Table.
GRADE Evaluation of interventions for Nausea and vomiting in people with cancer and other chronic diseases.
| Important outcomes | Ability to remove nasogastric tube, Adverse effects, Quality of life, Vomiting | ||||||||
| Studies (Participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of treatments for nausea and vomiting occurring as a result of either the disease or its treatment in adults with cancer? | |||||||||
| 41 (7891) | Vomiting | Dexamethasone versus placebo or no treatment in people receiving chemotherapy | 4 | 0 | 0 | –1 | +1 | High | Effect-size point added for OR >2. Directness point deducted for inclusion of other antiemetics |
| 3 (189) | Vomiting | Dexamethasone versus metoclopramide in people receiving chemotherapy | 4 | –1 | –1 | –1 | 0 | Very low | Quality point deducted for sparse data. Consistency point deducted for heterogeneity between RCTs. Directness point deducted for inclusion of 5HT3 antagonist in one study |
| 1 (51) | Vomiting | Dexamethasone plus metoclopromide versus metoclopramide alone in people with nausea owing to disease, chemotherapy, or radiotherapy | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (51) | Quality of life | Dexamethasone plus metoclopromide versus metoclopramide alone in people with nausea owing to disease, chemotherapy, or radiotherapy | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 11 (2119) | Vomiting | Dexamethasone plus 5HT3 antagonists versus 5HT3 antagonists alone in people receiving chemotherapy | 4 | 0 | 0 | 0 | 1 | High | Effect-size point added for OR of 0.42 |
| 15 (2634) | Vomiting | 5HT3 antagonists versus metoclopramide-based regimens in people receiving chemotherapy | 4 | 0 | 0 | 0 | 0 | High | |
| 1 (41) | Vomiting | Metoclopramide versus placebo or versus prochlorperazine (a phenothiazine) in people receiving chemotherapy | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for unusually high dose of metoclopramide used in the RCT |
| 4 (231) | Vomiting | Cannabinoids versus placebo in people receiving chemotherapy | 4 | 0 | 0 | 0 | 0 | High | |
| at least 19 (at least 2012) | Adverse effects | Cannabinoids versus placebo in people receiving chemotherapy | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for inclusion of both placebo and antiemetics in control group in analysis |
| 7 (422) | Vomiting | Cannabinoids versus other antiemetics in people receiving chemotherapy | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for range of antiemetics included in the comparison |
| 1 (53) | Vomiting | Lorazepam versus placebo in people receiving chemotherapy | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 2 (989) | Vomiting | Aprepitant versus placebo in people receiving a standard antiemetic regimen for chemotherapy-related nausea | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for narrowness of population in RCT |
| 1 (105) | Vomiting | 5HT3 antagonists versus metoclopramide in people receiving radiotherapy | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (191) | Vomiting | Adding corticosteroids versus adding placebo in people receiving 5HT3 antagonists | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
We initially allocate 4 points to evidence from RCTs, and 2 points to evidence from observational studies. To attain the final GRADE score for a given comparison, points are deducted or added from this initial score based on preset criteria relating to the categories of quality, directness, consistency, and effect size. Quality: based on issues affecting methodological rigour (e.g., incomplete reporting of results, quasi-randomisation, sparse data [<200 people in the analysis]). Consistency: based on similarity of results across studies. Directness: based on generalisability of population or outcomes. Effect size: based on magnitude of effect as measured by statistics such as relative risk, odds ratio, or hazard ratio.