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2016 Updated MASCC/ESMO consensus recommendations: Management of nausea and vomiting in advanced cancer

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Abstract

Purpose

The aim of this paper is to review the existing literature related to the management of nausea and vomiting (N & V) in advanced cancer and derive clinical evidence-based recommendations for its management.

Methods

Available systematic reviews on antiemetic drug effectiveness were used. One generic systematic review of antiemetics in advanced cancer (to 2009) was updated to February 2016. Agreement on recommendations was reached between panel members, and these were voted in favor unanimously by the larger antiemetic committee membership (n = 37).

Results

The evidence base in this field is minimal with largely poor quality trials or uncontrolled trials and case studies. The level of evidence in most studies is low. The drug of choice for managing N & V in advanced cancer is metoclopramide titrated to effect. Alternative options include haloperidol, levomepromazine, or olanzapine. For bowel obstruction, the recommendation is to use octreotide given alongside an antiemetic (haloperidol) and where octreotide is not an option to use an anticholinergic antisecretory agent. For opioid-induced N & V, no recommendation could be made.

Conclusion

These new guidelines, based on the existing (but poor) evidence, could help clinicians manage more effectively the complex and challenging symptoms of N & V in advanced cancer.

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Author information

Authors and Affiliations

  1. Academic Department of Palliative Medicine, Our Lady’s Hospice and Care Services, Dublin, Ireland

    Declan Walsh

  2. Faculty of Health Sciences, Trinity College Dublin, Dublin 2, Ireland

    Declan Walsh

  3. School of Medicine and Medical Science, University College Dublin, Dublin, Ireland

    Declan Walsh

  4. Section of Palliative Medicine and Supportive Oncology, Department of Hematology- Oncology, The Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA

    Mellar Davis

  5. Supportive Care in Cancer Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

    Carla Ripamonti

  6. Department of Palliative, Rehabilitation, & Integrative Medicine UT MD Anderson Cancer Center, Houston, TX, USA

    Eduardo Bruera

  7. Supportive & Palliative Care Department, St. Luke’s Cancer Centre, Royal Surrey County Hospital / St. Luke’s Cancer Centre, Guildford, UK

    Andrew Davies

  8. School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China, SAR

    Alex Molassiotis

Authors
  1. Declan Walsh
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  2. Mellar Davis
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  3. Carla Ripamonti
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  4. Eduardo Bruera
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  5. Andrew Davies
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  6. Alex Molassiotis
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Corresponding author

Correspondence to Declan Walsh.

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Conflict of interest

AD, EB, MD declare no conflict of interest. AM declares honoraria or grants from MSD Merck; Helsinn; Tesaro; Norgine; Acacia Pharma. DW Advisory Role for Nualtra Ltd. & Tesaro; CR from Teva; Norgine; Otsuka; Amgen.

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Walsh, D., Davis, M., Ripamonti, C. et al. 2016 Updated MASCC/ESMO consensus recommendations: Management of nausea and vomiting in advanced cancer. Support Care Cancer 25, 333–340 (2017). https://doi.org/10.1007/s00520-016-3371-3

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  • DOI: https://doi.org/10.1007/s00520-016-3371-3

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