Treatment of Nausea and Vomiting During Chemotherapy

Karen M Mustian, PhD, Katie Devine, Julie L Ryan, Michelle C Janelsins, PhD, Lisa K Sprod, Luke J Peppone,, Grace D Candelario, Supriya G Mohile, Gary R Morrow
US Oncology & Hematology, 2011;7(2):91-97
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Abstract

Abstract
Nausea and vomiting are two of the most troubling adverse 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.

Support: The publication of the article was funded by Eisai Inc. The views and opinions expressed are those of the authors and not necessarily those of Eisai Inc.
Keywords
Cancer, chemotherapy, nausea, vomiting
Disclosure The authors have no conflicts of interest to declare.
Received: April 19, 2011 Accepted May 31, 2011
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. E: gary_morrow@urmc.rochester.edu

Cancer treatments are quite challenging for cancer patients to endure. The cancer treatments and subsequent adverse effects patients experience often make them feel worse than the disease itself.1–3 Chemotherapy-induced nausea and vomiting (CINV) are two of the most common and troublesome adverse effects experienced by cancer patients.1–3 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 % of patients 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 among patients.4,7–9 In turn, physicians and patients increase usage of healthcare resources to manage these adverse effects, substantially increasing the public health burden of cancer and its effective treatment.2–9

The purpose of this article is to provide an overview of the patho-psychophysiology of CINV and the recommended guidelines for its treatment.

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Keywords: Nausea and vomiting, CINV, anticipatory and delayed nausea and vomiting, patho-psychophysiology of chemotherapy-induced nausea and vomiting, guidelines for CINV, Treatments for ANV, palonosetron HCI injection
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