Table 4.

Evidence summary of nonpharmacologic management for chemotherapy-induced nausea and vomiting (CINV).

Aspects	Evidence item		Evidence level	Recommendation level
Risk factor assessment	(1) Common risk factors for CINV are divided into chemotherapy drug related factors (emetic potential, dose, concentration, speed, mode of administration, concomitant use, and periodic use) and patient-intrinsic factors (gender, age, alcohol intake, anxiety, activity level, physical status, underlying diseases, previous history of motion sickness, pregnancy vomiting, or CINV) [10–12, 30].		1a	A
	(2) At each chemotherapy cycle, health care providers are invited to use MASCC assessment tool (MAT) developed by the Multinational Association for Supportive Care in Cancer for risk assessment [10]. From the 1st to 5th, 7th, 14th, and 21st days after chemotherapy, the patients used the MAT to self-evaluate their nausea and vomiting in the past 24 hours [15].		3c	B
Nursing process specification	(3) Through standardized training, nursing staff systematically learn the relevant guidelines and expert consensus of CINV and master the causes, symptoms, types, assessment tools, treatment principles, and precautions of commonly used drugs for CINV [16].		2d	A
	(4) During hospitalization, nursing staff provide patients with health education on CINV to administer the chemotherapy drugs on time, accurately; evaluate CINV and chemotherapy efficacy in time to obtain feedback that will help adjust the next cycle of a chemotherapy regimen. Place a vomiting record sheet at the bedside or foot of the bed to record vomiting time, frequency, contents, and MAT score can provide metrics on a patient's nausea and vomiting. This promotes communication between doctors and nurses [15, 16].		2d	B
	(5) After patients are discharged from the hospital, they were followed up via telephone or WeChat group. The follow-up contents include the psychological impact of nausea and vomiting, the time, frequency, amount and contents, and self-score using the MAT [30]. Nurses should detect and intervene delayed CINV in a timely manner [15].		5b	B
Nonpharmacological interventions for CINV	Auricular point therapy	(6) Auricular point treatment is often selected using Vaccinium vulgare seeds or magnetic beads. The Shen men, stomach, sympathetic, or subcortical are often selected as the main points. The liver and spleen are often selected as matching points. A compression effect is then created from the De-qi acuesthesia [17, 18, 32].	1a	B
	Aromatherapy	(7) Aromatherapy has antiemetic effects on acute and delayed CINV. It is best to use essential oils containing peppermint, which has a strong antiemetic effect. Some patients may have intolerances to single essential oils. Compound essential oils are more suitable when this is the case [20]. Moreover, inhaled aromatherapy is superior to other interventional approaches such as smear or oral administration [19].	1a	B
	Ginger therapy	(8) There is insufficient available evidence to recommend or oppose ginger therapy to prevent and manage CINV; ginger should be used cautiously [9, 11, 21].	1a	B
	Music therapy	(9) Music therapy is helpful for treating CINV [22, 23]. Nurse staff should choose appropriate soothing music based on patients' hobbies, lifestyles, habits, living environments, or other personalized characteristics. It recommends that music plays for 30 min-60 min [23].	1a	B
	Relaxation therapy	(10) Progressive muscle relaxation has positive effects on CINV [24, 30]. The progressive muscle relaxation training course published by the Chinese Medical Association audio and video publishing house is available regardless of time zone and region, and is worthy of clinical application [33].	1a	B
	Diet therapy	(11) Reasonable eating habits, eating patterns, and food choices can effectively prevent and treat CINV. Medical staff should formulate staged diet tables and individualized recipes for CINV patients according to disease characteristics, diagnosis and treatment plans, and dietary nutrients [12, 25, 30, 34].	1b	B
	Acupressure therapy	(12) Acupressure reduces the degree of acute and delayed CINV, and self-acupressure therapy has a positive effect on CINV. Neiguan acupoint is the most commonly used acupoint in clinical practice [26]. As soon as chemotherapy begins, medical staff can perform Neiguan (bilateral) acupressure on chemotherapy patients once per day until the end of the chemotherapy cycle [13].It is recommended that Neiguan point be used in combination with Hegu and Zusanli acupoints [14].	1a	A
	Acupuncture therapy	(13) Acupuncture therapy is effective in treating CINV [9, 11]. Common acupoints used in clinical practice are Zusanli, Neiguan, Zhongwan, Tianshu, and Gongsun points [29].It is recommended to treat patients with filiform needle acupuncture on the Neiguan (bilateral) acupoints 2 hours before the first day of chemotherapy, and then perform acupuncture once a day for a total of seven days [13]. Alternatively, patients were treated with transcutaneous electrical acupoint stimulation at Neiguan (bilateral) or Yongquan (bilateral) points twice a day for 30 minutes from the first to third day of each chemotherapy cycle [13].	1b	A
	Moxibustion therapy	(14) Moxibustion combined with antiemetic drugs is effective in decreasing the severity and frequency of CINV [11, 27]. Medical staff can select from moxa stick moxibustion, moxa cone moxibustion, and partitioned moxibustion or other moxibustion approaches; take rotary moxibustion, sparrow pecking moxibustion, and round-trip moxibustion or other different manipulation techniques. These are compatible with Zusanli, Zhongwan, Shenque, Neiguan, and other acupoints and can improve CINV status [35].	1a	B
	Comprehensive therapy	(15) It is recommended to combine acupressure, acupuncture, and other comprehensive methods with antiemetics to relieve CINV symptoms in cancer patients together. The effect is superior to traditional drug therapy alone [14].	5b	B