Relief available for chemo-induced nausea and vomiting
Nausea and vomiting due to cancer treatment are two of the most dreaded side effects of chemotherapy for many patients and their care providers. The good news is that steps can be taken to prevent and manage these unpleasant and potentially serious symptoms.
During cancer treatment, some patients have a very difficult time with vomiting (throwing up), while others may only experience nausea (feeling queasy). Although the two can occur separately, they are often termed together as chemotherapy-induced nausea and vomiting (CINV).
CINV can lead to dehydration and weight loss, which can make other complications of cancer and treatment worse, including fatigue and depression.
Some patients may end up in the emergency department because they are unable to drink fluids and feel extremely unwell. Others will suffer at home under the misperception that nausea and vomiting are “normal” side effects of chemotherapy.
CINV can even lead to treatment delays and refusal. When CINV is severe and not well controlled, some patients can develop anticipatory nausea and vomiting; the brain links the sight or smell of the hospital or chemotherapy unit with nausea and vomiting, which triggers a reaction even before the patient receives their treatment.
As a pharmacist, I recall a young male patient with Hodgkin’s lymphoma who refused further chemotherapy because of uncontrolled CINV. Although this was many years ago, this young man left a huge impact on me. He taught me there can be significant, even life-threatening, consequences if we do not do a good job at preventing CINV upfront. In his case, he refused further treatment in a potentially curable situation.
Better management through prevention
Fortunately, much has improved in the management of CINV over the past 10 years. There are new medications that target the vomiting centre of the brain. We understand more about how to better manage both nausea and vomiting using these medications.
Recognizing the impact that CINV can have on patients’ quality of life and health outcomes, Cancer Care Ontario has produced Antiemetic Recommendations Report: A Clinical Practice Guideline. This report outlines recommendations for the preventative treatment for CINV and aims to standardize its management in cancer centres in Ontario.
These guidelines were developed by a group of clinicians (nurses, pharmacists and physicians) from across Ontario. They reviewed literature and other practice guidelines from other jurisdictions to create recommendations that are patient-centred and specific for Ontario.
I encourage prescribers, pharmacists and nurses to review these guidelines and share them with their colleagues. Consistently applying the guidelines will ensure the correct regimens to prevent CINV are prescribed, dispensed and given to patients who are receiving chemotherapy. An algorithm for screening and assessing nausea and vomiting in adults with cancer is also available online to support the guidelines.
Patient education is also key to preventing CINV. Cancer Care Ontario has a guide to help patients prevent and manage nausea and vomiting and understand the importance of taking their medication as prescribed. This nausea and vomiting symptom management guide is available in six languages.
As these recommendations become standard practice in cancer centres across Ontario, patients will be able to complete their chemotherapy with less fear of nausea and vomiting.
Kathy Vu, PharmD, is Clinical Lead of Cancer Care Ontario’s Safety Initiatives, Systemic Treatment Program.
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