open access

Vol 10, No 3 (2016)
Review paper
Published online: 2017-03-13
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Nausea and vomiting in cancer patients — clinical practice recommendations

Wojciech Leppert, Jaroslaw Woron
Medycyna Paliatywna w Praktyce 2016;10(3):98-111.

open access

Vol 10, No 3 (2016)
Review articles
Published online: 2017-03-13

Abstract

Nausea and vomiting (NV) are frequent symptoms form the gastrointestinal system in cancer patients, especially in advanced disease. Chronic NV are most frequently evoked by the cancer progression, metabolic disturbances, oncologic treatment, opioids and other drugs administration. Significant group of causes of NV are cytotostatic drugs and other systemic therapies, local treatment: radiotherapy and surgery. The most difficult therapeutic challenge concerns NV in the course of inoperable bowel obstruction. According to a receptor theory NV are induced by numerous neurotransmitters that activate receptors located on the vagus nerve endings and in the CNS, thus the treatment should effectively block receptors involved. In cancer patients suffering from chronic NV unrelated to oncology treatment few randomized studies were conducted to date and in consequence there is a lack of therapeutic recommendations for the management of symptoms based on a high level of scientific evidence. Therapeutic interventions in patients with chronic NV should encompass possible causes, pathophysiology, meticulous clinical assessment (including detailed history, physical examination and if necessary laboratory and/or imaging investigations), which allows to introduce effective treatment and in consequence improve patients’ quality of life. In this article causes, pathophysiology and treatment are discussed including more frequently used antiemetics and therapeutic recommendations of the Multinational Association for Supportive care in Cancer (MASCC) and European Society of Medical Oncology (ESMO).

Abstract

Nausea and vomiting (NV) are frequent symptoms form the gastrointestinal system in cancer patients, especially in advanced disease. Chronic NV are most frequently evoked by the cancer progression, metabolic disturbances, oncologic treatment, opioids and other drugs administration. Significant group of causes of NV are cytotostatic drugs and other systemic therapies, local treatment: radiotherapy and surgery. The most difficult therapeutic challenge concerns NV in the course of inoperable bowel obstruction. According to a receptor theory NV are induced by numerous neurotransmitters that activate receptors located on the vagus nerve endings and in the CNS, thus the treatment should effectively block receptors involved. In cancer patients suffering from chronic NV unrelated to oncology treatment few randomized studies were conducted to date and in consequence there is a lack of therapeutic recommendations for the management of symptoms based on a high level of scientific evidence. Therapeutic interventions in patients with chronic NV should encompass possible causes, pathophysiology, meticulous clinical assessment (including detailed history, physical examination and if necessary laboratory and/or imaging investigations), which allows to introduce effective treatment and in consequence improve patients’ quality of life. In this article causes, pathophysiology and treatment are discussed including more frequently used antiemetics and therapeutic recommendations of the Multinational Association for Supportive care in Cancer (MASCC) and European Society of Medical Oncology (ESMO).

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Keywords

Treatment, bowel obstruction, nausea, gastrointestinal symptoms, vomiting

About this article
Title

Nausea and vomiting in cancer patients — clinical practice recommendations

Journal

Palliative Medicine in Practice

Issue

Vol 10, No 3 (2016)

Article type

Review paper

Pages

98-111

Published online

2017-03-13

Bibliographic record

Medycyna Paliatywna w Praktyce 2016;10(3):98-111.

Keywords

Treatment
bowel obstruction
nausea
gastrointestinal symptoms
vomiting

Authors

Wojciech Leppert
Jaroslaw Woron

References (43)
  1. Mannix KA. Palliation of nausea and vomiting. In: Doyle D, Hanks G, Calman K. ed. Oxford Textbook of Palliative Medicine. Oxford University Press, Oxford 2004: 459–468.
  2. Ripamonti C, Bruera E. Chronic nausea and vomiting. In: Ripamonti C, Bruera E. ed. Gastrointestinal Symptoms in Advanced Cancer Patients. Oxford University Press, Oxford 2002: 169–192.
  3. Leppert W. Postępowanie u chorych z objawami ze strony przewodu pokarmowego w medycynie paliatywnej. Terapia. 2011; 19: 59–66.
  4. Twycross R, Wilcock A. Anti–emetics. In: Twycross R, Wilcock A. ed. Palliative Care Formulary. Fourth Edition. Palliativedrugs.com Ltd 2011: 219–236.
  5. Kawecki A, Krzakowski M. Nudności i wymioty związane z chemioterapią i radioterapią. In: Krzakowski M, Warzocha K. ed. Zalecenia postępowania diagnostyczno-terapeutycznego w nowotworach złośliwych. Onkol. Prakt. Klin. 2013: 586–597.
  6. Twycross R, Back I. Nausea and vomiting in advanced cancer. Eur J Palliat Care. 1998; 5: 39–45.
  7. Laugsand EA, Kaasa S, Klepstad P. Management of opioid-induced nausea and vomiting in cancer patients: systematic review and evidence-based recommendations. Palliat Med. 2011; 25(5): 442–453.
  8. Wood JM, Chapman K, Eilers J. Tools for assessing nausea, vomiting, and retching. Cancer Nurs. 2011; 34(1): E14–E24.
  9. Leppert W, Forycka M, de Walden-Gałuszko K, et al. Ocena jakości życia u chorych na nowotwory – zalecenia dla personelu oddziałów onkologicznych i medycyny paliatywnej. Psychoonkologia. 2014; 18: 17–29.
  10. Gregory RE, Ettinger DS. 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting. A comparison of their pharmacology and clinical efficacy. Drugs. 1998; 55(2): 173–189.
  11. Saito M, Aogi K, Sekine I, et al. Palonosetron plus dexamethasone versus granisetron plus dexamethasone for prevention of nausea and vomiting during chemotherapy: a double-blind, double-dummy, randomised, comparative phase III trial. Lancet Oncol. 2009; 10(2): 115–124.
  12. Feyer P, Jahn F, Jordan K. Radiation induced nausea and vomiting. Eur J Pharmacol. 2014; 722: 165–171.
  13. Jordan K, Gralla R, Jahn F, et al. International antiemetic guidelines on chemotherapy induced nausea and vomiting (CINV): content and implementation in daily routine practice. Eur J Pharmacol. 2014; 722: 197–202.
  14. Leppert W, Wache A. Nudności i wymioty wywołane chemioterapią i radioterapią u chorych na nowotwory. Onkol Dypl. 2014; 11: 23–31.
  15. Aapro M, Rugo H, Rossi G, et al. A randomized phase III study evaluating the efficacy and safety of NEPA, a fixed-dose combination of netupitant and palonosetron, for prevention of chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy. Ann Oncol. 2014; 25(7): 1328–1333.
  16. Desta Z, Wu GM, Morocho AM, et al. The gastroprokinetic and antiemetic drug metoclopramide is a substrate and inhibitor of cytochrome P450 2D6. Drug Metab Dispos. 2002; 30(3): 336–343.
  17. Navari RM, Einhorn LH, Passik SD, et al. A phase II trial of olanzapine for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier Oncology Group study. Support Care Cancer. 2005; 13(7): 529–534.
  18. Matulonis UA, Seiden MV, Roche M, et al. Long-acting octreotide for the treatment and symptomatic relief of bowel obstruction in advanced ovarian cancer. J Pain Symptom Manage. 2005; 30(6): 563–569.
  19. Aapro MS, Molassiotis A, Olver I. Anticipatory nausea and vomiting. Support Care Cancer. 2005; 13(2): 117–121.
  20. Navari RM. Management of chemotherapy-induced nausea and vomiting : focus on newer agents and new uses for older agents. Drugs. 2013; 73(3): 249–262.
  21. Baines M, Oliver DJ, Carter RL. Medical management of intestinal obstruction in patients with advanced malignant disease. A clinical and pathological study. Lancet. 1985; 2(8462): 990–993.
  22. Mercadante S, Ferrera P, Villari P, et al. Aggressive pharmacological treatment for reversing malignant bowel obstruction. J Pain Symptom Manage. 2004; 28(4): 412–416.
  23. Ripamonti C, Twycross R, Baines M, et al. Working Group of the European Association for Palliative Care. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer. 2001; 9(4): 223–233.
  24. Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer. 2008; 44(8): 1105–1115.
  25. Leppert W, Łuczak J. Nudności i wymioty w zaawansowanej chorobie nowotworowej — zasady postępowania. Przew Lek. 2000; 1: 31–41.
  26. Benítez-Rosario MA, Salinas-Martín A, Martínez-Castillo LP, et al. Intermittent nasogastric drainage under sedation for unresponsive vomiting in terminal bowel obstruction. J Pain Symptom Manage. 2003; 25(1): 4–5.
  27. Leppert W, Swoboda D. Postępowanie u chorych na nowotwory z objawami niedrożności jelit. Med Paliat. 2010; 2: 177–189.
  28. Vickers AJ. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med. 1996; 89(6): 303–311.
  29. Walsh D, Davis M, Ripamonti C, et al. 2016 Updated MASCC/ESMO consensus recommendations: Management of nausea and vomiting in advanced cancer. Support Care Cancer. 2017; 25(1): 333–340.
  30. Bruera ED, MacEachern TJ, Spachynski KA, et al. Comparison of the efficacy, safety, and pharmacokinetics of controlled release and immediate release metoclopramide for the management of chronic nausea in patients with advanced cancer. Cancer. 1994; 74(12): 3204–3211.
  31. Bruera E, Belzile M, Neumann C, et al. A double-blind, crossover study of controlled-release metoclopramide and placebo for the chronic nausea and dyspepsia of advanced cancer. J Pain Symptom Manage. 2000; 19(6): 427–435.
  32. Bruera E, Moyano JR, Sala R, et al. Dexamethasone in addition to metoclopramide for chronic nausea in patients with advanced cancer: a randomized controlled trial. J Pain Symptom Manage. 2004; 28(4): 381–388.
  33. Atreya S, Datta SS. Olanzapine for refractory nausea and vomiting in patients with advanced malignancy. Eur J Palliat Care. 2016; 23: 214–218.
  34. Porreca F, Ossipov MH. Nausea and vomiting side effects with opioid analgesics during treatment of chronic pain: mechanisms, implications, and management options. Pain Med. 2009; 10(4): 654–662.
  35. Laugsand EA, Fladvad T, Skorpen F, et al. Clinical and genetic factors associated with nausea and vomiting in cancer patients receiving opioids. Eur J Cancer. 2011; 47(11): 1682–1691.
  36. Smith HS, Laufer A. Opioid induced nausea and vomiting. Eur J Pharmacol. 2014; 722: 67–78.
  37. Navari RM, Brenner MC. Treatment of cancer-related anorexia with olanzapine and megestrol acetate: a randomized trial. Support Care Cancer. 2010; 18(8): 951–956.
  38. Naing A, Dalal S, Abdelrahim M, et al. Olanzapine for cachexia in patients with advanced cancer: an exploratory study of effects on weight and metabolic cytokines. Support Care Cancer. 2015; 23(9): 2649–2654.
  39. Leppert W, Woźniak S, Łuczak J. Zastosowanie trójstopniowej drabiny leczenia nudności i wymiotów w zaawansowanej chorobie nowotworowej. Twój Mag Med. 2005; 5: 19–25.
  40. Dickman A, Schneider J, Varga J. Compatibility data tables. In: Dickman A, Schneider J, Varga J. ed. he Syringe Driver — Continuous subcutaneous infusions in palliative care. Oxford University Press, Oxford 2005: 117–318.
  41. Płotkowiak Z, Popielarz-Brzezińska M, Andrzejewska J, et al. Badania analityczne chlorowodorku tramadolu i jego mieszanin z lekammagającymi. Biul Inst Lek. 1996; 40: 3–8.
  42. Negro S, Azuara ML, Sánchez Y, et al. Physical compatibility and in vivo evaluation of drug mixtures for subcutaneous infusion to cancer patients in palliative care. Support Care Cancer. 2002; 10(1): 65–70.
  43. Roila F, Molassiotis A, Herrstedt J, et al. participants of the MASCC/ESMO Consensus Conference Copenhagen 2015. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol. 2016; 27(suppl 5): v119–v133.

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