Chemotherapy is one of the current treatments for malignancies; however, many chemotherapy patients experience varying degrees of nausea and vomiting, which can have a significant negative impact on patients’ emotional, social, and physical functioning, reduce their quality of life and treatment compliance, and in severe cases, even necessitate termination of anticancer treatment. What strategies will doctors adopt to deal with nausea and vomiting caused by chemotherapy? Learn more about them together.
Management principles for nausea and vomiting
The principles of management of chemotherapy-induced nausea and vomiting should be based on prevention:
- Before chemotherapy, the physician will fully assess the patient’s risk of nausea and vomiting and give prophylactic antiemetic treatment as appropriate;
- During chemotherapy, different antiemetic regimens are given depending on the patient’s risk for emesis, and the patient is expected to cooperate with the healthcare provider in keeping detailed records of nausea and vomiting. If vomiting persists despite prophylactic antiemetic regimens, the physician will give a rescue antiemetic regimen;
- After chemotherapy, it is also important to be alert for the onset of delayed nausea and vomiting, which may require antiemetic treatment 2 to 3 days after chemotherapy. Patients who continue to vomit despite a prophylactic antiemetic regimen will be given a rescue antiemetic regimen.
Regarding the choice of antiemetic medications, in addition to newer neurokinin-1 (NK-1) receptor antagonists [e.g., aprepitant], 5-hydroxytryptamine 3 (5-HT3) receptor antagonists [e.g., Ondansetron, Granisetron, Dolasetron], etc. Doctors may also give other medications to assist in treatment, including dexamethasone (Dexamethasone) , metoclopramide (Metoclopramide), lorazepam (Lorazepam), haloperidol (Haloperidol), olanzapine (Olanzapine), scopolamine ( Scopolamine ), Prochlorperazine (Prochlorperazine), and Promethazine (Promethazine).
What is the risk of nausea and vomiting and how is it managed?
Nausea and vomiting from chemotherapy can have significant negative effects on patients’ emotional, social, and physical functioning, and these harms from nausea and vomiting also require targeted prevention and management.
- Electrolyte disturbances Persistent vomiting during chemotherapy can lead to disturbances in the patient’s water-electrolyte balance, including hypokalemia, hypochlorhydria, and hyponatremia, resulting in headache, weakness, and palpitations. Therefore, during chemotherapy, it is advisable for patients to eat a reasonable diet, which is appropriately light, with fewer meals, 5~6 times a day, and eat more often (mostly in the early morning) during the time of day when nausea is least likely. Drink as little water as possible before and after eating. Do not lie down immediately after meals to avoid food reflux and nausea. Avoid alcohol, sweet, greasy, spicy and fried foods. Eat less tryptophan-rich foods, such as bananas, walnuts and eggplant. Avoid contact with people who are cooking or eating to reduce irritation. In case of frequent vomiting, abstain from eating and drinking for 4-8h, or up to 24h if necessary, and then slowly eat a liquid diet. Avoid drinking large amounts of water. Use broth, vegetable soup and juice to ensure the body’s nutritional needs and maintain electrolyte balance.
- Constipation and bloating are the most common adverse effects after the application of antiemetic and chemotherapeutic drugs, and the management includes.
- For diet and activity, drink more water, eat more vegetables, fruits and foods with more fiber, and encourage more activity to promote bowel movement and prevent constipation.
- Massage, doing clockwise circular massage in the abdomen in the direction of the colon, and more deep breathing to exercise the muscles and increase bowel power.
- For medication, use laxatives to lubricate the intestines, such as honey, sesame oil, or liquid paraffin oil; consider herbal treatments under medical supervision, such as Ma Ren Wan, Liu Wei Di Huang Wan, and Si Mo Tang; also use Glycerol Enema, Glycerol Suppositories, and soap bars for anal plugs, as appropriate.
- When medication is ineffective, physicians may consider direct transanal evacuation of fecal masses from the rectum or low-pressure enemas with warm saline, but this would be used with caution in those with increased intracranial pressure.
- Headache is a common adverse reaction after the application of antiemetics and chemotherapy drugs. It is managed as follows.
- When headache attacks are infrequent and not severe in intensity, hot compresses may be used.
- Massage: stroke the forehead and rub the temples; do a dry scrubbing motion.
- Acupuncture: Consult your doctor to consider acupuncture treatment.
- Medication: Consider antipyretic and analgesic medications for headache attacks, and in severe cases, ergotamine and Caffeine, which should be used under medical supervision.
- Anxiety and fear Nausea and vomiting can increase patients’ fear of treatment, leading to depression and even loss of confidence in treatment, so it is important to provide good psychological guidance and psychological care. During chemotherapy, doctors will keep abreast of the patient’s psychological state, give reasonable guidance, and stabilize the patient’s emotions. Patients can listen to pleasant and relaxing music in a quiet and relaxing environment to divert their attention in order to relax their mind and body.
A proactive and reasonable approach to prevent and manage chemotherapy-related nausea and vomiting under the guidance of a physician will provide for improved quality of life and successful treatment of gastric cancer patients. (Contributed by Cheng Yu, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)