Chemotherapy-Induced Nausea and Vomiting: The Importance of Acute Antiemetic Control

Abstract

Nausea and vomiting are two of the most feared side effects of cancer chemotherapy and radiotherapy. Chemotherapy-induced nausea and vomiting can be broadly categorized as acute (occurring within 24 hours of therapy), delayed (persisting for 6-7 days after therapy), or anticipatory (occurring prior to chemotherapy administration). Breakthrough and refractory nausea and vomiting describe the symptoms of uncontrolled emesis. Evidence suggests that good control of nausea and vomiting during the acute period correlates with the control of delayed emesis. Conversely, protection failure during the first 24 hours has a high predictive value for delayed emesis in the same cycle.The 5-HT 3 -receptor antagonists, regarded as the 'gold standard' in antiemetic therapy, are the first-line treatment for moderately and highly emetogenic chemotherapy and radiotherapy regimens in adults and children. Evidence suggests that the 5-HT 3 -receptor antagonists administered in combination with corticosteroids afford the best protection from symptoms of acute emesis and, by extrapolation, the most effective prevention of delayed emesis.Antiemetic therapeutic guidelines stress that the goal of therapy is to prevent cytostatic-induced nausea and vomiting. Therefore, the prophylactic use of the most effective antiemetic regimen-taking into consideration the emetogenicity of the chemotherapy and individual patient characteristics-must be adhered to in order to prevent acute, delayed, and anticipatory nausea and vomiting.

Side Effects of Chemotherapy among Cancer Patients in a Malaysian General Hospital: Experiences, Perceptions and Informational Needs from Clinical Pharmacists

“…CINV have been ranked as two of the most feared and distressing side effects since the last three decades (Coates et al, 1983;Schnell, 2003;Farrell et al, 2013). Consistent with these findings, Nausea and vomiting were selected by our patients as two side effects they were most worried about.…”

One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient

“…Some methodology issues regarding causality in the study need to be discussed. For example, anxiety is known as a risk factor for chemotherapy-induced nausea [9,13,44] and is also suggested to be a risk factor for radiotherapy-induced nausea. In our study, we do not have any longitudinal information regarding the anxiety, so the variable anxiety was excluded from the risk-analysis.…”

“…However, risk factors associated with chemotherapy-induced nausea may also be applicable for radiotherapy-induced nausea [2,17,23]. Lower age, female gender, low alcohol intake, anxiety and previous experience of nausea in other situations such as previous chemotherapy indicate an increased risk for chemotherapy-induced nausea [9,13,44] and are factors that would be interesting to evaluate further as factors in radiotherapy-induced nausea.…”

Effect of Chemotherapy on Nutritional Status of Pediatric Subjects with Hematological Malignancies - A Retrospective Longitudinal Study

“…However, studies have estimated that chemotherapeutic agents also impact and damage other normal cells in the body [2] , for instance the cells of the gastrointestinal tract, mouth, hair follicles, and bone marrow. Depending on the type and dose of drugs given and the duration of treatment, the side effects of chemotherapy include mouth sores (mucositis) [3] , stomatitis, dysphagia [4] , alterations in taste and smell [5] , anemia [4,6] , depression, anorexia, anxiety, nausea, vomiting [7] , and diarrhea [8] . These side effects overcome the nutritional status of the subjects and lead to malnutrition.…”