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A New Guide for Using Antiemetics

A significant proportion of all cancer patients experience nausea or vomiting during the course of their treatment. Nausea and vomiting have long been common adverse effects from certain types of cancer therapy and can lead to postponement or refusal of potentially curative treatments in some patients. In addition to reducing quality of life, these side effects often impede patients’ ability to maintain active lifestyles. With the emergence of serotonin receptor antagonists in the early 1990s and, more recently, the NK1 receptor antagonists, there have been steady improvements in the control of nausea and vomiting. In 1999, the American Society of Clinical Oncology (ASCO) published its first guideline on the use of antiemetic therapies to combat nausea and vomiting in cancer patients. In 2006, the guideline was revised based upon substantial developments, including the introduction of the NK1 receptor antagonists. In 2011, ASCO updated its guideline again to integrate new data that have emerged over the past 5 years (Table 1). “Clinicians need to communicate with their patients to optimize results.” “As knowledge about nausea and vomiting has emerged, so too have safe and effective treatments to battle this dreaded complication for patients,” says, Paul J. Hesketh, MD, who served on the steering committee for ASCO’s 2011 guideline. “The new guideline from ASCO emphasizes how the appropriate use of antiemetic therapies can vastly improve a patient’s treatment experience and quality of life by minimizing these side effects. In general, we have more effective and well-tolerated antiemetic agents than ever before. More recently, we’ve learned how to use these agents in more effective ways.” Reclassifying Risk for Vomiting & Nausea An...

Strategies to Treat Nausea & Vomiting During Pregnancy

According to published research, about 50% of women have nausea and vomiting in early pregnancy, and an additional 25% have nausea alone. The term “morning sickness” is a misnomer because it often persists throughout the day. In about 35% of women who have morning sickness, nausea and vomiting are clinically significant. As a result, family relationships may be negatively impacted or time may be lost at work. “Morning sickness symptoms may lead to dehydration and weight loss that require hospitalization in some cases,” says Jennifer R. Niebyl, MD, who described evidence-based strategies for managing nausea and vomiting in pregnant women in a review published in the October 14, 2010 New England Journal of Medicine. “Nausea and vomiting in pregnancy can severely reduce quality of life for women, but progress has been made in the means to treat it,” says Dr. Niebyl. “Pregnant women with dehydration are recommended to receive IV fluid replacement with multivitamins, especially thiamine. If the vomiting continues after 12 hours of IV therapy, hospitalization may be required.” Enteral or parenteral nutrition may also benefit patients, but should be reserved for those who continue to experience weight loss despite pharmacologic therapies. Examining the Clinical Course The cause of nausea and vomiting in pregnancy is unclear, and there are no evidence-based means to identify women who are risk for this complication. What is known, however, is that the onset of the nausea is typically within 4 weeks after the last menstrual period in most patients. The problem typically peaks at about 9 weeks gestation. “Research shows that about 60% of cases resolve by the end of the first trimester,...
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