Nausea, vomiting, and retching: complex problems in palliative care

Patients with advanced cancer commonly experience nausea, vomiting, and/or retching (NVR) as a result of the malignant process and its treatment. Recently, increasing attention is being focused on end-of-life care, which includes relief or reduction of symptoms such as NVR. Pre-chemotherapy preparation and patient education in the palliative care setting are essential to preventing acute and delayed distress from NVR, as well as anticipatory symptoms. Careful assessment of chemotherapy-related symptoms should distinguish between the three phenomena rather than taking a global approach. Strategies for preventing anticipatory nausea, for instance, may differ significantly from those designed to reduce frequency of vomiting. Management of anticancer treatment-related NVR should incorporate both pharmacologic and nonpharmacologic approaches, whenever appropriate, with the overall goal of improving and/or maintaining the patient's quality of life.