Best practice management of CINV in oncology patients: II. Antiemetic guidelines and rationale for use.

Antiemetic guidelines for chemotherapy-induced nausea and vomiting (CINV) are important to provide a framework for evidence-based care. Attention and adherence to guidelines can help to close the gap between practitioner prediction and patient experience of CINV. Recent updated recommendations have provided guidance on appropriate use of standard-of-care antiemetics--aprepitant, palonosetron, and other serotonin (5-hydroxytryptamine) type 3 (5-HT3) receptor antagonists and dexamethasone. Guidelines are also important, in that their use is often tied to Medicare or other third-party payment. Limitations of guidelines include an absence of provisions for moving patients up the risk ladder for CINV when they have a poor response to recommended antiemetic treatment, as well as an absence of recommendations for treatment beyond the first cycle of antiemetic therapy. Further work is needed to improve evidence-based care in CINV, including studies focusing on delayed CINV and studies in the palliative-care setting.