Treatment of Nausea and Vomiting During Chemotherapy

Abstract

Nausea and vomiting are two of the most troubling side effects patients experience during chemotherapy. While newly available treatments have improved our ability to manage nausea and vomiting, anticipatory and delayed nausea and vomiting are still a major problem for patients receiving chemotherapy. Many cancer patients will delay or refuse future chemotherapy treatments and contemplate stopping chemotherapy altogether because of their fear of experiencing further nausea and vomiting. The purpose of this article is to provide an overview of the patho-psychophysiology of chemotherapy-induced nausea and vomiting and the recommended guidelines for treatment. KeywordsCancer; chemotherapy; nausea; vomiting Cancer treatments are quite challenging for cancer patients to endure. The cancer treatments and subsequent side effects patients experience often make them feel worse than the disease itself. [1][2][3] Chemotherapy-induced nausea and vomiting (CINV) are two of the most common and troublesome side effects experienced by cancer patients. [1][2][3] Cancer patients will delay chemotherapy treatments and contemplate refusing future treatments because of fear of further CINV. 1-4 While significant advances have been made in the treatment of acute chemotherapy-induced vomiting (CIV), chemotherapy-induced nausea (CIN), anticipatory nausea and vomiting (ANV) and delayed nausea and vomiting (DNV) remain substantial problems for cancer patients. 1, 2 Anticipatory nausea is reported by 30% of patients who experienced nausea during earlier chemotherapy treatment cycles. 1 Anticipatory vomiting is reported in 20% who experienced vomiting during earlier chemotherapy treatment cycles. 5, 6 Anticipatory, acute and delayed CINV lead to poorer chemotherapy adherence, impaired function, increased anxiety and depression, and diminished quality of life (QOL) among patients. 4,[7][8][9] In turn, physicians and patients increase utilization of healthcare resources to manage these side effects, substantially increasing the public health burden of cancer and its effective treatment. 4, 7-92-6 The purpose of this chapter is to provide an overview of the patho-psychophysiology of CINV and the recommended guidelines for treatment of CINV.Correspondence: Gary R Morrow, PhD, MS, University of Rochester School of Medicine and Dentistry, James P Wilmot Cancer Center, Box 704, 601 Elmwood Avenue, Rochester, NY 14642. gary_morrow@urmc.rochester.edu. Disclosure: The authors have no conflicts of interest to declare. Pathophysiology of Chemotherapy-Induced Nausea and Vomiting: The NIH Public Access Role of NeurotransmittersCINV are distinct symptoms; however, they often go hand-in-hand and are one of the most unpleasant side effects of most chemotherapy regimens for cancer patients. It is important to note that nausea can occur without vomiting. CINV can be acute (during the first 24 hours post-treatment) and delayed (after the first 24 hours post-treatment and up to 5-8 days posttreatment). 10 CINV, once experienced during early chemother...

Current pharmacotherapy for chemotherapy-induced nausea and vomiting in cancer patients

“…94,95 Adherence to these guidelines improves control of CINV by approximately 20%. 96 Chemotherapy regimens are classified into four categories according to potential for CINV—highly emetogenic (>90%), moderately emetogenic (both with and without anthracycline and cyclophosphamide [AC]; 30–90%), low emetogenic (10–30%), and minimally emetogenic (<10%).…”

Health-Related Quality of Life in Children with Cancer

“…These interventions include behavioral, non-pharmacologic, and other supportive measures intended to decrease the effect of nausea on children with cancer. [99][100][101][102][103] The findings of this study also support the need for a dynamic collection process of HRQOL in children undergoing curative cancer treatments. Our study identified the longitudinal nature of HRQOL outcomes over time in children with cancer.…”

Pharmacists’ Role in Managing Patients with Chronic Lymphocytic Leukemia

“…Beyond recommending the appropriate use of myeloid growth factor and infection prophylaxis, pharmacists play an important role in preventing and managing chemotherapy-induced nausea and vomiting (CINV). CINV occurs in up to 80% of patients on active therapy and remains a significant barrier to quality of life [12]. When uncontrolled, CINV can alter electrolytes and enteral nutrition, leading to detrimental effects on patient adherence and health outcomes [13].…”