Nausea and vomiting in advanced cancer

Area of Science:

• Oncology
• Palliative Care
• Gastroenterology

Background:

• Nausea and vomiting (N&V) are prevalent and distressing symptoms in advanced cancer patients, often feared more than pain.
• Understanding the pattern and associated symptoms of N&V is crucial for determining the underlying etiology and guiding effective therapy.

Purpose of the Study:

• To review the causes and management strategies for nausea and vomiting in advanced cancer patients.
• To provide guidance on drug selection and treatment escalation for refractory symptoms.

Main Methods:

• Review of clinical history, symptom patterns, and physical examination findings to identify causes of N&V.
• Evaluation of evidence for various antiemetic drug classes, including metoclopramide, phenothiazines, tropisetron, and corticosteroids.
• Discussion of treatment algorithms for refractory N&V and specific interventions for malignant bowel obstruction.

Main Results:

• Continuous severe nausea often indicates medication side effects or metabolic issues, while nausea relieved by vomiting or related to eating suggests gastrointestinal obstruction or gastroparesis.
• Metoclopramide, phenothiazines, and tropisetron demonstrate efficacy, with metoclopramide having the strongest evidence.
• Corticosteroids are effective for bowel obstruction-related N&V. Management of refractory N&V involves multi-receptor targeting, combination therapy, or drug class rotation.

Conclusions:

• Accurate diagnosis of N&V etiology in advanced cancer is key to effective management.
• A stepwise approach to antiemetic therapy, including broad-spectrum agents and combination strategies, is recommended for refractory cases.
• Specific interventions like venting gastrostomy, octreotide, and corticosteroids can alleviate N&V associated with malignant bowel obstruction.