Treatment of Nausea and Vomiting in Terminally I11 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 patho-physiology 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.

This is a preview of subscription content, access via your institution.

Table I
Table II
Table III
Table IV

References

  1. 1.

    Nelson JE, Meier DE, Litke A, et al. The symptom burden of chronic critical illness. Crit Care Med 2004; 32: 1527–34

    PubMed  Article  Google Scholar 

  2. 2.

    Wolfe J, Grier HE, Klar N, et al. Symptoms and suffering at the end of life in children with cancer. N Engl J Med 2000; 342: 326–33

    PubMed  CAS  Article  Google Scholar 

  3. 3.

    Tranmer JE, Heyland D, Dudgeon D, et al. Measuring the symptom experience of seriously ill cancer and noncancer hospitalized patients near the end of life with the memorial symptom assessment scale. J Pain Symptom Manage 2003; 25: 420–9

    PubMed  Article  Google Scholar 

  4. 4.

    Chang VT, Hwang SS, Kasimis B, et al. Shorter symptom assessment instruments: the Condensed Memorial Symptom Assessment Scale (CMSAS). Cancer Invest 2004; 22: 526–36

    PubMed  Article  Google Scholar 

  5. 5.

    Grossman SA. Undertreatment of cancer pain: barriers and remedies. Support Care Cancer 1993; 1: 74–8

    PubMed  CAS  Article  Google Scholar 

  6. 6.

    Reuben DB, Mor V. Nausea and vomiting in terminal cancer patients. Arch Intern Med 1986; 146: 2021–3

    PubMed  CAS  Article  Google Scholar 

  7. 7.

    Greaves J, Glare P, Kristjanson LJ, et al. Undertreatment of nausea and other symptoms in hospitalized cancer patients. Support Care Cancer 2008. Epub 2008 Oct 18

  8. 8.

    Steadman K, Franks A. A woman with malignant bowel obstruction who did not want to die with tubes. Lancet 1996; 347: 944

    PubMed  CAS  Article  Google Scholar 

  9. 9.

    Ripamonti C, Bruera E. Palliative management of malignant bowel obstruction. Int J Gynecol Cancer 2002; 12: 135–43

    PubMed  Article  Google Scholar 

  10. 10.

    Tack J, Talley NJ, Camilleri M, et al. Functional gastroduodenal disorders. Gastroenterology 2006; 130: 1466–79

    PubMed  Article  Google Scholar 

  11. 11.

    Talley NJ, Phillips SF. Non-ulcer dyspepsia: potential causes and pathophysiology. Ann Intern Med 1988; 108: 865–79

    PubMed  CAS  Google Scholar 

  12. 12.

    Mitchelson F. Pharmacological agents affecting emesis: a review (part II). Drugs 1992; 43: 443–63

    PubMed  CAS  Article  Google Scholar 

  13. 13.

    Mitchelson F. Pharmacological agents affecting emesis: a review (part I). Drugs 1992; 43: 295–315

    PubMed  CAS  Article  Google Scholar 

  14. 14.

    Lichter I. Nausea and vomiting in patients with cancer. Hematol Oncol Clin North Am 1996; 10: 207–20

    PubMed  CAS  Article  Google Scholar 

  15. 15.

    Bentley A, Boyd K. Use of clinical pictures in the management of nausea and vomiting: a prospective audit. Palliat Med 2001; 15: 247–53

    PubMed  CAS  Article  Google Scholar 

  16. 16.

    Baines MJ. ABC of palliative care: nausea, vomiting, and intestinal obstruction. BMJ 1997; 315: 1148–50

    PubMed  CAS  Article  Google Scholar 

  17. 17.

    Mannix KA. Palliation of nausea and vomiting. In: Doyle D, Hanks G, Cherny NI, et al., editors. Oxford textbook of palliative medicine. 3rd ed. Oxford: Oxford University Press, 2004: 459–68

    Google Scholar 

  18. 18.

    Wood GJ, Shega JW, Lynch B, et al. Management of intractable nausea and vomiting in patients at the end of life: “I was feeling nauseous all of the time. nothing was working”. JAMA 2007; 298:1196–207

    PubMed  CAS  Article  Google Scholar 

  19. 19.

    Parischa PJ. Prokinetics, antiemetics and agents used in irritable bowel syndrome. In: Hardman JG, Limbird LE, Gilman AG, editors. Goodman & Gilman’s the pharmacologic basis of therapeutics. 10th ed. New York: McGraw-Hill, 2001: 1021–37

    Google Scholar 

  20. 20.

    Grunberg SM, Hesketh PJ. Control of chemotherapy-induced emesis. N Engl J Med 1993; 329: 1790–6

    PubMed  CAS  Article  Google Scholar 

  21. 21.

    Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med 2008; 358: 2482–94

    PubMed  CAS  Article  Google Scholar 

  22. 22.

    Meineche-Schmidt V, Christensen E. Classification of dyspepsia: identification of independent symptom components in 7270 consecutive, unselected dyspepsia patients from general practice. Scand J Gastroenterol 1998; 33: 1262–72

    PubMed  CAS  Article  Google Scholar 

  23. 23.

    Lee BN, Dantzer R, Langley KE, et al. A cytokine-based neuroimmunologic mechanism of cancer-related symptoms. Neuroimmunomodulation 2004; 11: 279–92

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Ripamonti C, Twycross R, Baines M, et al. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer 2001; 9: 223–33

    PubMed  CAS  Article  Google Scholar 

  25. 25.

    Valenzuela JE, Dooley CP. Dopamine antagonists in the upper gastrointestinal tract. Scand J Gastroenterol 1984; 96 Suppl.: 127–36

    CAS  Google Scholar 

  26. 26.

    Schuurkes JAJ, Helsen LFM, Ghoos ECR, et al. Stimulation of gastroduodenal motor activity: dopaminergic and cholinergic modulation. Drug Dev Res 1986; 8: 233–41

    CAS  Article  Google Scholar 

  27. 27.

    Matsuda H, Li Y, Yoshikawa M. Possible involvement of dopamine and dopamine2 receptors in the inhibitions of gastric emptying by escin Ib in mice. Life Sci 2000; 67: 2921–7

    PubMed  CAS  Article  Google Scholar 

  28. 28.

    De Maeyer JH, Lefebvre RA, Schuurkes JA. 5-HT4 receptor agonists: similar but not the same. Neurogastroenterol Motil 2008; 20: 99–112

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Tonini M, De Ponti F, Di Nucci A, et al. Cardiac adverse effects of gastrointestinal prokinetics. Aliment Pharmacol Ther 1999; 13: 1585–91

    PubMed  CAS  Article  Google Scholar 

  30. 30.

    Lynch B, Sarazine J. A guide to understanding malignant bowel obstruction. Int J Palliat Nurs 2006; 12: 164–6, 8–71

    PubMed  Google Scholar 

  31. 31.

    Jatoi A, Podratz KC, Gill P, et al. Pathophysiology and palliation of inoperable bowel obstruction in patients with ovarian cancer. J Support Oncol 2004; 2: 323–34; discussion 34-7

    PubMed  Google Scholar 

  32. 32.

    Peroutka SJ, Snyder SH. Antiemetics: neurotransmitter receptor binding predicts therapeutic actions. Lancet 1982; I: 658–9

    Article  Google Scholar 

  33. 33.

    Moore NA, Tye NC, Axton MS, et al. The behavioral pharmacology of olanzapine, a novel “atypical” antipsychotic agent. J Pharmacol Exp Ther 1992; 262: 545–51

    PubMed  CAS  Google Scholar 

  34. 34.

    Dahl SG, Strandjord RE. Pharmacokinetics of chlorpromazine after single and chronic dosage. Clin Pharmacol Ther 1977; 21: 437–48

    PubMed  CAS  Google Scholar 

  35. 35.

    Griffin DS, Baselt RC. Blood and urine concentrations of cyclizine by nitrogen-phosphorus gas-liquid chromatography. J Anal Toxicol 1984; 8: 97–9

    PubMed  CAS  Google Scholar 

  36. 36.

    Czock D, Keller F, Rasche FM, et al. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet 2005; 44: 61–98

    PubMed  CAS  Article  Google Scholar 

  37. 37.

    Dimmitt DC, Choo YS, Martin LA, et al. Intravenous pharmacokinetics and absolute oral bioavailability of dolasetron in healthy volunteers: part 1. Biopharm Drug Dispos 1999; 20: 29–39

    PubMed  CAS  Article  Google Scholar 

  38. 38.

    Lerman J, Sims C, Sikich N, et al. Pharmacokinetics of the active metabolite (MDL 74,156) of dolasetron mesylate after oral or intravenous administration to anesthetized children. Clin Pharmacol Ther 1996; 60: 485–92

    PubMed  CAS  Article  Google Scholar 

  39. 39.

    Barone JA. Domperidone: a peripherally acting dopamine2-receptor antagonist. Ann Pharmacother 1999; 33: 429–40

    PubMed  CAS  Article  Google Scholar 

  40. 40.

    Heykants J, Hendriks R, Meuldermans W, et al. On the pharmacokinetics of domperidone in animals and man: IV, the pharmacokinetics of intravenous domperidone and its bioavailability in man following intramuscular, oral and rectal administration. Eur J Drug Metab Pharmacokinet 1981; 6: 61–70

    PubMed  CAS  Article  Google Scholar 

  41. 41.

    Heykants J, Knaeps A, Meuldermans W, et al. On the pharmacokinetics of domperidone in animals and man: I, plasma levels of domperidone in rats and dogsage related absorption and passage through the blood brain barrier in rats. Eur J Drug Metab Pharmacokinet 1981; 6: 27–36

    PubMed  CAS  Article  Google Scholar 

  42. 42.

    Michiels M, Hendriks R, Heykants J. On the pharmacokinetics of domperidone in animals and man II: tissue distribution, placental and milk transfer of domperidone in the Wistar rat. Eur J Drug Metab Pharmacokinet 1981; 6: 37–48

    PubMed  CAS  Article  Google Scholar 

  43. 43.

    Meuldermans W, Hurkmans R, Swysen E, et al. On the pharmacokinetics of domperidone in animals and man: III, comparative study on the excretion and metabolism of domperidone in rats, dogs and man. Eur J Drug Metab Pharmacokinet 1981; 6: 49–60

    PubMed  CAS  Article  Google Scholar 

  44. 44.

    Huang YC, Colaizzi JL, Bierman RH, et al. Pharmacokinetics and dose proportionality of domperidone in healthy volunteers. J Clin Pharmacol 1986; 26: 628–32

    PubMed  CAS  Google Scholar 

  45. 45.

    Bateman DN, Gokal R, Dodd TR, et al. The pharmacokinetics of single doses of metoclopramide in renal failure. Eur J Clin Pharmacol 1981; 19: 437–41

    PubMed  CAS  Article  Google Scholar 

  46. 46.

    Seyffart G. Drug dosage in renal insufficiency. New York: Springer, 1991

    Book  Google Scholar 

  47. 47.

    Plosker GL, Goa KL. Granisetron: areview of its pharmacological properties and therapeutic use as an antiemetic. Drugs 1991; 42: 805–24

    PubMed  CAS  Article  Google Scholar 

  48. 48.

    Kudo S, Ishizaki T. Pharmacokinetics of haloperidol: an update. Clin Pharmacokinet 1999; 37: 435–56

    PubMed  CAS  Article  Google Scholar 

  49. 49.

    Twycross R, Wilcock A, Charlesworth S, et al. PCF2: palliative care formulary. 2nd ed. Oxford: Radcliffe Medical Press, 2002

    Google Scholar 

  50. 50.

    Herxheimer A, Haefeli L. Human pharmacology of hyoscine butylbromide. Lancet 1966; I: 418–21

    Article  Google Scholar 

  51. 51.

    Ebert U, Siepmann M, Oertel R, et al. Pharmacokinetics and pharmacodynamics of scopolamine after subcutaneous administration. J Clin Pharmacol 1998; 38: 720–6

    PubMed  CAS  Google Scholar 

  52. 52.

    Dahl SG. Pharmacokinetics of methotrimeprazine after single and multiple doses. Clin Pharmacol Ther 1976; 19: 435–42

    PubMed  CAS  Google Scholar 

  53. 53.

    Kutz K, Nuesch E, Rosenthaler J. Pharmacokinetics of SMS 201–995 in healthy subjects. Scand J Gastroenterol 1986; 119 Suppl.: 65–72

    CAS  Article  Google Scholar 

  54. 54.

    Chanson P, Timsit J, Harris AG. Clinical pharmacokinetics of octreotide: therapeutic applications in patients with pituitary tumours. Clin Pharmacokinet 1993; 25: 375–91

    PubMed  CAS  Article  Google Scholar 

  55. 55.

    Callaghan JT, Bergstrom RF, Ptak LR, et al. Olanzapine: pharmacokinetic and pharmacodynamic profile. Clin Pharmacokinet 1999; 37: 177–93

    PubMed  CAS  Article  Google Scholar 

  56. 56.

    Roila F, Del Favero A. Ondansetron clinical pharmacokinetics. Clin Pharmacokinet 1995; 29: 95–109

    PubMed  CAS  Article  Google Scholar 

  57. 57.

    Simpson KH, Hicks FM. Clinical pharmacokinetics of ondansetron: a review. J Pharm Pharmacol 1996; 48: 774–81

    PubMed  CAS  Article  Google Scholar 

  58. 58.

    Taylor WB, Bateman DN. Preliminary studies of the pharmacokinetics and pharmacodynamics of prochlorperazine in healthy volunteers. Br J Clin Pharmacol 1987; 23: 137–42

    PubMed  CAS  Article  Google Scholar 

  59. 59.

    Isah AO, Rawlins MD, Bateman DN. Clinical pharmacology of prochlorperazine in healthy young males. Br J Clin Pharmacol 1991; 32: 677–84

    PubMed  CAS  Google Scholar 

  60. 60.

    Taylor G, Houston JB, Shaffer J, et al. Pharmacokinetics of promethazine and its sulphoxide metabolite after intravenous and oral administration to man. Br J Clin Pharmacol 1983; 15: 287–93

    PubMed  CAS  Article  Google Scholar 

  61. 61.

    Paton DM, Webster DR. Clinical pharmacokinetics of H1-receptor antagonists (the antihistamines). Clin Pharmacokinet 1985; 10: 477–97

    PubMed  CAS  Article  Google Scholar 

  62. 62.

    Stoltz R, Cyong JC, Shah A, et al. Pharmacokinetic and safety evaluation of palonosetron, a 5-hydroxytryptamine-3 receptor antagonist, in US and Japanese healthy subjects. J Clin Pharmacol 2004; 44: 520–31

    PubMed  CAS  Article  Google Scholar 

  63. 63.

    Hunt TL, Gallagher SC, Cullen Jr MT, et al. Evaluation of safety and pharmacokinetics of consecutive multiple-day dosing of palonosetron in healthy subjects. J Clin Pharmacol 2005; 45: 589–96

    PubMed  CAS  Article  Google Scholar 

  64. 64.

    Fischer V, Baldeck JP, Tse FL. Pharmacokinetics and metabolism of the 5-hydroxytryptamine antagonist tropisetron after single oral doses in humans. Drug Metab Dispos 1992; 20: 603–7

    PubMed  CAS  Google Scholar 

  65. 65.

    Lee CR, Plosker GL, McTavish D. Tropisetron: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential as an antiemetic. Drugs 1993; 46: 925–43

    PubMed  CAS  Article  Google Scholar 

  66. 66.

    Laszlo J, Clark RA, Hanson DC, et al. Lorazepam in cancer patients treated with cisplatin: a drug having antiemetic, amnesic, and anxiolytic effects. J Clin Oncol 1985; 3: 864–9

    PubMed  CAS  Google Scholar 

  67. 67.

    McCallum RW, Prakash C, Campoli-Richards DM, et al. Cisapride: a preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use as a prokinetic agent in gastrointestinal motility disorders. Drugs 1988; 36: 652–81

    PubMed  CAS  Article  Google Scholar 

  68. 68.

    Davis MP. Oral nabilone capsules in the treatment of chemotherapy-induced nausea and vomiting and pain. Expert Opin Investig Drugs 2008; 17: 85–95

    PubMed  CAS  Article  Google Scholar 

  69. 69.

    Walkembach J, Brass M, Urban BW, et al. Interactions of metoclopramide and ergotamine with human 5-HT(3A) receptors and human 5-HT reuptake carriers. Br J Pharmacol 2005; 146: 543–52

    PubMed  CAS  Article  Google Scholar 

  70. 70.

    Malagelada JR, Malagelada C. Nausea and vomiting. In: Feld-man M, Friedman LS, Brandt LJ, editors. Sleisenger & Fordtran’s gastrointestinal and liver disease. 8th ed. Philadelphia (PA): Saunders, 2006: 143–58

    Google Scholar 

  71. 71.

    Magueur E, Hagege H, Attali P, et al. Pharmacokinetics of metoclopramide in patients with liver cirrhosis. Br J Clin Pharmacol 1991; 31: 185–7

    PubMed  CAS  Article  Google Scholar 

  72. 72.

    Osborne RJ, Slevin ML, Hunter RW, et al. Cardiotoxicity of intravenous domperidone. Lancet 1985; II: 385

    Article  Google Scholar 

  73. 73.

    Richelson E. Pharmacology of neuroleptics in use in the United States. J Clin Psychiatry 1985; 46: 8–14

    PubMed  CAS  Google Scholar 

  74. 74.

    Critchley P, Plach N, Grantham M, et al. Efficacy of haloperidol in the treatment of nausea and vomiting in the palliative patient: a systematic review. J Pain Symptom Manage 2001; 22: 631–4

    PubMed  CAS  Article  Google Scholar 

  75. 75.

    Skinner J, Skinner A. Levomepromazine for nausea and vomiting in advanced cancer. Hosp Med 1999; 60: 568–70

    PubMed  CAS  Google Scholar 

  76. 76.

    Patt RB, Proper G, Reddy S. The neuroleptics as adjuvant analgesics. J Pain Symptom Manage 1994; 9: 446–53

    PubMed  CAS  Article  Google Scholar 

  77. 77.

    Bymaster FP, Calligaro DO, Falcone JF, et al. Radioreceptor binding profile of the atypical antipsychotic olanzapine. Neuropsychopharmacology 1996; 14: 87–96

    PubMed  CAS  Article  Google Scholar 

  78. 78.

    Passik SD, Lundberg J, Kirsh KL, et al. A pilot exploration of the antiemetic activity of olanzapine for the relief of nausea in patients with advanced cancer and pain. J Pain Symptom Manage 2002; 23: 526–32

    PubMed  CAS  Article  Google Scholar 

  79. 79.

    Meltzer HY, Fibiger HC. Olanzapine: a new typical anti-psychotic drug. Neuropsychopharmacology 1996; 14: 83–5

    PubMed  CAS  Article  Google Scholar 

  80. 80.

    Bhana N, Foster RH, Olney R, et al. Olanzapine: an updated review of its use in the management of schizophrenia. Drags 2001; 61: 111–61

    CAS  Article  Google Scholar 

  81. 81.

    Wood CD, Cramer DB, Graybiel A. Antimotion sickness drug efficacy. Otolaryngol Head Neck Surg 1981; 89: 1041–4

    PubMed  CAS  Google Scholar 

  82. 82.

    King H, Corry P, Wauchob T, et al. Probable dystonic reaction after a single dose of cyclizine in a patient with a history of encephalitis. Anaesthesia 2003; 58: 257–60

    PubMed  CAS  Article  Google Scholar 

  83. 83.

    Tan LB, Bryant S, Murray RG. Detrimental haemodynamic effects of cyclizine in heart failure. Lancet 1988; I: 560–1

    Article  Google Scholar 

  84. 84.

    Hulme EC, Birdsall NJ, Buckley NJ. Muscarinic receptor subtypes. Annu Rev Pharmacol Toxicol 1990; 30: 633–73

    PubMed  CAS  Article  Google Scholar 

  85. 85.

    Golding JF, Stott JR. Comparison of the effects of a selective muscarinic receptor antagonist and hyoscine (scopolamine) on motion sickness, skin conductance and heart rate. Br J Clin Pharmacol 1997; 43: 633–7

    PubMed  CAS  Article  Google Scholar 

  86. 86.

    Baines M, Oliver DJ, Carter RL. Medical management of intestinal obstruction in patients with advanced malignant disease: a clinical and pathological study. Lancet 1985; II: 990–3

    Article  Google Scholar 

  87. 87.

    Gregory RE, Ettinger DS. 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting: a comparison of their pharmacology and clinical efficacy. Drugs 1998; 55: 173–89

    PubMed  CAS  Article  Google Scholar 

  88. 88.

    Gralla RJ, Osoba D, Kris MG, et al. Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. American Society of Clinical Oncology. J Clin Oncol 1999; 17: 2971–94

    CAS  Google Scholar 

  89. 89.

    Hardy J, Daly S, McQuade B, et al. A double-blind, randomised, parallel group, multinational, multicentre study comparing a single dose of ondansetron 24mg p.o. with placebo and meto-clopramide 10mg t.d.s. p.o. in the treatment of opioid-induced nausea and emesis in cancer patients. Support Care Cancer 2002; 10: 231–6

    CAS  Google Scholar 

  90. 90.

    Mystakidou K, Befon S, Liossi C, et al. Comparison of the efficacy and safety of tropisetron, metoclopramide, and chlor-promazine in the treatment of emesis associated with far advanced cancer. Cancer 1998; 83: 1214–23

    PubMed  CAS  Article  Google Scholar 

  91. 91.

    Currow DC, Coughlan M, Fardell B, et al. Use of ondansetron in palliative medicine. J Pain Symptom Manage 1997; 13: 302–7

    PubMed  CAS  Article  Google Scholar 

  92. 92.

    Aapro M. 5-HT(3)-receptor antagonists in the management of nausea and vomiting in cancer and cancer treatment. Oncology 2005; 69: 97–109

    PubMed  CAS  Article  Google Scholar 

  93. 93.

    Figg WD, Dukes GE, Pritchard JF, et al. Pharmacokinetics of ondansetron in patients with hepatic insufficiency. J Clin Pharmacol 1996; 36: 206–15

    PubMed  CAS  Google Scholar 

  94. 94.

    Maxwell RE, Long DM, French LA. The clinical effects of a synthetic glucocorticoid used for brain edema in the practice of neurosurgery In: Reulen HJ, Schurman K, editors.. Steroids and brain edema. Berlin, Heidelberg and New York: Springer-Verlag, 1972: 219–32

    Chapter  Google Scholar 

  95. 95.

    Graham K, Caird FI. High-dose steroid therapy of intracranial tumour in the elderly. Age Ageing 1978; 7: 146–50

    PubMed  CAS  Article  Google Scholar 

  96. 96.

    Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev 2000; (3): CD001219

  97. 97.

    Jordan K. Neurokinin-1-receptor antagonists: a new approach in antiemetic therapy. Onkologie 2006; 29: 39–43

    PubMed  CAS  Article  Google Scholar 

  98. 98.

    Dando TM, Perry CM. Aprepitant: a review of its use in the prevention of chemotherapy-induced nausea and vomiting. Drugs 2004; 64: 777–94

    PubMed  CAS  Article  Google Scholar 

  99. 99.

    LaRusso J, Waldman S, Kraft W. Aprepitant for the prevention of nausea and vomiting associated with chemotherapy and post-operative recivery. Expert Rev Clin Pharmacol 2008; 1(1): 27–37

    CAS  Article  Google Scholar 

  100. 100.

    Chahl LA. Tachykinins and neuropsychiatric disorders. Curr Drug Targets 2006; 7: 993–1003

    PubMed  CAS  Article  Google Scholar 

  101. 101.

    Chizh BA, Gohring M, Troster A, et al. Effects of oral pregabalin and aprepitant on pain and central sensitization in the electrical hyperalgesia model in human volunteers. Br J Anaesth 2007; 98: 246–54

    PubMed  CAS  Article  Google Scholar 

  102. 102.

    Bruera E, Belzile M, Neumann C, et al. A double-blind, crossover study of controlled-release metoclopramide and placebo for the chronic nausea and dyspepsia of advanced cancer. J Pain Symptom Manage 2000; 19: 427–35

    PubMed  CAS  Article  Google Scholar 

  103. 103.

    Lichter I. Results of antiemetic management in terminal illness. J Palliat Care 1993; 9: 19–21

    PubMed  CAS  Google Scholar 

  104. 104.

    Bruera E, Scifert L, Watanabe S, et al. Chronic nausea in advanced cancer patients: a retrospective assessment of a metoclopramide-based antiemetic regimen. J Pain Symptom Manage 1996; 11: 147–53

    PubMed  CAS  Article  Google Scholar 

  105. 105.

    Bruera ED, MacEachern TJ, Spachynski KA, et al. Comparison of the efficacy, safety, and pharmacokinetics of controlled release and immediate release metoclopramide for the management of chronic nausea in patients with advanced cancer. Cancer 1994; 74: 3204–11

    PubMed  CAS  Article  Google Scholar 

  106. 106.

    Glare P, Pereira G, Kristjanson LJ, et al. Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer. Support Care Cancer 2004; 12: 432–40

    PubMed  Article  Google Scholar 

  107. 107.

    Corli O, Cozzolino A, Battaiotto L. Effectiveness of levosulpiride versus metoclopramide for nausea and vomiting in advanced cancer patients: a double-blind, randomized, crossover study. J Pain Symptom Manage 1995; 10: 521–6

    PubMed  CAS  Article  Google Scholar 

  108. 108.

    Kennett A, Hardy J, Shah S, et al. An open study of metho-trimeprazine in the management of nausea and vomiting in patients with advanced cancer. Support Care Cancer 2005; 13: 715–21

    PubMed  CAS  Article  Google Scholar 

  109. 109.

    Twycross R, Bankby G, Hallowood J. The use of low-dose methotrimeprazine (levomepromazine) in the management of nausea and vomiting. Prog Palliat Care 1997; 5: 49–53

    Google Scholar 

  110. 110.

    Jackson WC, Tavernier L. Olanzapine for intractable nausea in palliative care patients. J Palliat Med 2003; 6: 251–5

    PubMed  Article  Google Scholar 

  111. 111.

    Shih A, Jackson 2nd KC. Role of corticosteroids in palliative care. J Pain Palliat Care Pharmacother 2007; 21: 69–76

    PubMed  Article  Google Scholar 

  112. 112.

    Mercadante S, Casuccio A, Mangione S. Medical treatment for inoperable malignant bowel obstruction: a qualitative systematic review. J Pain Symptom Manage 2007; 33: 217–23

    PubMed  CAS  Article  Google Scholar 

  113. 113.

    Hendolin H, Suojaranta-Ylinen R, Alhava E. Effect of single-dose omeprazole and ranitidine on gastric juice acidity and volume in patients undergoing laparotomy. Acta Anaesthesiol Scand 1993; 37: 484–7

    PubMed  CAS  Article  Google Scholar 

  114. 114.

    Boulay K, Blanloeil Y, Bourveau M, et al. Effects of oral ranitidine, famotidine and omeprazole on gastric volume and pH at induction and recovery from general anaesthesia. Br J Anaesth 1994; 73: 475–8

    PubMed  CAS  Article  Google Scholar 

  115. 115.

    O’Connor TA, Basak J, Parker S. The effect of three different ranitidine dosage regimens on reducing gastric acidity and volume in ambulatory surgical patients. Pharmacotherapy 1995; 15: 170–5

    PubMed  Google Scholar 

  116. 116.

    Agar M, Webster R, Lacey J, et al. The use of subcutaneous omeprazole in the treatment of dyspepsia in palliative care patients. J Pain Symptom Manage 2004; 28: 529–31

    PubMed  Article  Google Scholar 

  117. 117.

    Rhodes VA, McDaniel RW. Nausea, vomiting, and retching: complex problems in palliative care. CA Cancer J Clin 2001; 51: 232–48; quiz 49-52

    PubMed  CAS  Article  Google Scholar 

  118. 118.

    Bruera E, Strasser F, Palmer JL, et al. Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study. J Clin Oncol 2003; 21: 129–34

    PubMed  CAS  Article  Google Scholar 

  119. 119.

    Van Fleet S. Relaxation and imagery for symptom management: improving patient assessment and individualizing treatment. Oncol Nurs Forum 2000; 27: 501–10

    PubMed  Google Scholar 

  120. 120.

    Arakawa S. Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Cancer Nurs 1997; 20: 342–9

    PubMed  CAS  Article  Google Scholar 

  121. 121.

    Molassiotis A. A pilot study of the use of progressive muscle relaxation training in the management of post-chemotherapy nausea and vomiting. Eur J Cancer Care (Engl) 2000; 9: 230–4

    CAS  Article  Google Scholar 

  122. 122.

    Mundy EA, DuHamel KN, Montgomery GH. The efficacy of behavioral interventions for cancer treatment-related side effects. Semin Clin Neuropsychiatry 2003; 8: 253–75

    PubMed  Google Scholar 

  123. 123.

    Ahles TA, Tope DM, Pinkson B, et al. Massage therapy for patients undergoing autologous bone marrow transplantation. J Pain Symptom Manage 1999; 18: 157–63

    PubMed  CAS  Article  Google Scholar 

  124. 124.

    Grealish L, Lomasney A, Whiteman B. Foot massage: a nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nurs 2000; 23: 237–43

    PubMed  CAS  Article  Google Scholar 

  125. 125.

    Pan CX, Morrison RS, Ness J, et al. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. J Pain Symptom Manage 2000; 20: 374–87

    PubMed  CAS  Article  Google Scholar 

  126. 126.

    Ezzo JM, Richardson MA, Vickers A, et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev 2006: (2): CD002285

  127. 127.

    Hickok JT, Roscoe JA, Morrow GR, et al. A phase II/III randomized, placebo-controlled, double-blind clinical trial of ginger (Zingiber officinale) for nausea caused by chemotherapy for cancer: a currently accruing URCC CCOP Cancer Control Study. Support Cancer Ther 2007; 4: 247–50

    PubMed  Article  Google Scholar 

  128. 128.

    Drake R, Frost J, Collins JJ. The symptoms of dying children. J Pain Symptom Manage 2003; 26: 594–603

    PubMed  Article  Google Scholar 

  129. 129.

    Santucci G, Mack JW. Common gastrointestinal symptoms in pediatric palliative care: nausea, vomiting, constipation, anorexia, cachexia. Pediatr Clin North Am 2007; 54: 673–89

    PubMed  Article  Google Scholar 

  130. 130.

    Linder LA. Measuring physical symptoms in children and adolescents with cancer. Cancer Nurs 2005; 28: 16–26

    PubMed  Article  Google Scholar 

  131. 131.

    Collins JJ, Byrnes ME, Dunkel IJ, et al. The measurement of symptoms in children with cancer. J Pain Symptom Manage 2000; 19: 363–77

    PubMed  CAS  Article  Google Scholar 

  132. 132.

    Collins JJ, Devine TD, Dick GS, et al. The measurement of symptoms in young children with cancer: the validation of the Memorial Symptom Assessment Scale in children aged 7–12. J Pain Symptom Manage 2002; 23: 10–6

    PubMed  Article  Google Scholar 

  133. 133.

    Galloway KS, Yaster M. Pain and symptom control in terminally ill children. Pediatr Clin North Am 2000; 47: 711–46

    PubMed  CAS  Article  Google Scholar 

  134. 134.

    Goldman A, Hain R, Liben S, editors. Oxford textbook of palliative care for children. Oxford: Oxford University Press, 2006

    Google Scholar 

Download references

Acknowledgements

Dr Glare acknowledges the support of the National Health and Medical Research Council (NHMRC) Strategic Research Development Committee for the palliative care grant RMS 219308, “Improving the management of nausea in advanced cancer: pragmatic tools for the assessment and treatment of nausea in clinical practice”, which informed this article. Dr Hardy has provided advice regarding trials of levomepromazine and other drugs marketed by Link Pharmaceuticals in the UK. The other authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Paul A. Glare.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Glare, P.A., Dunwoodie, D., Clark, K. et al. Treatment of Nausea and Vomiting in Terminally I11 Cancer Patients. Drugs 68, 2575–2590 (2008). https://doi.org/10.2165/0003495-200868180-00004

Download citation

Keywords

  • Palliative Care
  • Olanzapine
  • Octreotide
  • Bowel Obstruction
  • Metoclopramide