Posttreatment Vomiting Research Articles

Prospective study of selective intra-arterial cerebral infusion and intra-operative local application of carboplatin for recurrent glioblastoma multiformis

Background. High-grade glioma is the commonest primary malignant brain tumour in adults. Intra-arterially selectively infused chemotherapeutic agents into the tumour bulk is being widely trialled recently with promising results.
 Methods. This is a prospective study designed between November 2015 and November 2019. Thirty patients were diagnosed with recurrent histo-pathologically proven GBM after one surgery at least and followed by standard radiotherapy and temodal. Patients aged between 37-76 years, 18 males and 12 females were subdivided into group A of 21 patients who underwent intra-arterial delivery of carboplatinand group B of 9 patients who underwent re-surgical resection and local application of carboplatin.
 Results. The mean age of the included cases was 55.4 years (range, 37-76 years). Selective intra-arterial injection was performed in 21 cases (70%), while the remaining 9 cases (30%) had local application of carboplatin in the tumour bed. Post-treatment vomiting was reported in 7 cases (23.3%). Significant and partial responses were achieved in 2 cases for each (6.7%). Time to tumour progression had a mean of 19.03 weeks (range, 3 – 30 weeks). After receiving carboplatin, the study cases had a mean survival of 26.5 weeks (range, 6 – 70 weeks). Intra-arterial injection had significantly better results compared to local tumour bed infiltration (p = 0.01).
 Conclusion. Although recurrent glioblastoma multiformis has poor survival, intra-arterial delivery of carboplatin may have a slight positive impact on patient survival. The procedure however is relatively safe with manageable complications.

A Pilot Trial of Topical Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome.

Patients with cannabinoid hyperemesis syndrome (CHS) present frequently to the emergency department. Previous case studies suggest dramatic symptomatic improvement with topical capsaicin treatment. This exploratory study examined the potential effectiveness of topical capsaicin in patients with nausea and vomiting due to a suspected CHS exacerbation. This was a double-blind, randomized placebo-controlled pilot trial. Adults who presented with vomiting suspected to be from CHS were eligible for enrollment. We excluded pregnant women and those with resolution of symptoms. Following randomization, topical 0.1% capsaicin or placebo cream was applied to the anterior abdomen in a uniform manner. The primary outcome was the severity of nausea on a visual analog scale (VAS) of 0 to 10cm assessed at 30minutes. Secondary outcomes were adverse events, occurrence of posttreatment vomiting, nausea by VAS at 60minutes, and hospital admission. This pilot trial enrolled 30 patients, 17 in the capsaicin arm and 13 in the placebo arm. One patient in the capsaicin arm did not tolerate treatment due to skin irritation. Mean± SD nausea severity at 30minutes was 4.1±2.3cm in the capsaicin arm and 6.1±3.3cm in the placebo arm (difference=-2.0cm, 95% confidence interval [CI]=0.2 to -4.2cm). At 60minutes, mean± SD nausea severity was 3.2±3.2cm versus 6.4±2.8cm (difference=-3.2cm, 95% CI=-0.9 to -5.4cm). The percent reduction in nausea at 60minutes from baseline was 46.0% in the capsaicin arm and 24.9% in the placebo arm (difference=21.1%, 95% CI=-5.6% to 47.9%). A higher proportion of capsaicin group patients (29.4% vs. 0%) had complete resolution of nausea (relative risk=3.4, 95% CI=1.6 to 7.1). In this pilot trial, the application of topical capsaicin cream was associated with a significant reduction in nausea at 60minutes but not at 30minutes and provided more complete relief of nausea.

Chemotherapy-Induced Nausea, Vomiting, and Fatigue – the Role of Individual Differences Related to Sensory Perception and Autonomic Reactivity

Background: In spite of antiemetics, postchemotherapy side effects continue to be common and may affect compliance to cancer treatment. Among the known factors associated with increased symptom severity are: younger age, treatment toxicity, expected severity, and distress, but little is still known about the role of other factors. The aim of our study was to investigate the role of individual differences related to sensory perception for posttreatment side effects. Methods: Hundred and twenty-five women receiving adjuvant chemotherapy for breast cancer completed measures of absorption, autonomic perception, somatosensory amplification, trait anxiety, and expected severity at baseline. Pretreatment distress and posttreatment nausea, vomiting, and fatigue were assessed at the 1st, 4th, 6th and last cycles of chemotherapy. Results: While univariate analyses showed several factors to be associated with side effects, only absorption and pretreatment distress remained independent predictors of nausea and fatigue when controlling for the remaining factors. Posttreatment vomiting was only predicted by expected severity of vomiting. Conclusion: Chemotherapy-induced side effects are related to increased autonomic nervous system activity, and absorption has been associated with increased autonomic nervous system reactivity to stress. The results suggest that individuals with high absorption may be at greater risk for developing side effects. Improved precision in identifying patients at risk of experiencing more severe side effects after cancer treatment will increase the ability to target treatments aimed at reducing these side effects.

Initiation of zinc treatment for acute childhood diarrhoea and risk for vomiting or regurgitation: a randomized, double-blind, placebo-controlled trial.

The childhood diarrhoea-management guidelines of the World Health Organization/United Nations Children's Fund (WHO/UNICEF) now include zinc treatment, 20 mg per day for 10 days. To determine if a dispersible zinc sulphate tablet formulation is associated with increased risk of vomiting or regurgitation following the initial, first treatment dose, a double-blind, placebo-controlled randomized clinical trial was carried out in the Dhaka hospital of ICDDR,B: Centre for Health and Population Research (n=800) and in an adjacent NGO outpatient clinic (n=800). Children were randomized to one of three groups: no treatment, placebo, or zinc sulphate tablet (20 mg). They were then observed for 60 minutes, and all vomiting or regurgitation episodes were recorded. When compared with placebo, zinc treatment resulted in an attributable risk increase of 14% for vomiting and 5.2% for regurgitation. The median time to vomiting among those receiving zinc was 9.6 minutes and was limited to one episode in 91.2% of the cases. Overall, the proportion of 60-minute post-treatment vomiting attributable to zinc, placebo, and the illness episode was estimated to be 40%, 26%, and 34% respectively. The dispersible zinc sulphate tablet formulation at a dose of 20 mg is associated with increased risks of vomiting and regurgitation. Both are transient side-effects.

Nausea and Vomiting Remain a Significant Clinical Problem: Trends Over Time in Controlling Chemotherapy-Induced Nausea and Vomiting in 1413 Patients Treated in Community Clinical Practices

Data from 1413 outpatients in community-based clinical practices were collected in order to characterize the use and effectiveness of 5-HT 3 receptor antagonists for control of chemotherapy-induced nausea and vomiting (NV). Patients were divided by treatment starting date into six cohorts for trend analysis. In addition, NV symptoms were compared in 252 patients treated prior to the commercial introduction of the 5-HT 3 receptor antagonist antiemetics, and an equal number of patients treated after their introduction. A comparison of cohorts revealed a significant (P = 0.027) downward trend over time for the frequency of post-treatment vomiting episodes, but not for frequency of post-treatment nausea (P = 0.69). The average duration of nausea following treatment increased significantly over time (P = 0.003). Although the introduction of 5-HT 3 receptor antagonist antiemetics has apparently led to a significant reduction in the frequency of post-treatment vomiting, there has been an accompanying increase in the duration of post-treatment nausea.

Anticipatory nausea and vomiting: prevalence and predictors in chemotherapy patients.

One hundred and seventy-five patients selected at random were prospectively studied. All patients were assessed at least after the first cycle of treatment by a self-report questionnaire which covered the occurrence of nausea and vomiting 24 before chemotherapy, as well as information regarding 22 clinical parameters. Forty-six (26%) patients developed anticipatory nausea. 'Intolerable' posttreatment vomiting and age under 45 were statistically significant parameters (p less than 0.05) in the multivariate analysis. Twenty-one (12%) of the 175 patients experienced anticipatory vomiting. Three variables, age under 45, 'intolerable' posttreatment vomiting and more than three cycles of treatment were found to be significant (p less than 0.05). The relative risk of developing anticipatory nausea and vomiting according to combination of significant clinical predictors in the multivariate analysis is proposed. Therefore recognition of these clinical predictors may serve as a marker for patients with high risk of presenting anticipatory nausea and vomiting, who may benefit from prophylactic behavioral approaches.