---
title: "Global inequities in seminal studies underlying chemotherapy-induced nausea and vomiting guidelines"
id: "pubmed-42601561"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42601561"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42601561/"
doi: "10.1007/s00520-026-11103-0"
published_at: "2026-08-15T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Global inequities in seminal studies underlying chemotherapy-induced nausea and vomiting guidelines
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42601561
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42601561/)
- **DOI:** [10.1007/s00520-026-11103-0](https://doi.org/10.1007%2Fs00520-026-11103-0)
- **Published At:** 2026-08-15T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Chemotherapy-induced nausea and vomiting (**CINV**) is a major quality-of-life toxicity in cancer care; decades of trials underpin contemporary guideline recommendations. - The authors reviewed primary research cited in the 2023 MASCC/ESMO, 2025 NCCN, and 2020 ASCO antiemetic guidelines to assess geographic and economic origins of the evidence base. - Review articles were excluded; 213 referenced articles were identified, 210 were retrievable and eligible, and consolidation for duplicate populations yielded 195 unique study populations for analysis. - Extracted study-level data included country of origin, World Bank income classification, patient age and sex distribution, primary cancer type, chemotherapy regimen and emetogenicity, and antiemetic regimen. - Most included trials studied patients receiving **highly emetogenic chemotherapy** (63.1%), with fewer trials in moderate (27.2%), minimal (8.7%), and low (1.0%) emetogenicity categories. - The evidence base was heavily concentrated in **high-income countries (HICs)**: among 191 studies with determinate income classification, 82.7% originated in HICs and 17.3% in low- and middle-income countries (LMICs). - This geographic and economic concentration persisted across all emetogenicity levels, indicating limited primary research in resource-limited settings despite guideline recommendations being applied globally. - The authors conclude that guideline evidence is concentrated in HIC settings and note the need for further studies assessing effectiveness and implementation of lower-cost or alternative antiemetic regimens in resource-limited contexts. - Conflict of interest: the authors declared no competing interests. Details on granular study characteristics and regional breakdowns beyond the reported percentages were not provided in the abstract.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. * 2 Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. * 3 Practical Pharmaceutical Research Center, Gifu Pharmaceutical University, 1-25-4 Daigaku-Nishi, Gifu, 501-1196, Japan. * 4 Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan. * 5 Cancer Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan. * 6 Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. ronald.chow@sunnybrook.ca. * 7 Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. ronald.chow@sunnybrook.ca. * 8 Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK. ronald.chow@sunnybrook.ca. * PMID: **42601561** * DOI: [ 10.1007/s00520-026-11103-0 ](https://doi.org/10.1007/s00520-026-11103-0) Item in Clipboard Review # Global inequitable distribution of seminal studies of chemotherapy-induced nausea and vomiting Gregory W Chai et al. Support Care Cancer. 2026. Show details Display options Display options Format Abstract PubMed PMID Support Care Cancer Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Support+Care+Cancer%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Support+Care+Cancer%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42601561/) . 2026 Aug 15;34(9):857. doi: 10.1007/s00520-026-11103-0. ### Authors [Gregory W Chai](https://pubmed.ncbi.nlm.nih.gov/?term=Chai+GW&cauthor_id=42601561)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42601561/#short-view-affiliation-1 "Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada."), [Yigeng Tan](https://pubmed.ncbi.nlm.nih.gov/?term=Tan+Y&cauthor_id=42601561)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42601561/#short-view-affiliation-1 "Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada."), [Jennifer Leigh](https://pubmed.ncbi.nlm.nih.gov/?term=Leigh+J&cauthor_id=42601561)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42601561/#short-view-affiliation-1 "Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42601561/#short-view-affiliation-2 "Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada."), [Daichi Watanabe](https://pubmed.ncbi.nlm.nih.gov/?term=Watanabe+D&cauthor_id=42601561)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42601561/#short-view-affiliation-3 "Practical Pharmaceutical Research Center, Gifu Pharmaceutical University, 1-25-4 Daigaku-Nishi, Gifu, 501-1196, Japan."), [Hirotoshi Iihara](https://pubmed.ncbi.nlm.nih.gov/?term=Iihara+H&cauthor_id=42601561)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42601561/#short-view-affiliation-4 "Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42601561/#short-view-affiliation-5 "Cancer Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan."), [Ronald Chow](https://pubmed.ncbi.nlm.nih.gov/?term=Chow+R&cauthor_id=42601561)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42601561/#short-view-affiliation-6 "Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. ronald.chow@sunnybrook.ca.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42601561/#short-view-affiliation-7 "Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. ronald.chow@sunnybrook.ca.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42601561/#short-view-affiliation-8 "Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK. ronald.chow@sunnybrook.ca.") ### Affiliations * 1 Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. * 2 Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. * 3 Practical Pharmaceutical Research Center, Gifu Pharmaceutical University, 1-25-4 Daigaku-Nishi, Gifu, 501-1196, Japan. * 4 Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan. * 5 Cancer Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan. * 6 Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. ronald.chow@sunnybrook.ca. * 7 Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. ronald.chow@sunnybrook.ca. * 8 Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK. ronald.chow@sunnybrook.ca. * PMID: **42601561** * DOI: [ 10.1007/s00520-026-11103-0 ](https://doi.org/10.1007/s00520-026-11103-0) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Chemotherapy-induced nausea and vomiting (CINV) remains one of the most quality of life limiting toxicities of cancer therapy. Decades of trials have produced robust antiemetic evidence, but their applicability to resource-limited settings where guideline-recommended regimens are frequently inaccessible has not been characterized. **Methods:** We reviewed the reference lists of the 2023 MASCC/ESMO, 2025 NCCN, and 2020 ASCO antiemetic guidelines to identify all primary research articles cited as evidence for antiemetic therapy. Review articles were excluded. For each study, we extracted country of origin, income classification, age, sex distribution, primary cancer type, chemotherapy regimen, chemotherapy emetogenicity, and antiemetic regimen. Findings were synthesized descriptively. **Results:** From the reference list, 213 articles were identified. Two could not be retrieved and one was identified as a review, leaving 210 studies for extraction. When the same patient population was reported across multiple studies, the reports were consolidated and represented by the most comprehensive study, resulting in 195 unique populations for analysis. Most studies enrolled patients receiving highly emetogenic chemotherapy (63.1%), followed by moderately emetogenic (27.2%), minimally emetogenic (8.7%), and low emetogenic (1.0%) regimens. The evidence base was overwhelmingly derived from high-income countries (HICs): Of 191 studies with a determinate income classification, 82.7% originated in HICs and only 17.3% in low- and middle-income countries, persisting across every emetogenicity category. **Conclusions:** The evidence supporting contemporary CINV guidelines is concentrated in high-income settings. As alternative, lower-cost antiemetic regimens for resource-limited settings are derived from this same evidence base, further studies are needed to assess their effectiveness in these settings. **Keywords:** Antiemetic therapy; Cancer therapy; Chemotherapy-induced nausea and vomiting. © 2026. The Author(s). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Conflict of interest: The authors declare no competing interests. ## References 1. 1. Piechotta V, Adams A, Haque M, Scheckel B, Kreuzberger N, Monsef I et al (2021) Antiemetics for adults for prevention of nausea and vomiting caused by moderately or highly emetogenic chemotherapy: a network meta‐analysis. Cochrane Database Syst Rev. - [DOI](https://doi.org/10.1002/14651858.cd012775.pub2) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/34784425/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/8594936/) 2. 1. Sommariva S, Pongiglione B, Tarricone R (2016) Impact of chemotherapy-induced nausea and vomiting on health-related quality of life and resource utilization: a systematic review. Crit Rev Oncol Hematol 99:13–36 - [PubMed](https://pubmed.ncbi.nlm.nih.gov/26697988/) - [DOI](https://doi.org/10.1016/j.critrevonc.2015.12.001) 3. 1. Navari RM, Aapro M (2016) Antiemetic prophylaxis for chemotherapy-induced nausea and vomiting. N Engl J Med 374(14):1356–1367 - [PubMed](https://pubmed.ncbi.nlm.nih.gov/27050207/) - [DOI](https://doi.org/10.1056/nejmra1515442) 4. 1. Chow R, Warr DG, Navari RM, Tsao M, Popovic M, Chiu L et al (2018) Should palonosetron be a preferred 5-HT(3) receptor antagonist for chemotherapy-induced nausea and vomiting? An updated systematic review and meta-analysis. Support Care Cancer 26(8):2519–2549 - [DOI](https://doi.org/10.1007/s00520-018-4237-7) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/29796708/) 5. 1. Chow R, Tsao M, Chiu L, Popovic M, Milakovic M, Lam H et al (2018) Efficacy of the combination neurokinin-1 receptor antagonist, palonosetron, and dexamethasone compared to others for the prophylaxis of chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis of randomized controlled trials. Annals of Palliative Medicine 7(2):221–233 - [PubMed](https://pubmed.ncbi.nlm.nih.gov/29764184/) - [DOI](https://doi.org/10.21037/apm.2018.03.09) Show all 230 references ## Publication types * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42601561/) ## MeSH terms * Antiemetics* / administration & dosage Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Antiemetics%2Fadministration+and+dosage%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Antiemetics) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42601561/) * Antiemetics* / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Antiemetics%2Ftherapeutic+use%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Antiemetics) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42601561/) * Antineoplastic Agents* / administration & dosage Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Antineoplastic+Agents%2Fadministration+and+dosage%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Antineoplastic+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42601561/) * Antineoplastic Agents* / adverse effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Antineoplastic+Agents%2Fadverse+effects%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Antineoplastic+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42601561/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42601561/) * Nausea* / chemically induced Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Nausea%2Fchemically+induced%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Nausea) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42601561/) * Nausea* / drug therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Nausea%2Fdrug+therapy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Nausea) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42601561/) * Neoplasms / drug therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.
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