A Focus on Supportive Care:
Strategies to Improve Nausea and Vomiting in Cancer Patients

Presented by the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing.

Supported by an educational grant from Merck & Co, Inc.

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.
The Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing take responsibility for the content, quality, and scientific integrity of this CME/CNE activity.

Accreditation Statements — This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Credit Designation Statements — The Johns Hopkins University School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category I CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This .5 contact hour of educational activity is provided by the Institute for Johns Hopkins Nursing. Claim only those contact hours actually spent in the activity. Statements will be awarded for this educational activity until November 19, 2018.

Release date: November 18, 2016    Expiration date: November 19, 2018

Full Disclosure Policy Affecting CME Activities
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.

Policy on Faculty and Provider Disclosure
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
Baltimore, Maryland

Nurse Planner
Rebecca Barshick, RN, MSN

Nurse Educator
The Institute for Johns Hopkins Nursing
Baltimore, Maryland

Participating Faculty
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

Nurse Reviewer
MiKaela Olsen, APRN-CNS, MS, AOCNS

Oncology and Hematology Clinical Nurse Specialist
Ambulatory Oncology
Sidney Kimmel Comprehensive Cancer Center
Johns Hopkins Hospital and Greenspring Oncology Baltimore, Maryland

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).

Planner Disclosures
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.

Note: 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).

Non-Endorsement of Products
The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity.

The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.

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I understand that while I am attending in this capacity, I may be exposed to "protected health information," as that term is defined and used in Hopkins policies and in the federal HIPAA privacy regulations (the “Privacy Regulations”). Protected health information is information about a person's health or treatment that identifies the person.

I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential. I agree not to post or discuss this protected health information, including pictures and/or videos, on any social media site (eg, Facebook, Twitter, etc.), in any electronic messaging program or through any portable electronic device.

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For CME questions, please contact the CME Office at 410-955-2959 or e-mail cmenet@jhmi.edu.
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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.


A Focus on Supportive Care:
Strategies to Improve Nausea and Vomiting in Cancer Patients

Susan Urba, MD


This activity was developed in collaboration with ASiM.

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