Improving Self-Management of Chemotherapy Induced Nausea and Vomiting in Patients with Breast Cancer through Nurse-Led Education
Abstract
Background: Chemotherapy-Induced Nausea and Vomiting (CINV) affects over 60% of oncology patients, and can cause dehydration, treatment disruption, and life-threatening emergencies. Current CINV guidelines recommend pharm & non-pharmacological methods to relieve CINV, however, multiple factors may impair self-management.
Objective: This project aimed to improve CINV self-management in a Southern Californian outpatient breast cancer clinic by integrating nurse-led written education, telephone follow-up, and a standardized CINV assessment tool into the existing practice flow.
Interventions/ Methods: The project was a pre/post quality improvement (QI) initiative. Baseline data were obtained via EHR chart review to evaluate CINV symptoms and antiemetic use in breast cancer patients receiving highly emetogenic chemotherapy (HEC). The intervention consisted of a nurse-led CINV patient education handout & antiemetic review, post-chemotherapy follow-up at 24 hrs and 96 hrs (acute & delayed CINV) with education reinforcement, and standardized CINV assessment using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool (MAT). Primary outcomes were CINV symptoms and antiemetic use.
Results: Antiemetic usage increased for initial encounters, all encounters, and first use patients post-intervention. Overall, CINV symptoms reduced from (94.7% to 41.7%) pre to post-intervention. 100% antiemetic adherence was seen in initial encounter and first use patients experiencing CINV. Prophylactic antiemetic use in all categories increased post-intervention.
Conclusions: This QI project demonstrated benefits of nurse-led written education, post-chemo follow-up, and a standardized CINV assessment tool. Outcomes included improved adherence to abortive and prophylactic antiemetic regimens and reduced CINV symptoms.
Implications for Oncology Nursing Practice: The QI project success and future expansion across oncology specialties ensures health equity, clinical consistency, and improved patient outcomes. Addressing CINV self-management improves hydration, nutrition, and experience promoting treatment adherence, quality of life, and, ideally, disease remission. Utilization of standardized materials and evidence-based assessment tools serve as a scalable framework for enhancing interprofessional collaboration, patient monitoring, and patient-provider communication.