Obstacles to managing chemotherapy-induced nausea and vomiting in high-dose chemotherapy with stem cell transplant

Response

“…We wholeheartedly agree with Tendas et al that education on chemotherapy-induced nausea and vomiting (CINV) in bone marrow transplant (BMT) patients is important and might improve outcomes [1][2][3][4].…”

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Dear Editor,We wholeheartedly agree with Tendas et al that education on chemotherapy-induced nausea and vomiting (CINV) in bone marrow transplant (BMT) patients is important and might improve outcomes [1][2][3][4].While we did not ask our survey participants if they took care of BMT patients, one could speculate that the 15-22 % who indicated they disagreed with the need for education on this topic were likely not involved with BMT patients [1]. Importantly, in our survey, a full 78 to 85 % of hematology/ oncology physicians and nurses, respectively, indicated they either agreed or strongly agreed that education on the prevention/management of CINV in BMT is warranted.

That CINV occurs in patients undergoing BMT is reason enough to offer further education on this topic to health-care providers.

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Chemotherapy induced nausea and vomiting in bone marrow transplant: the unmet need

“…In table 4, when survey results among hematologists/oncologists are reported topic by topic, the second lowest percentage of Bstrong agreementâ nd the highest percentage of Bdisagreement^in the judgment of physicians, with nurse judgment just barely better, are reported for the issue BPrevent/manage CINV in patients undergoing bone marrow transplant.Î t is our opinion that interviewers were not particularly expert in the field of BMT with a low educational need on CINV management in this setting. Indeed, CINV management in BMT is complex [2], knowledge of health care providers is limited, adherence to guidelines is low [3], and moreover, the strength of guidelines recommendations for CINV manage-ment in high-dose chemotherapy is weak, when compared with recommendations for CINV in standard-dose chemotherapy [4]; consequently, contrary to what the reader might deduce, we strongly believe that health care providers need in the field of BMT is high, so that, in order to verify our opinion, we suggest to disseminate the same survey to physicians and nurses operating in this field.…”

Prevention of chemotherapy-induced nausea and vomiting after high-dose melphalan and stem cell transplantation: review of the evidence and suggestions

“…Management of chemotherapy-induced nausea and vomiting (CINV) in high-dose chemotherapy with hemopoietic stem cell transplant (SCT) is challenging [1,2]. However, two features identified in this setting should help facilitate CINV management: First, the same conditioning regimens are often used for different diseases, for example, in autologous SCT, BEAM conditioning is used in both Hodgkin and non-Hodgkin lymphoma, and in allogenic SCT, conditioning has both a myeloablative and immunosuppressive function.…”