Cancer and nausea
[3] Nausea and vomiting may be experienced as the most unpleasant side effects of cytotoxic drugs[4] and may result in patients delaying or refusing further radiotherapy[5] or chemotherapy.
[7] Medical treatments or conditions associated with a high risk of nausea and/or vomiting include chemotherapy, radiotherapy, and malignant bowel obstruction.
[9] Nausea and vomiting may lead to further medical conditions and complications including: dehydration, electrolyte imbalance, malnutrition, and a decrease in quality of life.
Some medical conditions that arise as a result of cancer or as a complication of its treatment are known to be associated with a high risk of nausea and/or vomiting.
[14] Impaired gastric emptying as a result of bowel obstruction may not respond to drugs alone, and surgical intervention is sometimes the only means of symptom relief.
[15] Some constipating drugs used in cancer therapy such as opioids may cause a slowing of peristalsis of the gut, which may lead to a functional bowel obstruction.
[12] Chemotherapy-induced nausea and vomiting (CINV) is one of the most feared side effects of chemotherapy[16] and is associated with a significant deterioration in quality of life.
[9] The European Society of Medical Oncology (ESMO) and the Multinational Association of Supportive Care in Cancer (MASCC) in 2010[9] as well as the American Society of Clinical Oncology (ASCO) (2011)[19] recommend a prophylaxis to prevent acute vomiting and nausea following chemotherapy with high emetic risk drugs by using a three-drug regimen including a 5-HT3 receptor antagonist, dexamethasone and aprepitant (a neurokinin-1 antagonist) given before chemotherapy.
[9][20] Behavioral treatment techniques, such as systematic desensitization, progressive muscle relaxation, and hypnosis have been shown to be effective against ANV.
The emetogenic potential of radiotherapy is classified into high, moderate, low and minimal risk depending on the site of irradiation:[5] Nausea and vomiting may have a number of causes in people with cancer.
[10] Some of the brain stem nuclei which have been identified as important in the coordination of the emetic reflex include the parvicellular reticular formation, the Bötzinger complex and the nucleus tractus solitarii.
Depending on the type of drug and dosage prescribed, common side effects may include: headache, constipation, diarrhea, insomnia, agitation, acne, weight loss/weight gain, dizziness, or drowsiness.
The World Health Organization (WHO) defines it as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems (such as nausea or vomiting), physical, psychosocial, and spiritual.
[8] The surgical approach proves beneficial in affected people with operable lesions, a life expectancy greater than two months and good performance status.
[37] In addition to hospital fees, studies have found that costs incurred for prescription antiemetics averaged between $100–1400 per chemotherapy cycle depending on the drugs prescribed.
General cancer symptom management has shown to make up 5% of annual hospital expenses, with the cost of CINV changing with antiemetic treatment.
