Oncology 101

Optimizing Treatment Outcomes in Patients at Risk for Chemotherapy-Induced Nausea and Vomiting

Nancy Thompson

nausea/vomiting, chemotherapy
CJON 2012, 16(3), 309-313. DOI: 10.1188/12.CJON.309-313

Prevention of chemotherapy-induced nausea and vomiting (CINV) is crucial in maximizing patients' quality of life and optimizing outcomes of cancer therapy, and can be done more effectively than ever before. Appropriate antiemetic therapy combined with targeted patient education, clear communication, and management of patient expectations results in optimal emetogenic control. Oncology nurses play a critical role in the prevention and management of CINV. This column reviews the history and pathophysiology of treatments for CINV, as well as patient- and chemotherapy-specific risk factors that should be considered to optimize treatment outcomes in patients with CINV.

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    Basch, E., Prestrud, A. A., Hesketh, P. J., Kris, M. G., Feyer, P. C., Somerfield, M. R., … Lyman, G. H. (2011). Antiemetics: American Society of Clinical Oncology clinical practice guideline update. Journal of Clinical Oncology, 29, 4189-4198. doi:10.1200/JCO.2010.34.4614
    Berger, A. M., & Clark-Snow, R. A. (2005). Adverse effects of treatment. In V. T. DeVita, S. Hellman, & S. A. Rosenberg (Eds.), Cancer: Principles and practice of oncology (7th ed., pp. 2515-2523). Philadelphia, PA: Lippincott Williams and Wilkins.
    Bonadonna, G., Moliterni, A., Zambetti, M., Daidone, M. G., Pilotti, S., Gianni, L., & Valagussa, P. (2005). 30 years' follow up of randomised studies of adjuvant CMF in operable breast cancer: Cohort study. BMJ, 330, 217. doi:10.1136/bmj.38314.622095.8F
    Eisai. (2009). Aloxi® (palonosetron HCI) for injection [Prescribing information]. Retrieved from http://www.aloxi.com/docs/pdf/PI.pdf
    Grunberg, S. M., & Hesketh, P. J. (1993). Control of chemotherapy-induced emesis. New England Journal of Medicine, 329, 1790-1796.
    Hesketh, P. J. (1999). Defining the emetogenicity of cancer chemotherapy regimens: Relevance to clinical practice. Oncologist, 4(3), 191-196.
    Hesketh, P. J., Grunberg, S. M., Herrstedt, J., de Wit, R., Gralla, R. J., Carides, A. D., … Horgan, K. J. (2006). Combined data from two phase III trials of the NK1 antagonist aprepitant plus a 5HT3 antagonist and a corticosteroid for prevention of chemotherapy-induced nausea and vomiting: Effect of gender on treatment response. Supportive Care in Cancer, 14, 354-360.
    Hesketh, P. J., Van Belle, S., Aapro, M., Tattersall, F. D., Naylor, R. J., Hargreaves, R., … Horgan, K. J. (2003). Differential involvement of neurotransmitters through the time course of cisplatin-induced emesis as revealed by therapy with specific receptor antagonists. European Journal of Cancer, 39, 1074-1080. doi:10.1016/S0959-8049(02)00674-3
    Jakobsen, J. N., & Herrstedt, J. (2009). Prevention of chemotherapy-induced nausea and vomiting in elderly cancer patients. Critical Reviews in Oncology/Hematology, 71, 214-221. doi:10.1016/j.critrevonc.2008.12.006
    Martin, M., Pienkowski, T., Mackey, J., Pawlicki, M., Guastalla, J. P., Weaver, C., … Vogel, C. (2005). Adjuvant docetaxel for node-positive breast cancer. New England Journal of Medicine, 352, 2302-2313. doi:10.1056/NEJMoa043681
    Merck & Co., Inc. (2011). Emend® (fosaprepitant dimeglumine) for injection [Prescribing information]. Retrieved from http://www.merck.com/product/usa/pi_circulars/e/emend_iv/emend_iv_pi.pdf
    Mok, T. S., Wu, Y. L., Thongprasert, S., Yang, C. H., Chu, D. T., Saijo, N., … Fukuoka, M. (2009). Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. New England Journal of Medicine, 361, 947-957. doi:10.1056/NEJMoa0810699
    National Comprehensive Cancer Network. (2012a). Clinical Practice Guidelines in Oncology: Antiemesis [v.1.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf
    National Comprehensive Cancer Network. (2012b). Clinical Practice Guidelines in Oncology: Breast cancer [v.1.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf
    National Comprehensive Cancer Network. (2012c). Clinical Practice Guidelines in Oncology: Colon cancer [v.3.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf
    National Comprehensive Cancer Network. (2012d). Clinical Practice Guidelines in Oncology: Head and neck cancer [v.1.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf
    National Comprehensive Cancer Network. (2012e). Clinical Practice Guidelines in Oncology: Hodgkin lymphoma [v.1.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf
    National Comprehensive Cancer Network. (2012f). Clinical Practice Guidelines in Oncology: Non-small cell lung cancer [v.2.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf
    National Comprehensive Cancer Network. (2012g). Clinical Practice Guidelines in Oncology: Ovarian cancer[v.2.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf
    National Comprehensive Cancer Network. (2012h). Clinical Practice Guidelines in Oncology: Rectal cancer [v.3.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf
    Navari, R. M. (2003). Pathogenesis-based treatment of chemotherapy-induced nausea and vomiting—Two new agents. Journal of Supportive Oncology, 1(2), 89-103.
    Norton, L. (2001). Theoretical concepts and the emerging role of taxanes in adjuvant therapy. Oncologist, 6(Suppl. 3), 30-35. doi:10.1634/theoncologist.6-suppl_3-30
    Osoba, D., Zee, B., Pater, J., Warr, D., Latreille, J., & Kaizer, L. (1997). Determinants of postchemotherapy nausea and vomiting in patients with cancer. Quality of Life and Symptom Control Committees of the National Cancer Institute of Canada Clinical Trials Group. Journal of Clinical Oncology, 15(1), 116-123.
    Polovich, M., Whitford, J. M., & Kelleher, L. O. (2009). Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed.). Pittsburgh, PA: Oncology Nursing Society.
    Roila, F., Hesketh, P. J., & Herrstedt, J. (2006). Prevention of chemotherapy- and radiotherapy-induced emesis: Results of the 2004 Perugia International Antiemetic Consensus Conference. Annals of Oncology, 17(1), 20-28.
    Roldán, G. B., Sijben, A. E., McIntyre, J. B., Easaw, J. C., Yan, E., Forsyth, P. A., … Cairncross, J. G. (2008). Toxicity from chemoradiotherapy in older patients with glioblastoma multiforme [Abstract]. Journal of Clinical Oncology, 26(15, Suppl.), 2054.
    Saito, M., & Tsukuda, M. (2010). Review of palonosetron: Emerging data distinguishing it as a novel 5-HT(3) receptor antagonist for chemotherapy-induced nausea and vomiting. Expert Opinion on Pharmacotherapy, 11, 1003-1014.
    Schwartzberg, L. S. (2007). Chemotherapy-induced nausea and vomiting: Clinician and patient perspectives. Journal of Supportive Oncology, 5(2, Suppl. 1), 5-12.
    Shih, V., Wan, H. S., & Chan, A. (2009). Clinical predictors of chemotherapy-induced nausea and vomiting in breast cancer patients receiving adjuvant doxorubicin and cyclophosphamide. Annals of Pharmacotherapy, 43, 444-452.
    Tavorath, R., & Hesketh, P. J. (1996). Drug treatment of chemotherapy-induced delayed emesis. Drugs, 52, 639-648.
    Tournigand, C., André, T., Achille, E., Lledo, G., Flesh, M., Mery-Mignard, D., … de Gramont, A. (2004). FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: A randomized GERCOR study. Journal of Clinical Oncology, 22, 229-237.
    Vasey, P. A., Jayson, G. C., Gordon, A., Gabra, H., Coleman, R., Atkinson, R., … Kaye, S. B. (2004). Phase III randomized trial of docetaxel-carboplatin versus paclitaxel-carboplatin as first-line chemotherapy for ovarian carcinoma. Journal of the National Cancer Institute, 96, 1682-1691.