Sue Faulkner, BSN RN OCN October 18, 2017 Updates from Congress 2017

Transcription

1 Report: Occurrence and Implications of Chemotherapy-Induced nausea and Vomiting (CINV): Implications for the Oncology Nurse Practitioner to Optimize Patient Outcomes Sue Faulkner, BSN RN OCN October 18, 2017 Updates from Congress 2017

2 Scope of the Problem Chemotherapy- Induced Nausea and Vomiting (CINV) CINV is among the most common, unpleasant, and feared side effects of chemotherapy Approximately 70-80% of all patients who receive chemotherapy experience nausea or vomiting CINV can be prevented in 70-80% of patients with the application of evidence-based treatment guidelines

3 Most Feared Side Effects of Chemotherapy Rank Vomiting Nausea Fatigue 2 Nausea Hair Loss Nausea 3 Hair Loss Vomiting Sleep Disturbances 4 Thought of Coming for Treatment 5 Length of Treatment Time Chronic Fatigue Injections Weight Loss Hair Loss

4 Case Study 1: 48 y/o Female with NSCLC 48 y/o female, smoker Initially diagnosed stage II NSCLC, resected and received adjuvant chemotherapy 1 yr later cancer spread to liver & adrenal glands Significant nausea with cisplatin-based chemotherapy after surgery Single mom of 1 child; her mother very supportive Here to start chemo with pemetrexed 500mg/m 2 + Carboplatin AUC 5

5 According to NCCN guidelines, what is Her risk of CINV with this chemotherapy? a. Minimal b. Low c. Moderate d. High

6 Factors Contributing to CINV: Patient Female Age < 50 years History of low alcohol intake (<1.5 oz/day) History of prior CINV History of motion sickness History of morning sickness Anxiety

7 Case Study 1, cont.: 46 y/o Female with NSCLC To start C1 of pemetrexed and carboplatin chemotherapy Has significant risk factors

8 Goals of Treatment Prevention, rather than reaction, is key Minimize CINV by using optimal meds Choose regimen that will minimize side effects of antiemetics with each patient Have rescue medications on hand at home

9 Key Clinical Takeaways 2 types of risk factors Drug risk level Patient risk factors New changes to NCCN guidelines: Carboplatin at AUC 4 or greater now considered highly emetogenic Patient risk factors should also be considered

10 Other Classes of Agents for CINV Corticosteriods: dexamethasone is most used Benzodiazepines: lorazepam, alprazolam, midazolam Dopamine RAs: metoclopramide, prochorperazine, halperidol Cannabinoids: dronabinol, nabilone

11 Updates on Miscellaneous Agents Ginger Recent studies reported with controversial results and potential interactions with anticoagulants Gabapentin Failed to show benefit over standard 5HT-3 + Dex Megestrol acetate Questionable results due to study design and can have side effects Nifedipine Currently undergoing early phase trials as an antiemetic Dex-sparing regimens Minimizing dex is attractive due to side effects and increasing investigation of adding immunotherapies to standards regimens Currently under investigation

12 Antiemetics in Development for CINV TX-019, an IV NK-1 RA that is WITHOUT polysorbate 80, decreased likelihood of hypersensitivity reaction IV formulation netupitant/palonosetron IV formulation rolapitant Carbamazepine Casopitant- NK-1, did not get FDA approval Intranasal granisetron? Studied in past, not market?

13 References Eaby-Sandy, B. (2017, August 14). Occurrence and implications of chemotherapyinduced nausea and vomiting (CINV). Retrieved from oncolink.org: Eaby-Sandy, M. C. (2017, May 6). Occurence and implications of Chemotherapy-Induced Nausea and Vomiting (CINV): Implications for the Oncology Nurse Practitioner to Optimize Patient Outcomes. Denver, CO, USA: Merck. Jordan, K., Jahn, F., & Aspro, M. (2015, June 1). Recent developments in the prevention of chemotherapy-induced nausea and vomiting (CINV): a comprehensive review. Annals of Oncology, pp Retrieved from National Comprehensive Cancer Network Inc. (2017, May 6). National Comprehensive Cancer Network Guidelines, 2. Retrieved from Antiemesis: Zhang, L. (2017). Abstract Journal of Clinical Oncology(35).