The management of nausea and vomiting in advanced cancer

Nausea and vomiting are distressing and debilitating symptoms frequently reported in advanced disease. They are also complex and multifactorial in nature, which can make palliation difficult. The primary method of treatment is pharmacological, with current recommendations based on the presumed cause, knowledge of the emetogenic pathways, and matching of the emetogenic stimulus with the drug most likely to act on the relevant receptors. This is often complicated by the difficulty in identifying the cause(s) and the fact that many antiemetics work on multiple receptors. This article offers an overview of the physiology of the emetogenic pathways, the pathophysiology of common aetiologies, the clinical assessment required and tools available, and the pharmacological and non-pharmacological management of these symptoms.