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Oncology Consults: A Focus on Supportive Care: Strategies to Improve Nausea and Vomiting in Cancer Patients

Oncology Consults: A Focus on Supportive Care: Strategies to Improve Nausea and Vomiting in Cancer Patients

Format

Patient Case Study

Time to Complete

30 minutes

Released

December 15, 2016

Expires

December 15, 2017
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Maximum Credits

0.50 / AMA PRA Category 1 CreditTM
0.50 / CE for Nurses

Accredited Provider

Provided by the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing.

Commercial Supporter

Supported by an educational grant from Merck & Co, Inc.

Program Description

Chemotherapy-induced nausea and vomiting (CINV) is a serious problem that can negatively impact a cancer patient’s quality of life and affect the timely delivery and ability to give the most effective doses of the chemotherapy treatment. The risk for CINV in any given patient is dependent on patient-related factors, and most importantly, the innate emetogenicity of the chemotherapy agents themselves. If left untreated, agents classified as highly emetogenic will likely cause CINV in more than 90% of patients, and moderately-emetogenic regimens have a 30% to 90% frequency of emesis. Prevention of emesis is key, and evidence-based guidelines exist to direct healthcare practitioners in the proper use of the most effective regimens recommended for each level of chemotherapy emetogenicity. These regimens typically include a serotonin antagonist, a neurokinin-1 antagonist, and dexamethasone. These medications must cover both the acute and delayed period of time after chemotherapy is given. If breakthrough nausea or emesis occurs despite optimal prophylaxis, then appropriate antiemetics must be given, typically from a class of drugs that is different from what was originally administered. Anticipatory nausea may occur prior to chemotherapy in patients whose symptoms were not well controlled in a previous cycle of chemotherapy and should be treated preventively.

Intended Audience

This activity is designed for oncology healthcare providers (oncologists, oncology nurses, and oncology physician assistants) who care for patients with CINV. No prerequisites required.

Educational Objectives

After participating in this activity, the participant will demonstrate the ability to:

  • RECOGNIZE the impact untreated CINV has on chemotherapy adherence and overall patient outcomes.
  • ASSESS patient-specific and therapy-specific CINV risk factors.
  • IDENTIFY current and emerging antiemetics used as single agents or in combination therapy for CINV.
  • APPLY evidence-based strategies to prevent and manage CINV in patients receiving moderately or highly emetogenic chemotherapy regimens.
The Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing take responsibility for the content, quality, and scientific integrity of this CME/CNE activity.

Conflict Of Interest Disclosure Policy

Full Disclosure Policy Affecting CME Activities
As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine Office of Continuing Medical Education (OCME) to require signed disclosure of the existence of financial relationships with industry from any individual in a position to control the content of a CME activity sponsored by OCME. Members of the Planning Committee are required to disclose all relationships regardless of their relevance to the content of the activity. Faculty are required to disclose only those relationships that are relevant to their specific presentation.

Policy on Faculty and Provider Disclosure
It is the policy of the Institute for Johns Hopkins Nursing to require our continuing nursing education faculty and planning committee members to disclose any financial relationships with companies providing program funding or manufacturers of any commercial products discussed in the educational activity.

Faculty

Chair and Planner
David S. Ettinger, MD

Alex Grass Professor in Oncology
Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
Baltimore, MD

Dr. Ettinger reports serving as a principal investigator for Golden Biotechnology Corp; serving on the data monitoring committee for ARIAD Pharmaceuticals Inc; and serving as a consultant for Boehringer Ingelheim GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, EMD Serono Inc, and Genentech Inc, Helsinn Therapeutics, Inc.

Nurse Planner
Rebecca Barshick, RN, MSN

Nurse Educator
The Institute for Johns Hopkins Nursing
Baltimore, MD

Ms. Barshick has indicated that she has no financial interests or relationships with a commercial entity.

Participating Faculty
Susan Urba, MD

Professor of Internal Medicine
Division of Hematology/Oncology
Medical Director, Symptom Management and Supportive Care Program
University of Michigan Comprehensive Cancer Center
Ann Arbor, MI

Dr. Urba reports receiving grants/research support from Aduro Biotech.

Nurse Reviewer
MiKaela Olsen, APRN-CNS, MS, AOCNS

Oncology and Hematology Clinical Nurse Specialist
Ambulatory Oncology
Sidney Kimmel Comprehensive Cancer Center
Johns Hopkins Hospital and Greenspring Oncology
Baltimore, MD

Ms. Olsen has indicated that she has no financial interests or relationships with a commercial entity.

Planner/Reviewer Disclosures

Dr. Ettinger and Dr. Urba reported their disclosures under the Faculty heading above.

No other planners have indicated that they have any financial interests or relationships with a commercial entity.

Note: Grants to investigators at The Johns Hopkins University are negotiated and administered by the institution that receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).

Credit

0.50

Type

AMA PRA Category 1 Credit(s)TM

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statement

The Johns Hopkins University School of Medicine designates this enduring material for a maximum of 0.50 AMA PRA Category I Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Credit

0.50

Type

CE for Nurses

Accreditation Statement

The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Designation Statement

This 0.50 contact hours of educational activity is provided by the Institute for Johns Hopkins Nursing. Claim only those contact hours actually spent in the activity. Statements will be awarded for this educational activity until December 15, 2017.

Disclosure of Unlabeled Use

No faculty member has indicated that their presentation will include information on off-label products.

Non-Endorsement of Products
The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity.

Disclaimer

The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.

Instructions

The following is an interactive case module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, an interactive case study, and a CME/CNE post-test and evaluation. All 3 sections must be completed to receive CME/CNE credit. Participants must also score at least 70% on the post-test. Certificates will be distributed online at the conclusion of the activity. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.

For information about the accreditation of this program, please contact the CME Office 410-955-2959 or email cmenet@jhmi.edu.

Confidentiality Disclaimer for CME Activity Participant

I certify that I am participating in this Johns Hopkins University School of Medicine activity for CME-accredited training and/or educational purposes.

I understand that while I am attending in this capacity, I may be exposed to "protected health information," as that term is defined and used in Hopkins policies and in the federal HIPAA privacy regulations (the “Privacy Regulations”). Protected health information is information about a person's health or treatment that identifies the person.

I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential. I agree not to post or discuss this protected health information, including pictures and/or videos, on any social media site (eg, Facebook, Twitter, etc.), in any electronic messaging program or through any portable electronic device.

I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is: Johns Hopkins Privacy Officer, telephone: 410-735-6509, e-mail: HIPAA@jhmi.edu.

“The Office of Continuing Medical Education at the Johns Hopkins University School of Medicine, as sponsor of this activity, has relayed information with the CME attendees/participants and certify that the visitor is here for training, education and/or observation purposes only.”

For CME questions, please contact the CME Office 410-955-2959 or email cmenet@jhmi.edu.

Johns Hopkins University School of Medicine
Office of Continuing Medical Education
720 Rutland Avenue/ Turner 20
Baltimore, Maryland 21205-2195
Reviewed & Approved by: General Counsel, Johns Hopkins Medicine (4/1/03)
(Updated 4/09 and 3/14)

myCME privacy policy

THE INSTITUTE FOR JOHNS HOPKINS NURSING MISSION STATEMENT

The mission of the Institute for Johns Hopkins Nursing is to share the innovations of Johns Hopkins Nursing in practice, education, and research—locally, nationally, and globally. Our goal in continuing nursing education is to bring you activities that reflect the expertise and creativity of Johns Hopkins Nursing. Our service values are quality, integrity, flexibility, and personal attentiveness. We appreciate your thoughts and welcome your concerns—please feel free to e-mail us: IJHN@.jhmi.edu.

HARDWARE & SOFTWARE REQUIREMENTS

Pentium 800 processor or greater, Windows 98/NT/200/XP or Mac OS 9/X or later, Microsoft Internet Explorer, Safari, Firefox, Windows Media Player 9.0 or later Flash player, 128 MB of RAM Monitor settings: High color at 800 x 600 pixels, Sound card and speakers, Adobe Acrobat Reader.

SYSTEM REQUIREMENTS

Hardware and Software Requirements
  • A computer with an internet connection
  • Internet Browser: Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser
  • Additional Software: Adobe Flash Player and/or an HTML 5 capable browser maybe required for video or audio playback. PowerPoint or Adobe Acrobat Reader may occasionally be required
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