| 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. © 2008 Adis Data Information BV. All rights reserved. |
| Keywords: |
constipation; drowsiness; fatigue; review; anamnesis; side effect; skin manifestation; cancer patient; neoplasms; unindexed drug; edema; nephrotoxicity; blood toxicity; gastrointestinal symptom; nausea; vomiting; chlorpromazine; haloperidol; lorazepam; olanzapine; extrapyramidal symptom; qt prolongation; sedation; terminally ill patient; bedtime dosage; dexamethasone; diagnostic approach route; continuous infusion; dizziness; hyperglycemia; confusion; gastrointestinal toxicity; hypotension; insomnia; terminally ill; drug mechanism; cardiovascular disease; xerostomia; serotonin antagonist; granisetron; ondansetron; mental disease; terminology as topic; injection site pain; antiemetic agent; octreotide; seizure; headache; terminal care; vestibular disorder; physical examination; intestine obstruction; respiration depression; somnolence; corticosteroid; drug therapy; ileus; metoclopramide; levomepromazine; prochlorperazine; musculoskeletal disease; endocrine disease; drug use; soft tissue disease; antihistaminic agent; aprepitant; agitation; drug indication; weight gain; drug choice; amitriptyline; increased appetite; intracranial hypertension; dolasetron mesilate; palonosetron; tropisetron; dystonia; anxiolytic agent; antihistamines, therapeutic use; cancer, management; cholinergic receptor antagonists, therapeutic use; dopamine receptor antagonists, therapeutic use; nausea and vomiting, treatment; serotonin receptor antagonists, therapeutic use; cholinergic receptor blocking agent; cyclizine; domperidone; dopamine receptor blocking agent; prokinetic agent; promethazine; scopolamine bromide; scopolamine butyl bromide; anticholinergic syndrome; excitation; gastric stasis; injection site burning; injection site stinging; neuroleptic malignant syndrome; restlessness; stomach disease; paraneoplastic syndromes
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