Dr. Hesketh on Developing Guidelines and Protocols

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.