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Chemotherapy-induced Organ Toxicity Mitigation / Complementary and Alternative Medicine Studies · Journal article
Supportive Care in Cancer · August 15, 2026
Early or partial results. Treat as a signal, not a conclusion.
This descriptive analysis of 195 unique study populations cited in three major CINV guideline reference lists found that 82.7% of evidence originated from high-income countries and only 17.3% from low- and middle-income countries, a disparity consistent across all chemotherapy emetogenicity categories. The finding documents a substantial geographic and economic imbalance in the evidence base underpinning current antiemetic recommendations, but does not directly measure clinical outcomes or the validity of extrapolating HIC-derived evidence to resource-limited settings.
Descriptive systematic review of guideline evidence sources. Primary research articles cited in three major antiemetic guidelines for evidence on antiemetic therapy in cancer patients.. n = 195. Not specified; articles were classified by country of origin.
Of 191 studies with determinate income classification, 82.7% originated in high-income countries and 17.3% in low- and middle-income countries 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 Evidence disparity persisted across every emetogenicity category
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians and guideline authors should recognize that contemporary CINV antiemetic recommendations rest predominantly on evidence from high-income settings. When lower-cost regimens are recommended for resource-limited settings based on this same evidence base, additional studies in those settings are needed to establish whether efficacy and safety are comparable, particularly in populations that may differ in comorbidities, drug metabolism, access to supportive care, and adherence.
A descriptive analysis of published trial citations in three major guidelines, identifying a geographic and economic disparity in the evidence base for CINV antiemetics, but without direct clinical outcome data or intervention testing.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and guideline authors should recognize that contemporary CINV antiemetic recommendations rest predominantly on evidence from high-income settings. When lower-cost regimens are recommended for resource-limited settings based on this same evidence base, additional studies in those settings are needed to establish whether efficacy and safety are comparable, particularly in populations that may differ in comorbidities, drug metabolism, access to supportive care, and adherence.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
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.
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