Paul J. Hesketh, MD, Department of Hematology and Oncology, Lahey Clinic Medical Center, discusses developing guidelines and protocols for antiemetic therapy for HEC (highly emetogenic chemotherapy).

	Hesketh says that some guidelines take economic concerns into account while others do not. These guidelines may simply be evidence-based and more concerned with finding the most effective therapy for a patient.

	When individual institutions implement their own guidelines, they will usually adapt existing guidelines to their own institution. Hesketh says that, from his standpoint, efficacy should be the primary determinant of what treatment should be used. However, in some situations, there may be only one option. For example, with a NK-1 (neurokinin-1) receptor antagonist, there is only a single agent available and clinicians need to incorporate it.

	In other situations, for example using a serotonin antagonist with dexamethasone, there may be other potential choices because there are a number of selective serotonin antagonists that are available. If all things are equal and clinicians have a choice of a variety of agents in the same class, then economics can be a secondary driver in determining the treatment regimen.

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Dr. Paul J. Hesketh, from Lahey Clinic Medical Center, on Developing Guidelines and Protocols

Dr. Hesketh on Developing Guidelines and Protocols

Paul J. Hesketh, MD, Department of Hematology and Oncology, Lahey Clinic Medical Center, discusses two barriers that hinder compliance with clinical recommendations outlined in the guidelines established by the Multinational Association of Supportive Care in Cancer (MASCC).

First, Hesketh feels the guidelines are not followed because many physicians and nurses are unaware that they exist. The guidelines have been presented in multiple different venues and are available on the MASCC website. Increasing awareness of the MASCC guidelines is needed in order to increase the overall compliance (

Secondly, one of the reasons the guidelines go unnoticed is because many physicians feel that their patients are not experiencing issues that require supportive care. However, studies have shown that if patients are not directly asked whether they are experiencing nausea or vomiting these side effects will go unrecorded.

Overall, greater awareness of the need for guidelines and effective supportive care is needed in the oncology community as a whole.

Paul J. Hesketh, MD, from Lahey Clinic Medical Center, on Barriers to Multinational Association of Supportive Care in Cancer Guideline Compliance

Paul J. Hesketh, MD

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Dr. Hesketh on Developing Guidelines and Protocols

Dr. Hesketh on Barriers to MASCC Guideline Compliance