Nausea and Vomiting

Published on 04/03/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 04/03/2015

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Nausea and Vomiting

John D. Hainsworth

Summary of Key Points

Incidence

• Most common chemotherapy-associated toxicities

• More frequent and severe with repetitive doses of chemotherapy

• Significant impact on quality of life and can influence patient compliance with treatment

Etiology of Complication

• Acute nausea and vomiting often mediated by activation of serotonin type 3 receptors in the gastrointestinal tract

• Mechanism of delayed nausea and vomiting (more than 24 hours after chemotherapy) unknown

Evaluation of the Patient

• Risk factors, including type of chemotherapy (drugs, doses, schedule), age, sex, and prior alcohol use should be assessed before treatment

Grading of Complication

• Episodes of vomiting should be recorded (number, duration, and time to onset); severity of nausea can be graded with a visual analog scale

Treatment

• Optimal treatment provides complete control of acute nausea and vomiting in the majority of patients receiving chemotherapy; only 15% of patients receiving highly emetogenic chemotherapy regimens have severe nausea and vomiting

• Treatment of delayed nausea and vomiting has improved with the introduction of aprepitant and palonosetron; this complication can now be completely controlled in two thirds of patients

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