Abstract
Nausea and vomiting is a common and distressing symptom complex in patients with far-advanced cancer, affecting up to 60% of individuals at some stage of their illness. The current approach to the palliative care of patients with nausea and vomiting is based on identifying the cause, understanding its patho-physiology and knowing the pharmacology of the drugs available for its amelioration. The following six main syndromes are identified: gastric stasis, biochemical, raised intracranial pressure, vestibular, mechanical bowel obstruction and ileus. A careful history, focused physical examination and appropriate investigations are needed to elucidate the syndrome and its cause, so that therapy is rational. Drugs are the mainstay of treatment in terminal cancer, and the main classes of antiemetic agents are prokinetics, dopamine antagonists, antihistamines, anticholinergics and serotonin antagonists. Dexamethasone and octreotide are also used, especially in bowel obstruction. Non-drug measures are important in relieving the associated distress. Patients should be able to die comfortably, without tubes. Despite decades of practice affirming this approach, the evidence base is weak and well designed studies are urgently needed.
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Acknowledgements
Dr Glare acknowledges the support of the National Health and Medical Research Council (NHMRC) Strategic Research Development Committee for the palliative care grant RMS 219308, “Improving the management of nausea in advanced cancer: pragmatic tools for the assessment and treatment of nausea in clinical practice”, which informed this article. Dr Hardy has provided advice regarding trials of levomepromazine and other drugs marketed by Link Pharmaceuticals in the UK. The other authors have no conflicts of interest that are directly relevant to the content of this review.
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Glare, P.A., Dunwoodie, D., Clark, K. et al. Treatment of Nausea and Vomiting in Terminally I11 Cancer Patients. Drugs 68, 2575–2590 (2008). https://doi.org/10.2165/0003495-200868180-00004
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DOI: https://doi.org/10.2165/0003495-200868180-00004