CINV Prevention – Opportunities to Improve Patient Care

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

Supported by an educational grant from Helsinn Therapeutics (US), Inc.

Chemotherapy-induced nausea and vomiting (CINV) is a serious problem that can negatively impact a cancer patient’s quality of life and affect timely delivery of the most effective doses of chemotherapy treatment. The risk for CINV in any given patient depends on patient-related factors, and most importantly, the innate emetogenicity of the chemotherapy agents themselves. If no preventive treatment is given, agents classified as highly emetogenic will likely cause CINV in more than 90% of patients, and moderately-emetogenic regimens cause CINV in 30% to 90% of patients. Prevention of emesis is key, and evidence-based guidelines direct healthcare practitioners on proper use of the most effective regimens recommended for each level of chemotherapy emetogenicity. 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 rescue antiemetics must be given from a class of drugs that is different from those that were 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 prophylactically.

The goal of this activity is to provide guidance on the use of antiemetic regimens for prevention of nausea and vomiting that is associated with highly and moderately emetogenic chemotherapy, according to evidence-based guidelines. Principles of treatment for breakthrough nausea and vomiting that occur despite appropriate prophylaxis will also be described.

This activity is intended for oncology healthcare providers, including oncologists, physician assistants, nurse practitioners, and nurses who care for patients at-risk for CINV. No prerequisites are 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 highly or moderately 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
accme_logoThis 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 internet activity for a maximum of 0.5 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This .5 contact hour 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 September 25, 2018.

The estimated time to complete this activity: 30 minutes.

Release date: October 8, 2018    Expiration date: October 8, 2019

Policy On Speaker and Provider Disclosure
It is the policy of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing that the speaker and provider globally disclose conflicts of interest. The Johns Hopkins University School of Medicine OCME has established policies that will identify and resolve conflicts of interest prior to this educational activity. Detailed disclosure will be made prior to presentation of the education.

Full Disclosure Policy Affecting CME Activities
As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), Johns Hopkins University School of Medicine Office of Continuing Medical Education (OCME) requires attested and signed global disclosure of the existence of all financial interests or relationships with commercial interest from any individual in a position to control the content of a CME activity sponsored by OCME. The following relationships have been reported for this activity:

Planner Disclosures
Dr. Ettinger reports serving as a principal investigator for Golden Biotechnology Corp and serving as a consultant for AbbVie Inc, BeyondSpring Pharmaceuticals, Inc, Boehringer Ingelheim Vetmedica, Inc, Bristol-Myers Squibb Company/Sanofi-Aventis US LLC, Eli Lilly and Company, Guardant Health Inc., and Genentech Inc.

Dr. Urba reports serving on the advisory board for Heron Therapeutics Inc.

No other individual with the opportunity to affect this educational content has indicated any financial interests or relationships with a commercial entity.

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).

Johns Hopkins University School of Medicine Chair and Planner
David S. Ettinger, MD

Alex Grass Professor of Oncology
Sidney Kimmel Comprehensive Cancer Center
Baltimore, Maryland

Participating Faculty
Susan G. Urba, MD

Professor of Internal Medicine
Division of Hematology/Oncology
Medical Director, Symptom Management and Supportive Care Program
University of Michigan Rogel Cancer Center
Ann Arbor, Michigan

Nurse Planner
Rebecca Barshick, RN, MSN

Nurse Educator
The Institute for Johns Hopkins Nursing
Baltimore, Maryland

Nurse Reviewer

Oncology and Hematology Clinical Nurse Specialist
Ambulatory Oncology
Sidney Kimmel Comprehensive Cancer Center
Johns Hopkins University School of Medicine
Baltimore, Maryland

Peer Reviewer
Dwight Kloth, PharmD, FCCP, BCOP

Director of Pharmacy
Fox Chase Cancer Center
Philadelphia, Pennsylvania

Off-Label Product Discussion
No author has indicated that he/she will reference unlabeled/unapproved uses of drugs or products.

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.

I certify that I am participating in this Johns Hopkins University School of Medicine activity for CME-accredited training and/or educational purposes.

I understand that while I am participating 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.

I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is: Johns Hopkins Privacy Officer, telephone: 410-735-6509, e-mail: HIPAA@jhmi.edu.

“The Office of Continuing Medical Education at the Johns Hopkins University School of Medicine, as sponsor of this activity, has relayed information with the CME attendees/participants and certify that the visitor is here for training, education and/or observation purposes only.”

For CME questions, please contact the CME Office at 410-955-2959 or e-mail cmenet@jhmi.edu.
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Reviewed & Approved by: General Counsel, Johns Hopkins Medicine (4/1/03) (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.


CINV Prevention – Opportunities to Improve Patient Care

Susan G. Urba, MD

Postassessment and Evaluation

This activity was developed in collaboration with ASiM.

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