Summary
Chronic nausea with no apparent cause lasting longer than one month occurs in most patients with advanced malignancy, especially in those patients admitted to palliative care units just prior to death. Unfortunately this syndrome has been poorly studied to date, compared to other types of nausea and vomiting, particularly that associated with cytotoxic chemotherapy. Autonomic dysfunction possibly associated with opioid and non steroidal anti-inflammatory drug use is the likely cause. Aggressive approaches to this type of nausea can control the symptom complex in most patients. The combination of metoclopramide plus corticosteroids is the backbone of therapy. Early data suggests that 5HT3 antagonists may also be beneficial in this syndrome but prospective randomized controlled trials are required to confirm this. Research on this subject is the only way to make progress and further improve the quality of life of patients with advanced malignancy, especially in the time just prior to their death.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Warr D. Standard treatment of chemotherapy induced emesis. Supportive Care in Cancer 1997; 5:12–16.
Herrstedt J. New perspectives in antiemetic treatment. Supportive Care in Cancer 1996; 4:416–19.
Hesketh PJ. Treatment of chemotherapy induced emesis in the 1990’s: Impact of the 5HT3 receptor antagonists. Supportive Care in Caner 1994; 2:286–92.
Reuben DB, Mor V. Nausea and vomiting in terminal cancer patients. Arch Intern Med 1983; 146:2021–3.
Faisinger R, Bruera E, Miller MJ, Hanson J, MacEachern T. Symptom control during the last week of life on a palliative care unit. J Palliat Care 1991; 7:5–11.
Curtis EB, Krech R, Walsh TD. Common symptoms in patients with advanced cancer. J Palliat Care 1991; 7:25–9.
Blaines M. Nausea and vomiting in patients with advanced cancer. J Pain Symptom Manage 1988; 3:81–5.
Bruera Ed, MacEachern TJ, Spachynski KA, LeGatt DF. MacDonald RN, Babul N, Harsanyi Z, Darke AC. Comparison of the efficacy, safety and pharmacokinetics of controlled release and immediate release of metoclopramide for the management of chronic nausea in patients with advanced cancer. Cancer 1994; 74:3204–11.
Dunlop GM. A study of the relative frequency and importance of gastrointestinal symptoms and weakness in patients with far advanced cancer. Palliative Medicine 1989; 4:37–43.
Andrews PLR and Hawthorn J. The neurophysiology of vomiting. Ballieres Clinical Gastroenterology 1988; 21:141–68.
Andrews PLR. the mechanism of emesis induced by chemotherapy and radiotherapy. IN antiemetics in the supportive care of patients. Ed. M. Tonato ESO Monograph, Springer Verlag Berlin, Germany 1996 pp.3–24.
Andrews PLR and David CJ. The physiology of emesis induced by anticancer therapy. In: Serotonin and scientific basis of anti-emetic therapy. Eds J Reynolds, PLR Andrews and CJ Davis — Oxford Clinical Communication, Oxford UK, 1995;25–49.
Mosdell KW, Visconti JA. Emerging indications for octreotide therapy. I, II AM. J. Hosp Pharmacy 1994; 5:1184–1192.
Mosdell KW, Visconti JA. Emerging indications for octreotide therapy. I, II AM. J. Hosp Pharmacy 1994; 5: 1318–1330.
Allan SG. Nausea and vomiting. In: Oxford Textbook of Palliative Medicine Eds. Doyle D Hanks GWC and MacDonald, Oxford University Press, Oxford England 1993, pp 282–90.
Lichter I. Results of antiemetic management in terminal illness. J Palliat Care 1993; 9:19–21.
Walsh TD, West TS. Controlling symptoms in advanced cancer. BMJ 1988; 296:477–81.
Nelson KA, Walsh TD, Shechan FG, O’Donovan PB, Falk GW. Assessment of upper gastrointestinal motility in the cancer associated dyspepsia syndrome. J Palliat Care 1993; 9:27–31.
Bruera ED, Catz Z, Hooper R, Lentie B, MacDonald RN. Chronic nausea and anorexia in advanced cancer patients: A possible role for autonomic dysfunction. J Pain Symptom Manage 1987; 2:19–21.
Ewing D, Campbell I, Clarke B. Assessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Int Med 1980; 92–308–11.
Schuffler M, Wallace H, Fleming C, Bell CE, Bouldin TW, Malagelada JR, McGill DB, LeBauer SM, Abrams, Love J. Intestinal pseudo-obstruction as the presenting manifestation of small-cell carcinoma of the lung: A paraneoplastic neuropathy of the gastrointestinal tract. Ann Int Med 1983; 98:129–34.
Barkin JS, Goldberg RI, Sfakianakis GN, Lei J. Pancreatic carcinoma is associated with delayed gastric emptying. Digestive Diseases & Science 1986; 31:265–7.
Morrow GR. The assessment of nausea and vomiting — Past problems, current issues and suggestions for future research. Cancer 1984; 53:2267–78.
Bruera E, Seifert L, Watanabe S, Babul N, Darke A. Harsanyi Z, Suarez-Almazor M. Chronic nausea in advanced cancer patients: A retrospective assessment of a metoclopramide-based antiemetic regimen. J Pain Symptom Manage 1996; 11:147–53.
Currow DC, Couglan M, Fardell B, Cooney NJ. Use of ondansetron in palliative medicine. J Pain symptom Manage 1997; 13:302–7.
Loprinzi CL, et al. Controlled trial of megastrol acetate for the treatment of cancer, anorexia and cachexia. J N.C.I. 1990; 82:1127–32.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1998 Springer-Verlag Tokyo
About this paper
Cite this paper
Feld, R. (1998). The Treatment of Chronic Nausea in Patients with Advanced Cancer. In: Eguchi, K., Klastersky, J., Feld, R. (eds) Current Perspectives and Future Directions in Palliative Medicine. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68494-7_4
Download citation
DOI: https://doi.org/10.1007/978-4-431-68494-7_4
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-68496-1
Online ISBN: 978-4-431-68494-7
eBook Packages: Springer Book Archive