| Evidential dimension | Content of evidence | Level of evidence | Recommended strength |
| Risk assessment and management | 1. Prior to chemotherapy, it is recommended to collect and assess the risk factors for nausea and vomiting, the risk of vomiting caused by the proposed chemotherapy regimen, and the history and existing diseases of patients. At present, there is no unified standard for the formulation of antiemetic programs based on the above collected information, but it is suggested that patients with high risk factors and accompanying diseases should be appropriately strengthened than patients without antiemetic programs [13] . | Level 3 | B |
| 2. Before the start of tumor-related therapy, the risk of vomiting should be fully evaluated according to the emetic risk of the proposed antitumor therapy, the patient’s own high risk factors, and the severity of nausea and vomiting in the past, and an individualized vomiting prevention and treatment program should be formulated [14] [15] . | Level 2 | A | |
| 3. History assessment included opioid use, incomplete or complete intestinal obstruction, vestibular dysfunction, tumor brain metastases, electrolyte disturbances, uremia, and liver dysfunction. Be aware of other factors that may contribute to or aggravate nausea and vomiting in cancer patients, such as age (less than 50 years), female gender, prior history of nausea and vomiting, anxiety, fatigue, motion sickness, poor quality of life, and low alcohol intake [13] [15] [16] . | Level 5 | A | |
| 4. All patients receiving hyperemetic or moderate emetic chemotherapy should be fully assessed for their risk of CINV, taking into account emetogenic and patient factors such as gender, age, and history of nausea and vomiting in the planned chemotherapy regimen, and effective preventive measures based on evidence-based guidelines [17] . | Level 3 | A | |
| 5. It is recommended that the Dranitsaris score system can be used to predict the risk of CINV in patients individually [16] . | Level 4 | B | |
| 6. The MASCC antiemetic Evaluation tool (MAT) is recommended as a self-measuring tool for patients to measure nausea and vomiting [16] . | Level 4 | B | |
| 7. Focus on the reassessment of CINV risk: the treatment plan should be reassessed and adjusted before the next cycle of treatment; If the objective of chemotherapy is non-curative, the treatment of refractory vomiting may be adjusted [16] . | Level 5 | A | |
| 8.The efficacy of antiemetic therapy should be evaluated for outpatients at each visit and for inpatients within 24 hours after chemotherapy [18] . | Level 5 | A | |
| 9. The antiemetic effect should be evaluated within 24 hours after application of antiemetic [19] . | Level 2 | A | |
| 10. Strict evaluation of the effect of antiemesis should be reported by the patient to the medical staff [19] . | Level 3 | B | |
| 11. It is recommended that patients’ needs and preferences be centered and that patients’ home medication be supervised with the help of mobile technology [16] . | Level 5 | A | |
| 12. It is recommended to follow up CINV from the beginning of chemotherapy to the 5th day after chemotherapy, including the frequency and degree of nausea and vomiting, physical condition and medication [13] . | Level 3 | B | |
| Non-drug management | 13. The treatment of CINV should focus on prevention [16] . | Level 4 | B |
| 14. The whole course management before, during and after chemotherapy can effectively reduce and control the occurrence of CINV [13] . | Level 3 | B | |
| 15. Acupressure can be used as an effective auxiliary treatment measure to improve CINV, which can reduce acute and delayed nausea. Neiguan acupressure can improve the severity of nausea and vomiting symptoms caused by chemotherapy in cancer patients, and reduce the frequency of nausea, vomiting and retching, but the effect is not obvious in improving the severity of retching and vomiting experience time [20] [21] [22] . | Level 2 | B | |
| 16. Chinese acupuncture has been shown to be effective in controlling anticipatory nausea and vomiting [26] . | Level 2 | B | |
| 17. Aromatherapy can significantly relieve acute nausea, acute retching and delayed retching after chemotherapy [23] . | Level 2 | B | |
| 18. Ginger and other Chinese herbs are not recommended for CINV prevention [16] . | Level 2 | B | |
| 19. On the basis of routine nursing during chemotherapy, individualized music intervention can significantly reduce the occurrence of severe nausea and vomiting in patients, and can significantly improve patients’ tolerance to nausea and vomiting [24] . | Level 2 |
B | |
| 20. It is recommended to create a pleasant and comfortable environment, and encourage patients to listen to music, read, watch TV, draw and other activities to divert patients’ attention and stabilize their emotions, so as to relieve nausea and vomiting. Behavioral therapies such as yoga, progressive muscle relaxation, hypnotherapy, biofeedback and systematic desensitization can also be used [15] [25] . | Level 5 | A | |
| 21. Behavioral therapy, especially progressive muscle relaxation training, systematic desensitization/behavioral therapy, relaxation therapy and hypnotherapy, is effective in improving anticipatory nausea and vomiting [18] . | Level 2 | A | |
| 22. Ensure adequate liquid supply, maintain water and electrolyte balance, and correct acid-base imbalance [25] . | Level 5 | A | |
| 23. It is recommended to replace plain water with sour fruit juice, broth and vegetable soup during chemotherapy to supplement water and nutrition, so as to relieve nausea and vomiting [25] . | Level 5 | A | |
| 24. It is recommended to eat a reasonable diet, choose easy to digest, fit the appetite of the food, control the amount of food, do not eat cold or overheated food, eat a small number of meals, eat 5 to 6 meals a day, and eat more in the morning, less water before and after eating [14] [25] . | Level 3 | A | |
| 25. Patients are advised to avoid eating for 1 to 2 hours before and after chemotherapy, and to lie down half an hour after eating [25] . | Level 5 | A | |
| 26. Avoiding exposure to irritating, odorous, or smelly gases can help in the treatment of anticipatory nausea and vomiting [15] . | Level 3 | A | |
| 27. According to the emetic risk of chemotherapeutic drugs and regiments, hierarchical management was carried out [25] . | Level 5 | A | |
| 28. It is recommended to establish a follow-up file for patients, complete record and dynamic assessment of patients’ nausea and vomiting, and periodic summary for dynamic adjustment of management strategies [25] . | Level 4 | A | |
| Drug management | 29. The choice of antiemetic drugs should be based on the emetic risk of chemotherapy regimen and previous experience with antiemetic drugs, with full consideration of the patient’s relevant risk factors (female, history of motion sickness or morning sickness, under 50 years of age, history of alcohol consumption, anxiety, and history of chemotherapy induced nausea and vomiting) [16] . | Level 5 | A |
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| 30. Determine the best treatment for patients at risk of emesis. If oral administration is difficult for vomiting patients, rectum or intravenous administration may be possible; Multiple drug combinations can be used when necessary, and different regimens or pathways can be selected [25] . | Level 5 | A |
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| 31. For patients without a history of nausea and vomiting, antiemetic drugs do not need to be routinely administered before chemotherapy [25] . | Level 2 | A |
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| 32. Intensive antiemesis is recommended for patients with a history of vomiting, motion sickness, anxiety and other high risk factors for nausea and vomiting [13] . | Level 3 | B |
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| 33. Antiemetic drugs for CINV may be administered orally, percutaneous, intravenously, and non-oral routes are recommended for patients at risk of CINV or who are unable to swallow and digest tablets due to vomiting [16] . | Level 5 | A |
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| 34. Long-acting or combination antiemetics are recommended for patients with day chemotherapy prior to chemotherapy to reduce the need for home administration [16] . | Level 1 | A |
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| 35. Oral or topical dosage forms are recommended for patients at home to increase convenience of administration and patient comfort [16] . 36. Intravenous injection 30 minutes before the first dose of chemotherapy; Oral preparations should be used 30 to 60 minutes before the first dose of chemotherapy drugs. The transdermal patch should be applied to the flat skin of the upper arm/forechest 24 to 48 hours before the first dose of chemotherapy. For the prevention of delayed nausea and vomiting, oral antiemetic medication should be taken in the morning when getting up [16] . | Level 5 | A |
| Level 5 | A | ||
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| 37. While preventing and treating vomiting, care should be taken to avoid adverse reactions to antiemetic drugs [14] . | Level 3 | A |
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| 38. Patients should self-manage the use of oral medications. However, optional intravenous administration should be considered in cases where nausea and vomiting prevent patients from receiving oral therapy [27] . | Level 4 | B |
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| 39. In the presence of CINV, single antiemetic oral medication or prophylaxis is recommended for patients receiving low or minimal emetic oral medication. If multiple oral medications are used in combination, the risk of vomiting may increase and adequate prevention is needed [28] . | Level 2 | B |
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| 40. For breakthrough nausea and vomiting, 24 hours of fixed administration should be considered, depending on the patient’s symptoms [18] . | Level 3 | B |
| Multidisciplinary cooperation | 41. The establishment of MDT teams including oncologists, gastroenterologists, nurses, clinical pharmacists and dietitians is conducive to standardizing CINV management, reducing the incidence of CINV, improving patients’ compliance, improving patients’ quality of life, and improving patients’ treatment satisfaction [16] . | Level 3 | A |
| Education and training | 42. Strengthen training of CINV nurses, including awareness of highly emetic chemotherapy (HEC) and moderate emetic chemotherapy (MEC) regiments, the role of patient-related factors, and the importance of optimal preventive care [17] . | Level 4 | B |
| Health education | 43. For patients with anticipatory nausea and vomiting, more knowledge about CINV can be provided so that they can fully understand what may happen in the course of treatment and corresponding measures can be given. For patients with excessive anxiety, antianxiety medication may be administered the night before [13] . | Level 3 | B |
| 44. Life and psychological education for patients and their caregivers is helpful to reduce the occurrence of CINV [16] . | Level 2 | A | |
| 45. The doctor, nurse, or clinical pharmacist should describe the various types of CINV, such as acute, delayed, and anticipatory nausea and vomiting, to the patient in detail. Key talking points include describing how CINV treatment is preventative in nature, and that they should continue to use anti-emetic medication on time even if they do not experience nausea or vomiting. Education on delayed nausea and vomiting should be paid particular attention to patients discharged from hospital and at home with oral chemotherapy [16] . | Level 3 | A | |
| 46. Common adverse reactions to antiemetic drugs include constipation, headache, extrapyramidal reactions, arrhythmia, excessive sedation, and metabolic syndrome. We should strengthen the education of patients, treat the symptoms when the symptoms are serious, and adjust the next cycle of chemotherapy to prevent and stop emesis program accordingly [16] . | Level 3 | A |