and administered by the institution that receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).
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(Updated 4/09 and 3/14)
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The following is an interactive case module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, an interactive case study, and a CME/CNE post-test and evaluation. All 3 sections must be completed to receive CME/CNE credit. A certificate of participation will be available online immediately following successful completion of the activity.