Guidelines for anti-emetic therapy: Acute emesis

Anti-emetic therapy has become integral to the management of patients with cancer. Goals related to complete emesis control include providing treatmen t that reduces hospitalisation and time in the ambulatory setting, care tha t is convenient for the patient and therapy that enhances patients' quality of life. A panel of clinical, health economic and basic scientists with ex pertise in various oncology disciplines reviewed published literature to de velop evidence-based consensus guidelines for the prevention and treatment of chemotherapy-induced emesis. Currently, serotonin receptor antagonists a nd corticosteroids are the two categories of anti-emetics that are most eff ective, have the fewest side-effects and are convenient to use. These agent s are recommended in combination for highly emetogenic chemotherapy regimen s and as single agents or in combination for moderately to highly emetogeni c chemotherapy. When possible, these agents may be given orally in single d oses; current evidence does not support dose escalation for either category of anti-emetics. In special situations, such as the use of high-dose chemo therapy combination regimens, the most emetogenic component of the regimen should dictate the choice of anti-emetic. Appropriate anti-emetic use descr ibed in these guidelines represents both good medical practice and a sensib le economic approach to care. (C) 1999 Elsevier Science Ltd. All rights res erved.