CAM Therapies and New Antiemetic Delivery Methods on the Rise in CINV Management

Researchers are looking at new ways to deliver some antiemetics for managing chemotherapy-induced nausea and vomiting (CINV). The 5-HT3 receptor antagonist granisetron is available orally and now as a transdermal patch. Studies have shown that the patch, which is placed on a patient’s skin 24–48 hours before chemotherapy, is just as effective as the oral capsule, which will be beneficial for patients who are unable to swallow pills (Hawkins & Grunberg, 2009).

Metoclopramide, ondansetron, and granisetron are also being studied for intranasal delivery, with preliminary results showing that the delivery system is feasible (Ozsoy & Güngör, 2011). Intranasal delivery has the added benefit of rapid, high-systemic drug absorption for emergency treatment of severe breakthrough CINV (Hawkins & Grunberg, 2009).

In an effort to help manage a variety of conditions, nearly 40% of Americans are turning to complementary or alternative medicine (CAM). That percentage is expected to be higher in patients with serious illnesses such as cancer. Several CAM therapies are reportedly used for CINV, such as consumption of ginger, acupressure, and biofeedback. Although healthcare providers may be skeptical about CAM’s effectiveness, the fact remains that patients with cancer are using these treatments. Oncology nurses should be aware of the treatments patients are using, ask patients about their use during assessments, and be prepared to answer patients’ questions about CAM (Bell, 2010).

Evidence-based research supports the effectiveness of P6 acupressure for CINV and electroacupuncture for nausea and vomiting (Bell, 2010). The ONS Putting Evidence Into Practice materials, which have synthesized the research from reliable studies, indicate that acupressure, acupuncture, guided imagery, music therapy, and progressive muscle relaxation are all likely to be effective for CINV.

As the first line of contact for patients with cancer experiencing CINV, oncology nurses play a critical role in ensuring this distressing side effect is managed effectively. For more information on the nurse’s role in CINV management, refer to the full articles by Hawkins and Grunberg (2009), Bell (2010), and Rogers and Blackburn (2010).


Bell, R.M. (2010). A review of complementary and alternative medicine practices among cancer survivors. Clinical Journal of Oncology Nursing, 14, 365–370. doi: 10.1188/10.CJON.365-370

Hawkins, R., & Grunberg, S. (2009). Chemotherapy-induced nausea and vomiting: Challenges and opportunities for improved patient outcomes. Clinical Journal of Oncology Nursing, 13, 54–64. doi: 10.1188/09.CJON.54-64

Ozsoy, Y., & Güngör, S. (2011). Nasal route: An alternative approach for antiemetic drug delivery. Expert Opinion on Drug Delivery, 8,1439–1453.doi: 10.1517/17425247.2011.607437

Rogers, M.P., & Blackburn, L. (2010). Use of neurokinin-1 receptor antagonists in patients receiving moderately or highly emetogenic chemotherapy. Clinical Journal of Oncology Nursing, 14, 500–504. doi: 10.1188/10.CJON.500-504