Dr. Grunberg on Barriers to Effective Supportive Care

Steven M. Grunberg, MD, Professor of Medicine and Pharmacology, Division of Hematology/Oncology, University of Vermont, discusses the adoption of guidelines by clinicians as well as the biggest barrier to starting patients on supportive care therapies such as the combination of NK-1 antagonists, 5-HT3 antagonists, and dexamethasone.

Grunberg adds that the adoption of pathways is always a slow process and perhaps should not always be adopted 100%. He feels guidelines should act as a starting point that is built upon using a clinician’s clinical judgment in order to individualize the treatment. As an example, the 5-HT3 antagonist in combinations with a corticosteroid has been used for some time and is widely accepted by most treating physicians. However, the adoption of newer NK-1 antagonists has been a slower process because many physicians are not in the habit of prescribing this treatment.

There will always be some form of obstacle that makes providing the best patient care difficult. One of the challenges is the different types of vomiting that can occur. It is easy to see the results of therapy on acute vomiting; however, delayed vomiting is harder to recognize and treat because it can occur multiple days after the patient has left the clinic.

Providing the best patient care involves communication between the patients and their care team. Grunberg encourages nurses and physicians to call the patients days after the treatment to ensure that side effects have not presented themselves. If the side effects are not known, they cannot be treated.