Chemotherapy-induced nausea and vomiting: prevention, detection, and treatment--how are we doing?

As cancer chemotherapy has led to better medical outcomes, patients' concerns about quality of life and adverse effects have become increasingly important. Chemotherapeutic regimens have improved and are more finely targeted than in the past, but chemotherapy-induced nausea and vomiting (CINV) remains a major obstacle and affects patients' satisfaction with treatment. Despite the development of effective antiemetic therapies and practice guidelines recommending their use, clinical practice lags behind. Patients continue to be undertreated when receiving moderately or highly emetogenic chemotherapy while, perhaps, being overtreated when receiving mildly emetogenic chemotherapy. An understanding of the physiologic and psychological processes that lead to CINV has improved. Different neurotransmitters may trigger acute versus delayed emesis, whereas psychological factors appear to predominate in anticipatory nausea. This supplement will examine current clinical practice to explore where prophylactic treatment for CINV is lagging, determine the role of psychological triggers, and discuss treatment approaches that are supported by existing practice guidelines. In addition, new approaches to treatment, such as neurokinin-1 antagonists, acupressure, and acustimulation, will be discussed.