Nausea and vomiting related to cancer treatment

The guidelines for managing nausea & vomiting are different for anticipatory, acute, or delayed nausea & vomiting.

Anticipatory nausea and vomiting: occurs prior to the beginning of a new cycle of chemotherapy. This occurs after the patient has experienced N&V from an earlier chemotherapy treatment.

Acute nausea and vomiting: occurs during the first 24-hours after chemotherapy.

Delayed nausea and vomiting: occurs more than 24 hours after chemotherapy. Patients at highest risk for delayed N&V include those receiving cyclophosphamide, cisplatin, doxorubicin and ifosfamide.
(National Cancer Institute, http://www.cancer.gov/)

Chemotherapy agents are categorized according to their potential to induce nausea & vomiting.
High risk >90%
Moderate risk 30-90%
Low risk 10-30%
Minimal risk <10%

Single IV Agents
Highly emetogenic:
Cisplatin
Mechlorethamine
Cyclophosphamide >1500mg/m2
Carmustine
Dacarbazine

Moderate emetogenic:
Oxaliplatin
Cytarabine >1gm/m2
Carboplatin
Ifosfamide
Cyclophosphamide <1500mg/m2
Doxorubicin

Daunorubicin

Epirubicin

Idarubicin

Irinotecan

Low emetogenic:
Paclitaxel
Docetaxel
Topotecan
Etoposide
Methotrexate
Mitomycin
Gemcitabine
Cytarabine

Minimal emetogenic:
Bleomycin
Busulfan
Fludarabine
Vinblastine
Vincristine
Vinorelbine
Bevacizumab

Guideline for Antiemetic Use:
An antiemetic regimen administered before chemotherapy is recommended to prevent acute nausea and vomiting. This three-drug combination is recommended by ASCO (American Society of Clinical Oncology) for highly emetogenic chemotherapy medications:
1. Serotonin 5-HT3 receptor antagonist (Ondansetron, dolasetron, granisetron, palonosetron)
2. Dexamethasone (corticosteroid)
3. Aprepitant (NK1 receptor antagonist)
(©MASCC 2007, Multinational Association of Supportive Care in Cancer)

5-HT3 antagonists are most effective in the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV), especially that caused by highly emetogenic drugs such as cisplatin; when used for this purpose, they may be given alone or, more frequently, with glucocorticoid, usually dexamethasone. They are usually given intravenously, shortly before administration of the chemotherapeutic agent. The concomitant administration of a NK1 receptor antagonist, such as aprepitant, increases the efficacy of 5-HT3 antagonists in preventing both acute and delayed CINV.
The 5-HT3 antagonists are also indicated in the prevention and treatment of radiation-induced nausea and vomiting (RINV) and post-op nausea and vomiting (PONV).
From Wikipedia, the free encyclopedia

Suggestions for managing delayed nausea & vomiting:

The combination of dexamethasone and aprepitant

Suggestions for managing anticipatory nausea & vomiting:

Physchological techniques and/or the use of benzodiazepines such as lorzepam (Ativan®)




Nutrition Tips for Managing Nausea & Vomiting:
*Eat small, frequent meals and snacks
*Eat toast, crackers, dry cereal, bread sticks, pretzels
*Try yogurt, sherbet, rice, noodles, baked chicken
*Serve foods cold or at room temperature
*Avoid hot, spicy foods
*Avoid fatty, greasy and fried foods- potato chips, french fries, fried meat and sausage
*Avoid sweet, fatty foods such as candy, cookies or cake
*Avoid caffeine and alcohol
*Suck on hard candies, peppermints or lemon drops
*Slowly drink or sip liquids throughout the day including sports drinks, ginger ale, apple juice and flat pop
*Try Ensure® Enlive! (apple or mixed berry) supplement or Nestle Nutritional juice beverage