Table 5. . Nausea and vomiting: assessment and management.

Prevention	– Patient education including dietary advice
	– Mint or ginger taken as a tea or capsule
Nausea severity†:
– Grade 1	– Loss of appetite without alteration in eating habits
– Grade 2‡	– Oral intake decreased without significant weight loss, dehydration or malnutrition; iv. fluids indicated <24 h
– Grade 3§	– Inadequate oral caloric or fluid intake; iv. fluids, tube feedings or TPN indicated ≥24 h
– Grade 4	–
– Grade 5	–
Vomiting severity†
– Grade 1¶	– 1 episode in 24 h
– Grade 2#	– 2–5 episodes in 24 h; iv. fluids indicated <24 h
– Grade 3††	– ≥6 episodes in 24 h; iv. fluids, or TPN indicated ≥24 h
– Grade 4‡‡	– Life-threatening consequences
– Grade 5	– Death
Reactive management	– Antiemetic supportive care:
	• Glucocorticoids; anti-histamines or 5-HT3 receptor antagonists
	– Adequate fluid intake
Nintedanib dose interruption required	– Vomiting ≥grade 2
	and/or
	– Nausea ≥grade 3 despite antiemetic treatment

^†Defined according to Common Terminology Criteria for Adverse Events (CTCAE) v3.0 used in the LUME-Lung 1 study, which differed slightly from the most recent version (v4.03) in the definitions as follows:

^‡For grade 2 nausea, iv. fluids indicated <24 h is excluded as part of the definition, as per CTCAE v4.03;

^§For grade 3 nausea, iv. fluids and TPN indicated ≥24 h are excluded as part of the definition, as per CTCAE 4.03;

^¶Grade 1 vomiting is defined as 1–2 episodes (separated by 5 min) in 24 h;

^#Grade 2 vomiting is defined as 3–5 episodes (separated by 5 min) in 24 h;

^††Grade 3 vomiting is defined as ≥6 episodes (separated by 5 min) in 24 h; tube feeding, TPN or hospitalization indicated;

^‡‡Grade 4 vomiting is defined as life-threatening consequences; urgent intervention indicated.

iv.: Intravenous; TPN: Total parenteral nutrition.

Data taken from [6].