Review Article

Nausea and Vomiting Not Related to Cancer Therapy: Intractable Problem or Clinical Challenge?

Rita J. Wickham, PhD, RN

From Rush University College of Nursing, Chicago, Illinois

Author’s disclosure of conflict of interest is found at the end of this article.

Correspondence to: Rita Wickham, PhD, RN, 600 S Paulina Street, Chicago, IL 60612. E-mail: rita.j.wickham@gmail.com


J Adv Pract Oncol 2020;11(5):476–488 | https://doi.org/10.6004/jadpro.2020.11.5.4 | © 2020 Harborside™


  

ABSTRACT

Purpose: Unlike therapy-related nausea and vomiting (chemotherapy or radiotherapy induced), nausea and vomiting (N/V) in patients with advanced cancer is often multicausal and thus presents unique challenges. Few professional guidelines address the palliative management of N/V, and those that do are insufficiently detailed to bolster clinical decision-making. Nonetheless, oncology advanced practitioners (APs) are frequently challenged to manage these high-impact symptoms. This requires collaborating with other oncology care providers and cultivating a knowledge base to educate and mentor professional colleagues to optimize N/V unrelated to treatment. Methods: Literature reviewed included current and classic articles that address the physiologic bases of N/V related to disease and with malignant bowel obstruction, agents used to alleviate nausea or N/V, and nonpharmacologic adjunctive measures. This information was framed within palliative care and symptom management clinical experience. Results: This review article summarizes what is known about the neuropharmacology of N/V in advanced disease. Focused assessment, pharmacologic agents (antiemetics, central neuromodulators, and peripheral prokinetic agents), and nondrug adjunctive measures that may be useful for N/V are included. Conclusions: Managing N/V in advanced cancer is a quality-of-life imperative that requires persistence and interprofessional collaboration among oncology APs and other clinicians to personalize management. This work can change the perception that N/V related to progressive disease is frequently intractable to one that considers it as a manageable clinical challenge.




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