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Overview
Introduction
Classifications
Prevention and control of nausea and vomiting are paramount in the treatment of
cancer patients. Nausea and vomiting can result in serious metabolic
derangements, nutritional depletion and anorexia, deterioration of patients’
physical and mental status, esophageal tears, fractures, wound dehiscence,
withdrawal from potentially useful and curative antineoplastic treatment, and
degeneration of self-care and functional ability. Despite advances in
pharmacologic and nonpharmacologic management, nausea and vomiting remain two of
the more distressing and feared side effects to cancer patients and their
families, and incidence may be underestimated by physicians and nurses.[1-5]
Introduction
Nausea is a subjective phenomenon of an unpleasant, wavelike sensation
experienced in the back of the throat and/or the epigastrium that may or may
not culminate in vomiting. Vomiting is the forceful expulsion of the contents
of the stomach, duodenum, or jejunum through the oral cavity. Retching is
gastric and esophageal movements of vomiting without expulsion of vomitus and
is also referred to as dry heaves.
Classifications
Various classifications of nausea and vomiting (N&V) have been used,[1,6]
including acute, delayed, late or persistent, chronic, anticipatory,
breakthrough, or refractory, as well as distinctions related to type of
treatment (e.g., chemotherapy- or radiation-induced), and clinical course (e.g.,
advanced or terminal disease).[7,8] Despite this variety, the most commonly
described types are acute, delayed, and anticipatory chemotherapy-induced N&V;
and chronic N&V in advanced cancer patients. Although there are no standard
definitions, the following are commonly used to classify the different types.
-
Acute nausea and vomiting (or emesis): N&V experienced during the first 24-hour
period after chemotherapy administration is considered acute N&V.[1]
-
Delayed (or late) nausea and vomiting (or emesis): N&V that occurs more than 24
hours after chemotherapy administration is considered delayed, or late, N&V.
Delayed N&V is associated with cisplatin, cyclophosphamide, and other drugs
(e.g., doxorubicin and ifosfamide) given at high doses or on 2 or more
consecutive days.
-
Anticipatory nausea and vomiting (ANV): ANV is nausea and/or vomiting that
occur prior to the beginning of a new cycle of chemotherapy, in response to
conditioned stimuli such as the smells, sights, and sounds of the treatment
room. ANV is a classically conditioned response that typically occurs after three
or four prior chemotherapy treatments, following which the person experienced
acute or delayed N&V.
-
Chronic nausea and vomiting (or emesis) in advanced cancer patients: Chronic
nausea and vomiting in the advanced cancer patient is N&V associated with a
variety of potential etiologies. A definitive understanding of cause is not
well known, nor well researched, but potential causal factors include
gastrointestinal, cranial, metabolic, drug-induced (e.g., morphine), cytotoxic
chemotherapy, and radiation-induced mechanisms.[9]
Criteria for Grading Severity of Nausea and Vomiting*
|
|
Grade 1
|
Grade 2
|
Grade 3
|
Grade 4
|
Grade 5
|
|
*Adapted from Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0, DCTD, NCI, NIH, DHHS.
|
| Nausea |
Loss of appetite without alteration in eating habits |
Oral intake decreased without significant weight loss, dehydration or malnutrition; IV fluids indicated <24 h |
Inadequate oral caloric or fluid intake; IV fluids, tube feedings, or TPN indicated ≥24 h |
Life-threatening consequences |
Death |
| Vomiting |
1 episode in 24 h |
2–5 episodes in 24 h; IV fluids indicated <24 h |
≥6 episodes in 24 h; IV fluids, or TPN indicated ≥24 h |
Life-threatening consequences |
Death |
References
-
Wickham R: Nausea and vomiting. In: Yarbo CH, Frogge MH, Goodman M, eds.: Cancer Symptom Management. 2nd ed. Sudbury, Mass: Jones and Bartlett Publishers, 1999, pp 228-263.
-
Coates A, Abraham S, Kaye SB, et al.: On the receiving end--patient perception of the side-effects of cancer chemotherapy. Eur J Cancer Clin Oncol 19 (2): 203-8, 1983.
[PUBMED Abstract]
-
Craig JB, Powell BL: The management of nausea and vomiting in clinical oncology. Am J Med Sci 293 (1): 34-44, 1987.
[PUBMED Abstract]
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Passik SD, Kirsh KL, Rosenfeld B, et al.: The changeable nature of patients' fears regarding chemotherapy: implications for palliative care. J Pain Symptom Manage 21 (2): 113-20, 2001.
[PUBMED Abstract]
-
Grunberg SM, Deuson RR, Mavros P, et al.: Incidence of chemotherapy-induced nausea and emesis after modern antiemetics. Cancer 100 (10): 2261-8, 2004.
[PUBMED Abstract]
-
Pisters KM, Kris MG: Treatment-related nausea and vomiting. In: Berger A, Portenoy RK, Weissman DE, eds.: Principles and Practice of Supportive Oncology. Philadelphia, Pa: Lippincott-Raven Publishers, 1998, pp 165-199.
-
Fallon BG: Nausea and vomiting unrelated to cancer treatment. In: Berger A, Portenoy RK, Weissman DE, eds.: Principles and Practice of Supportive Oncology. Philadelphia, Pa: Lippincott-Raven Publishers, 1998, pp 179-189.
-
Allan SG: Nausea and vomiting. In: Doyle D, Hanks GW, MacDonald N, eds.: Oxford Textbook of Palliative Medicine. 2nd ed. New York, NY: Oxford University Press, 1998, pp 282-290.
-
Schwartzberg L: Chemotherapy-induced nausea and vomiting: state of the art in 2006. J Support Oncol 4 (2 Suppl 1): 3-8, 2006.
[PUBMED Abstract]
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