Nausea and vomiting

Abstract

Chemotherapy-induced nausea and vomiting (CINV) remains a significant problem for many cancer patients despite recent advances in pharmacologic therapy (Grunberg et al. Cancer 2004;100(10):2261–8). In addition to significant physical consequences including dehydration, nutritional compromise, and metabolic alterations, it may have a dramatic impact on a patient’s quality of life (Mitchell EP Semin Oncol 1992;19(5):566–79). Despite the dissemination of detailed guidelines for preventive antiemetic regimens, some patients continue to receive suboptimal prophylaxis against CINV. Symptoms of nausea and vomiting after chemotherapy are often more difficult to manage than if the symptoms had been prevented initially with appropriate pharmacologic intervention. Notably, some patients actually develop a psychological component to their nausea and vomiting as a result of inadequate management in the past. The pathophysiology of CINV, principles of antiemetic prophylaxis, the emetogenic potential of common chemotherapeutics, classes of antiemetic therapy, and guidelines for prevention and acute management of CINV will be discussed.