Treatment of nausea and vomiting in terminally ill cancer patients.

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 pathophysiology 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.

journal_name

Drugs

journal_title

Drugs

authors

Glare PA,Dunwoodie D,Clark K,Ward A,Yates P,Ryan S,Hardy JR

doi

10.2165/0003495-200868180-00004

subject

Has Abstract

pub_date

2008-01-01 00:00:00

pages

2575-90

issue

18

eissn

0012-6667

issn

1179-1950

pii

68184

journal_volume

68

pub_type

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