CHEMOTHERAPY INDUCED NAUSEA AND VOMITING

Nausea can be described as an unpleasant or queasy feeling causing a desire to vomit. It is important to note that nausea is not always accompanied by vomiting. The act of vomiting can be defined as the expulsion of gastric content through the mouth. Nausea and vomiting are common side effects of chemotherapy treatment for cancer. Chemotherapy-induced nausea and vomiting (emesis) can significantly affect a patient’s quality of life, leading to poor compliance with further chemotherapy or radiation therapy treatment. In addition, nausea and vomiting can result in metabolic imbalances, degeneration of self-care and functional ability, nutrient depletion, anorexia, decline of the patient’s performance status and mental status, wound dehiscence, esophageal tears, and withdrawal from potentially useful or curative anticancer treatment. But in most cases, these side effects can be controlled with preventive medications and other measures.

More than 90% of patients receiving highly emetogenic chemotherapy will have episodes of vomiting. However, only about 30% of these patients will vomit if they receive prophylactic (preventive) antiemetic regimens before treatment with highly emetogenic chemotherapy.

Whether you’ll experience nausea and vomiting as a result of chemotherapy depends on:

• What chemotherapy drugs you receive and their dosage
• Whether you receive other cancer treatments — such as radiation — during your chemotherapy treatment
• Whether you’ve experienced nausea and vomiting in the past

Chemotherapy drugs are classified into four different categories based on the likelihood they will cause nausea and vomiting: high, moderate, low or minimal. If you get one of the drugs that is known to cause nausea and vomiting, your doctor will probably give you preventive medicine.

Whether a drug will cause nausea and vomiting also depends on the amount you receive. Some drugs may be less likely to cause side effects at lower doses. Ask your doctor whether your treatment plan is likely to cause nausea and vomiting.

Personal factors that may increase your risk

Not everyone reacts to chemotherapy in the same way. Certain factors may make you more vulnerable to treatment-related nausea and vomiting.

You may be more vulnerable if one or more of the following apply to you:

• You’re a woman.
• You’re younger than 50.
• You’ve experienced nausea and vomiting with previous treatments, or you have a history of motion sickness.
• You have a high level of anxiety.
• You experienced morning sickness during pregnancy.
• You are prone to vomiting when you’re sick.
• You have a history of drinking little or no alcohol.

Also, if you expect that your treatment will cause nausea and vomiting, there’s a chance that it will. This might happen if you think that all cancer treatments cause these side effects, which isn’t true. Your doctor can tell you whether the treatment you’ll receive is likely to cause nausea and vomiting.

Common sign and symptoms that may accompany nausea include:

• Tachycardia
• Perspiration
• Light-Headedness
• Dizziness
• Pallor
• Excess Salivation
• Anorexia
• Weakness

In general, to provide maximal protection against chemotherapy induced emesis, antiemetic therapy should be initiated before chemotherapy. The antiemetic therapy should also be continued for the same length of time as the duration of the emetic activity of the chemotherapeutic agent being used. However, daily use of antiemetics is not recommended for some therapeutic agents that are taken long term (e.g. imatinib, erlotinib). Antiemetic agents can be administered by the oral, rectal, IV, intramuscular, or transdermal route. For patients at risk for CINV or unable to swallow or digest tablets because of emesis, IV antiemetics should be used. In selected patients who are unable to swallow, transdermal antiemetics may be of value.
Some of the antiemetic therapies are given below;

Most people undergoing chemotherapy receive anti-nausea (anti-emetic) medications to prevent nausea and vomiting. Doctors take this proactive approach to prevent nausea and vomiting because these side effects can be difficult to control once they begin. Nausea and vomiting can make you feel miserable, add to your fatigue and distress, and make you reluctant to stick to your treatment schedule.

You can take steps to reduce your risk of nausea and vomiting. For example:

• Eat small meals: Stagger small meals throughout the day rather than eating fewer, larger meals. If possible, don’t skip meals. Eating a light meal a few hours before treatment also may help.
• Eat what appeals to you: It’s best, however, to avoid foods that are sweet, fried or fatty. In addition, cool foods may give off less bothersome odors.
• Cook and freeze meals in advance of treatment to avoid cooking when you’re not feeling well. Or have someone else cook for you.
• Drink lots of fluids: Try cool beverages, such as water, unsweetened fruit juices, tea or ginger ale that’s lost its carbonation. It may help to drink small amounts throughout the day, rather than larger amounts less frequently.
• Avoid unpleasant smells: Pay attention to what smells trigger nausea for you and limit your exposure to unpleasant smells. Fresh air may help.
• Make yourself comfortable: Rest after eating, but don’t lie flat for a couple of hours. Try wearing loose-fitting clothing and distracting yourself with other activities.
• Use relaxation techniques: Examples include meditation and deep breathing.
• Consider complementary therapies: Complementary and alternative therapies, such as acupuncture and aromatherapy, may help you feel better when used in combination with medications from your doctor. Tell your doctor if you’re interested in trying these treatments. He or she may be able to recommend a practitioner who works with people undergoing cancer treatments.

These self-care measures may help you prevent nausea and vomiting, but they can’t take the place of anti-nausea medications.

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• https://www.mayoclinic.org/tests-procedures/chemotherapy/in-depth/cancer/art-20047517