# Expert Consensus Guidance on the Management of Chemotherapy-Induced Nausea and Vomiting: An Indian Perspective

## TL;DR

This paper presents expert consensus on managing chemotherapy-induced nausea and vomiting in India, aiming to improve cancer care by adapting international guidelines to local needs.

## Contribution

The study provides region-specific clinical statements for CINV management in India, incorporating expert consensus and local healthcare realities.

## Key findings

- Netupitant and palonosetron with dexamethasone are recommended as preferred CINV prophylactic regimens in India.
- 11 clinical statements achieved consensus among Indian oncologists using the modified Delphi method.
- Three statements received near or fair consensus, highlighting areas needing further research or discussion.

## Abstract

Chemotherapy-induced nausea and vomiting (CINV) significantly impact patients' quality of life and treatment adherence, with high incidence rates despite the use of antiemetic prophylaxis. While international guidelines provide recommendations for managing CINV, the diverse healthcare landscape in India necessitates tailored, region-specific guidelines. This study was conducted to develop and validate consensus-based clinical statements on CINV management tailored to the Indian context, aiming to enhance the quality of cancer care across the nation by aligning international insights with local experiences. A comprehensive literature review and a consensus-based methodology were employed. 150 Indian oncologists participated in developing 14 clinical statements through the modified Delphi method. Two rounds of voting were conducted to assess agreement levels, categorizing the statements into the following three categories: consensus, near or fair consensus, and no consensus. Consensus was achieved for 11, while three received near or fair consensus. In areas where data or agreement was lacking, expert opinions were incorporated to supplement the findings. One of the findings from this study indicated strong consensus for the use of netupitant and palonosetron along with dexamethasone as the preferred CINV prophylactic regimens in an Indian setting. The consensus statements developed in this study will assist Indian oncologists in making informed, tailored decisions regarding CINV prevention and management across diverse healthcare settings.