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Sally Yowell Barbour

Chemotherapy-induced nausea and vomiting (CINV) is one of the most feared side effects of cancer treatment, despite the advances over the past decades. Corticosteroids have been shown to be effective in the management of CINV. These agents are usually used in combination with serotonin antagonists and neurokinin-1 antagonists for highly or moderately emetogenic chemotherapy or as monotherapy for low-emetogenic chemotherapy. Consensus guidelines provide guidance regarding the scenarios in which corticosteroids are recommended. This article reviews the mechanism of action, role, and safety of corticosteroids in the management of CINV.

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David S. Ettinger, Debra K. Armstrong, Sally Barbour, Michael J. Berger, Philip J. Bierman, Bob Bradbury, Georgianna Ellis, Steve Kirkegaard, Dwight D. Kloth, Mark G. Kris, Dean Lim, Michael Anne Markiewicz, Lida Nabati, Carli Nesheiwat, Hope S. Rugo, Steven M. Sorscher, Lisa Stucky-Marshal, Barbara Todaro and Susan Urba

Antiemesis Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lowerlevel evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lowerlevel evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Overview Chemotherapy-induced vomiting (emesis) and nausea can significantly affect a patient's quality of life, leading to poor compliance with further chemotherapy treatment. Nausea and vomiting can also result in metabolic imbalances, degeneration of self-care and functional ability, nutrient depletion, anorexia, decline of performance and mental status, wound dehiscence, esophageal tears, and withdrawal from potentially useful or curative anticancer treatment.1–4 The incidence and severity of nausea and/or vomiting in patients undergoing chemotherapy are affected by numerous factors, including 1) the specific chemotherapeutic agents used, 2) dosage of the agents, 3) schedule and route of administration of the agents, and 4) individual patient variability (e.g., age, sex, prior chemotherapy, history of alcohol use). Approximately 70% to 80% of all patients undergoing chemotherapy experience nausea and/or vomiting,5,6 whereas 10% to 44% experience anticipatory nausea and/or vomiting;7–10 patients often experience more...
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David S. Ettinger, Debra K. Armstrong, Sally Barbour, Michael J. Berger, Philip J. Bierman, Bob Bradbury, Georgianna Ellis, Steve Kirkegaard, Dwight D. Kloth, Mark G. Kris, Dean Lim, Laura Boehnke Michaud, Lida Nabati, Kim Noonan, Hope S. Rugo, Darby Siler, Steven M. Sorscher, Sundae Stelts, Lisa Stucky-Marshall, Barbara Todaro and Susan G. Urba

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Michael J. Berger, David S. Ettinger, Jonathan Aston, Sally Barbour, Jason Bergsbaken, Philip J. Bierman, Debra Brandt, Dawn E. Dolan, Georgiana Ellis, Eun Jeong Kim, Steve Kirkegaard, Dwight D. Kloth, Ruth Lagman, Dean Lim, Charles Loprinzi, Cynthia X. Ma, Victoria Maurer, Laura Boehnke Michaud, Lisle M. Nabell, Kim Noonan, Eric Roeland, Hope S. Rugo, Lee S. Schwartzberg, Bridget Scullion, John Timoney, Barbara Todaro, Susan G. Urba, Dorothy A. Shead and Miranda Hughes

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Antiemesis address all aspects of management for chemotherapy-induced nausea and vomiting. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Antiemesis, specifically those regarding carboplatin, granisetron, and olanzapine.