Academic Day Seminars

ADS – Supportive Measures in Oncology pt. 2

Today we continued to learn about the importance of supportive care in onc patients. Specifically we spoke about Chemotherapy-induced nausea & vomiting (CINV). 

  • Types:
    • acute – within 24 hours of chemo
    • delayed – 2-5 days after chemo
    • anticipatory – prior to chemo
      • They haven’t received the chemo, but because they have had N/V to it in the past, are already N/V just knowing they are about to get it.
    • breakthrough – occuring despite appropriate prophylactic antiemetics
    • refractory – acute/delayed recurring in subsequent cycles
  • Risk factors:
    • females > males
    • adolescents >> older children > younger children (<6y/o)
    • increased ICP
    • GI obstruction
    • infections
    • other emetogenic meds
  • Chemotherapy agents divided into minimal, low, moderate, and high emetogenicity (the same drug can be moderate and low – depending on the dose or route it’s administered)
  • Treatment Alternatives: serotonin 5-HT3 receptor antagonists (e.g. ondansetron), corticosteroids, neurokinin-1 receptor antagonists (e.g. aprepitant), dopamine antagonists (e.g. metoclopramide), anxiolytics (e.g. lorazepam), anticholinergics/antihistamines (e.g. dimenhydrinate), cannadbinoids (e.g. nabilone).
    • Improved effectiveness when used in combination for CINV
    • Refer to POGO guidelines for step-by-step chart
  • Place in therapy:
    • 5-HT3 antagonists: Acute and delayed
    • NK-1 antagonists: Acute and delayed (in combo)
    • Corticosteroids: Acute and delayed (in combo)
    • Dopamine Antagonists: Acute and delayed (low emetogenicity), breakthrough add-on, refractory add-on
    • BZDs: Anticipatory add-on, breakthrough add-on, refractory add-on
    • Cannabinoids: Breakthrough add-on, refractory add-on
    • Antihistamines/Anticholinergics: potentially add-on for breakthrough and refractory
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