Use Of Antiemetic Medication Research Articles

Perception of healthcare providers versus patient reported incidence of chemotherapy-induced nausea and vomiting after the addition of NK-1 receptor antagonists

Physicians and nurses often underestimate the incidence of chemotherapy-induced nausea and vomiting (CINV) after both highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). This study assesses physicians' and nurses' perceptions of CINV in their own practices after the introduction of aprepitant. A prospective observational study of patients receiving the first cycle of HEC regimens with CDDP and without CDDP or MEC was performed. Eligible patients completed a 6-day diary recording emetic episodes, nausea assessment, and antiemetic medication use. Physicians and nurses estimated the incidence of acute and delayed CINV after the first administration of HEC and MEC. The observed incidence rates of CINV were compared with the rates predicted by healthcare providers. Aprepitant was given to patients receiving HEC regimes with CDDP. Twenty-nine physicians and nurses and 95 patients (87% receiving HEC and 14% MEC) were recruited. The global control of CINV was 66.67% for all patients and 73.33%, 47.06%, and 55.56% for patients receiving HEC regimens with CDDP, HEC regimens without CDDP and MEC, respectively. Physicians and nurses underestimated the control of acute CINV in patients receiving HEC regimens with CDDP, but they accurately predicted the control of delayed CINV. All physicians and nurses predicted the control of acute CINV after HEC regiments without CDDP and after MEC quite accurately, whereas they overestimated the control of delayed CINV after both regimens. Aprepitant allows for better control of CINV in HEC regimens with CDDP, and this control is accurately perceived by physicians and nurses. However, physicians and nurses overestimate the control of delayed CINV after HEC regimens without CDDP and after MEC. CINV is still an important target for improved therapeutic intervention and the healthcare providers must be aware of its actual incidence.

Impact on daily functioning and indirect/direct costs associated with chemotherapy-induced nausea and vomiting (CINV) in a US population

Chemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect of chemotherapy, but it may be prevented or mitigated with medications. Uncontrolled CINV can lead to reduced quality of life and can result in increased costs (due to health care utilization and missed work). We prospectively assessed the prevalence and burden of CINV in a US population. Final analysis was performed on 178 patients, beginning chemotherapy during 2007-2008 at oncology specialty settings. Patients kept a diary recording use of antiemetic medications just before the start of chemotherapy and use of antiemetic medications, health care resources, and episodes of nausea and vomiting during the 5days following. In addition, they completed a Functional Living Index-Emesis (FLIE) questionnaire and a Work Productivity and Assessment Inventory-Nausea and Vomiting assessment, to determine the impact of CINV on daily functioning and on work productivity, respectively. Physicians independently recorded prescribed medications and health care utilization. Of the patients, 61.2% reported experiencing CINV (34.3% with acute CINV and 58.4% with delayed CINV). Based on the FLIE assessment, 37.2% of all patients reported reduced daily functioning, and of those with poorly managed CINV, about 90% reported a significant impact on daily functioning. Total costs due to CINV were on average $778.58 per patient from the day of administration through the 5days following the first cycle of chemotherapy; patients with more severe CINV typically had higher costs. CINV remains a significant problem among US patients, suggesting a need for more effective prophylaxis use in clinical practice.

Effect of acupressure on chemotherapy-induced nausea and vomiting in gynecologic cancer patients in Turkey

Purpose The aim of the current study was to assess the effect of acupressure applied to the pericardium 6 (P6 or Neiguan) acupuncture point with a wristband (Sea-Band™) on nausea–vomiting in addition to the standard antiemetic medications used to prevent nausea–vomiting due to chemotherapy in gynecologic cancer patients. Method In this prospective research we used pre- and posttests. The study consisted of 34 patients with gynecologic cancer. Results We found a significant decrease in the patients' mean scores of nausea and the use of antiemetic medications following acupressure applied to the patients with a wristband, when compared with their mean scores of nausea and the use of antiemetic medications prior to the application ( p < 0.05), and we also observed a decline in their mean scores of vomiting and retching episodes; however, this decline was not found to be statistically significant ( p > 0.05). Conclusions The findings from this study suggest that the acupressure applied to P6 acupuncture point with wristbands may be effective in reducing chemotherapy-related nausea and may decrease the antiemetic use after chemotherapy. Further research with more subjects is needed.

Incidence of chemotherapy-induced nausea and vomiting after highly and moderately emetogenic chemotherapy in the era of NK-1 receptor antagonists. Perception versus reality

e20636 Background: Physicians and nurses had underestimated the incidence of chemotherapy-induced nausea and vomiting (CINV) after both high emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) (Grumberg, Cancer 2004;100:2261–8; Erazo Valle, Curr Med Res Opin 2006;22:2403–10). We have assessed if physicians and nurses’ perception of CNIV in their own practices after the introduction of Aprepitant was closer to reality. Methods: A prospective, observational unicenter study of adult patients receiving their first chemotherapy cycle was performed. Medical oncologists and oncology nurses also estimated the incidence of acute (Day 1) and delayed (Days 2–5) CINV after first administration of HEC and MEC. Eligible patients completed a 6-day diary including emetic episodes, nausea assessment, and antiemetic medication use. Observed incidence rates of acute and delayed CINV were compared with physician/nurse predictions. Results: Twenty-nine physicians and nurses and 95 patients (86.3% receiving HEC and 13.7%MEC) were recruited. Acute nausea and emesis were observed in 14.3% and 2.4% respectively of HEC patients receiving Aprepitant, and delayed nausea and emesis were observed in 14.3% and 7.1% of these patients, respectively. Physicians and nurses accurately predicted the incidence of acute and delayed CINV after HEC patients receiving Aprepitant. Acute nausea and emesis were observed in 22.2% and 0% respectively of MEC patients and delayed nausea and emesis in 33.3% and 22.2% of MEC patients, respectively. All physicians and nurses underestimated the incidence of acute nausea and delayed nausea and emesis after MEC by 15, 28 and 18 percentage points, respectively. Conclusions: The addition of aprepitant in the prevention of CINV after HEC allows a better control of CINV that is perceived accurately by physicians and nurses. By contrary, physicians and nurses continue markedly underestimating the incidence of CINV after MEC. CINV still remain important targets for improved therapeutic intervention and physicians and nurses must be aware about the real incidence of CNIV. No significant financial relationships to disclose.

In children with vomiting related to acute gastroenteritis, are antiemetic medications an effective adjunct to fluid and electrolyte therapy?

Vomiting is unpleasant and distressing for a child and for the parents. Vomiting can limit the effectiveness of oral rehydration therapy, and can increase the risk of dehydration, as well as the need for intravenous hydration and hospitalization. Antiemetic medications are commonly prescribed to treat vomiting in children with acute gastroenteritis (1–4). However, only a few efficacy studies (5–10) have been published on the use of antiemetic medications in paediatric gastroenteritis. These studies are summarized in Table 1. TABLE 1 Double-blind, randomized, controlled studies on the use of antiemetics in the treatment of vomiting related to acute gastroenteritis In a Cochrane review, Alhashimi et al (11) reviewed three of the above five studies. The study by van Eygen et al (5) was excluded because the outcome measures were considered to be unsatisfactory. The study by Reeves et al (7) was also excluded, because patients up to 22 years of age were included. The studies by Cubeddu et al (6), Ramsook et al (8) and Freedman et al (9) were criticized by these Cochrane reviewers, because the outcome measures were a reduction of emetic episodes rather than the precise time to cessation of vomiting. Alhashimi et al (11) concluded that the three trials provided some evidence, albeit weak and unreliable, that favoured the use of ondansetron and metoclopramide over placebo for the treatment of vomiting associated with childhood gastroenteritis. It was hoped that the study by Reeves et al (7) would be included in the review after the data from the adult patients were excluded from the analysis. The study by Stork et al (10) was not included in the review, presumably because the study had not been published at the time of the review. In summary, all existing studies demonstrated that specific antiemetic medications were efficacious in reducing vomiting, as well as the need for intravenous fluid administration and possibly hospitalization of children with acute gastroenteritis.

Reevaluating resumption of oral intake after abdominoplasty

Traditional postoperative management of patients undergoing abdominoplasty has involved withholding food until patients demonstrate evidence of bowel activity. No literature exists to support this practice, however, and with the expanding trend toward ambulatory abdominoplasty, early feeding may obviate, at least partially, the need for postoperative hospital admission for intravenous hydration, thereby allowing for faster discharge. We sought to investigate whether early feeding of patients contributed to an increased incidence of postoperative nausea and vomiting (PONV), as well as impacted the return of bowel sounds or the usage of antiemetic medications. Hospital records of the authors' patients who underwent full abdominoplasty with adjunctive suction-assisted lipoplasty were examined. The senior author (A.M.) held patients nil per os (NPO) until bowel sounds were auscultated (group I), whereas the other authors (S.S.J., M.J.O.) began a regimen of feeding immediately after surgery (group II). No significant differences in age, gender, or body mass index were present. Operative time was significantly shorter in group I. The incidence of PONV, use of antiemetic medications, and presence of audible bowel sounds on postoperative day 1 did not vary significantly between groups. None of the patients with inaudible bowel sounds in either group experienced PONV. Early feeding after abdominoplasty did not lead to an increased incidence of PONV, increased use of antiemetic medications, or delayed return of bowel sounds. In routine abdominoplasties, early feeding may permit patients to sustain adequate hydration and possibly allow for earlier discharge.

Acute Gastroenteritis in Children

Acute gastroenteritis is associated with significant morbidity in developed countries and each year is the cause of death of several million children in developing countries. Acute gastroenteritis is usually self-limiting. Oral rehydration therapy (ORT) is effective and successful in the majority of patients. Vomiting is common at the outset of viral gastroenteritis and can limit the effectiveness of ORT. Treatment with newer anti-emetic medications has been reported to facilitate ORT and to minimize the risk of dehydration and the need for intravenous hydration and hospitalization. The role of anti-emetic medications in the treatment of gastroenteritis-related vomiting is not clear. Some physicians agree with the use of anti-emetic medications because vomiting is unpleasant and distressing for the child and parents alike, and because vomiting can increase the likelihood of dehydration, electrolyte imbalance, and the need for intravenous hydration or hospitalization. Several surveys have shown that anti-emetic medications are commonly prescribed in the treatment of pediatric gastroenteritis and that adverse events are uncommon. Efficacy studies of the newer anti-emetic medications are now available and reveal that some are effective and help facilitate ORT. Other physicians disagree with the use of anti-emetic medications because acute gastroenteritis is a self-limiting condition, vomiting might help rid the body of toxic substances, there was previously a relative lack of published evidence of clinical benefit, and there are potential adverse events associated with the use of an anti-emetic medication. Anti-emetic medications that are currently available include ondansetron, granisetron, tropisetron, dolasetron, ramosetron, promethazine, dimenhydrinate, metoclopramide, domperidone, droperidol, prochlorperazine, and trimethobenzamide. Randomized, placebo-controlled trials suggest that ondansetron is efficacious and superior to other anti-emetic medications in the treatment of gastroenteritis-related vomiting. A recent double-blind clinical trial showed that a single oral dose of ondansetron reduces gastroenteritis-related vomiting and facilitates ORT without significant adverse events. Ondansetron shows promise as a first-line anti-emetic, and judicious use of this agent might increase the success of ORT, minimize the need for intravenous therapy and hospitalization, and reduce healthcare costs. Ondansetron should be considered in situations where vomiting hinders ORT, but a larger randomized, placebo-controlled trial is necessary before the medication can be routinely recommended for the treatment of gastroenteritis-related vomiting in children.

Derivation and validation of a clinical index for prediction of rapid progression of kidney dysfunction

Chronic kidney disease is common among the elderly, and these patients are at risk of progressive kidney dysfunction. To develop an index to predict rapid progression of kidney dysfunction. Community-based cohort divided into derivation (n = 6789) and validation (n = 3395) subsets. We identified 10 184 subjects aged >/=66 years from computerized laboratory data. Prescription drug data was used to define disease categories and medication exposure, and an index for predicting rapid progression of kidney dysfunction (> or =25% decline in glomerular filtration rate over a 2-year period) was obtained from a logistic regression model in the derivation cohort. The risk score for each subject was calculated by summing the component variables together, which were subsequently categorized into five risk classes. Five predictors of rapid progression were identified: age >75 years, cardiac disease, diabetes mellitus, gout, and use of anti-emetic medications. Rates of rapid progression for risk classes I through V were 8.6%, 10.9%, 13.9%, 15.6%, and 24.1%, respectively, for the derivation cohort, and 8.4%, 11.6%, 15.5%, 17.3%, 21.9%, respectively, for the validation cohort. The risk index distinguished between low and high risk of rapid progression, with a 2.5-fold greater risk for the highest, compared to the lowest, risk decile. Readily available clinical data can be used to identify most elderly at risk of rapid progression of kidney dysfunction. This simple index could help clinicians to identify patients at risk, and implement strategies to slow the progression of kidney dysfunction.

26 Protein and ginger for the treatment of chemotherapy‐induced delayed nausea and gastric dysrhythmia

Background: Delayed nausea occurs in many cancer patients during the three days following administration of a cytotoxic agent. Meals high in protein content decrease the nausea of motion sickness and pregnancy, possibly by enhancing normal gastric myoelectrical activity and/or by reducing gastric dysrhythmias. Ginger may also have anti‐nausea properties. The aim of this study was to explore the use of a nutritional intervention consisting of high protein meals and ginger for the management of delayed nausea experienced by chemotherapy‐naïve cancer patients.Method: Twenty‐eight cancer patients receiving emetogenic cytotoxic agents were assigned to one of three groups. During the three day study period following their first chemotherapy session, Control Group patients (n = 9) continued with their normal diet, Protein Group patients (n = 9) were provided with a protein drink (ProSure®; 15 g protein) and 1 g of dried ginger root to consume twice daily, and High Protein Group patients (n = 10) were provided with a protein drink with additional protein powder (ProSure® and ProMod®; 31 g protein) and 1 g of dried ginger root to consume twice daily. All patients were asked to complete a symptom diary over the three days to assess the severity, frequency, and bothersomeness of the nausea they experienced, as well as their use of antiemetic medication. Gastric myoelectrical activity was assessed by electrogastrography as five patients ingested a protein meal with ginger on the first morning of the study.Results: Reports of nausea, of nausea being experienced often, and of nausea being bothersome were significantly less frequent in the High Protein Group than in the Control and Protein Groups (ps &lt; 0.05); the Control and Protein Groups were not significantly different from each other. Furthermore, significantly fewer patients in the High Protein Group elected to use antiemetic medication than patients in the other two groups (p &lt; 0.05). A significant increase in normal gastric myoelectrical activity, and a significant decrease in gastric tachyarrhythmia, the gastric dysrhythmia that frequently accompanies nausea, occurred with ingestion of the protein meals and ginger (ps &lt; 0.05).Conclusions: High protein meals with ginger reduced the delayed nausea of chemotherapy, and reduced the use of antiemetic medications. Anti‐nausea effects of high protein meals with ginger were associated with enhancement of normal gastric myoelectrical activity and decreased gastric dysrhythmias. High protein meals with ginger represent a novel, nutritionally based treatment for the delayed nausea.

Antiemetic-related dystonic reaction unmasked by removal of a scopolamine transdermal patch

A case of a dystonic reaction is presented that occurred after the use of prochlorperazine, metoclopramide and ondansetron for the treatment of post-operative nausea and vomiting. The onset of dystonia coincided temporally with the removal of a transdermal scopolamine patch used as adjunctive antiemetic therapy. Withdrawal of concurrently administered anticholinergic medication, after recent use of antiemetic medications with dopamine receptor (D 2) inhibition, can unmask a dystonic reaction. This case also suggests that transdermal scopolamine may offer an innovative therapy for the treatment of acute dystonic reactions.

Anesthesia for pediatric lithotripsy

We describe 7 years experience of providing anesthesia for children undergoing lithotripsy in a hospital without pediatric inpatient facilities. A pediatric team, including anesthetist, pediatric nurse along with the equipment travel across the city with the patient from the children's hospital. As a high incidence of postoperative vomiting and discomfort was observed, the effect of increasing intraoperative analgesia and the use of antiemetic medication was examined. From 1998 to 2004, 69 children (49 boys and 20 girls) were anesthetized for 120 procedures: 67 extracorporeal shock wave lithotripsy (ESWL) and 53 endosurgical procedures, consisting of percutaneous nephrolithotomy (29), ureteroscopic laser lithotripsy (17) and percutaneous bladder litholapaxy (7). The mean age was 5.4 years (10 months to 13 years) and weight 23.7 kg (7.1-59 kg). ESWL was performed initially with a Wolf Piezolith 2300, and after 1999, a Dornier Compact Delta. Increased administration of intraoperative analgesia resulted in reduced postoperative analgesia requirements in all the groups, with a significant reduction (P < 0.05) in the endosurgical group. Those who required more postoperative analgesia had more vomiting significantly (P < 0.05). For ESWL postoperative pain is dependent on the type of lithotriptor and the resultant stone fragment size created. This study suggests that postoperative vomiting could be reduced more effectively by the increased administration of intraoperative analgesia, than by a single intraoperative dose of an antiemetic drug.

Incidence of chemotherapy-induced nausea and emesis after modern antiemetics.

The authors determined the incidence of acute and delayed chemotherapy-induced nausea and emesis (vomiting) (CINV) among patients receiving highly (HEC) or moderately (MEC) emetogenic chemotherapy. They also assessed whether physicians and nurses accurately recognized the incidence of acute and delayed CINV in their own practices. A prospective, observational study of adult patients receiving HEC or MEC for the first time was performed. Before patient enrollment, medical oncologists and oncology nurses estimated the incidence of acute (Day 1) and delayed (Days 2-5) CINV after first administration of HEC and MEC in their own practices. Eligible patients from their practices then completed a 6-day diary including emetic episodes, nausea assessment, and antiemetic medication use. Observed incidence rates of acute and delayed CINV were compared with physician/nurse predictions. Twenty-four physicians and nurses and 298 eligible patients (67 receiving HEC and 231 receiving MEC) were recruited from 14 oncology practices in 6 countries. Greater than 35% of patients overall experienced acute nausea, whereas 13% experienced acute emesis. Delayed nausea and emesis were observed in 60% and 50% of HEC patients, respectively, and in 52% and 28% of MEC patients, respectively. Delayed symptoms appeared without acute symptoms after HEC (emesis, 38%; nausea, 33%) and MEC (emesis, 19%; nausea, 21%). Physicians and nurses accurately predicted the incidence of acute CINV but underestimated the incidence of delayed nausea and emesis after HEC by 21 and 28 percentage points, respectively, and delayed nausea after MEC by 28 percentage points. Greater than 75% of physicians and nurses underestimated the incidence of delayed CINV after both HEC and MEC. Physicians and nurses markedly underestimated the incidence of delayed nausea and emesis after both HEC and MEC. Delayed nausea and emesis, which may appear even in the absence of acute nausea and emesis, remain important targets for improved therapeutic intervention.

Antiemetic therapy in patients receiving cancer chemotherapy.

To examine the currently available antiemetic medications and review their uses in the treatment of chemotherapy-induced nausea and vomiting (NV). Published articles and book chapters. NV is a common yet potentially serious side effect of chemotherapy. Nurses must understand the physiology of NV, its impact on patients, and the proper use of antiemetic medications to effectively manage this problem. Antiemetic medications vary in mechanism of action, indications for use, and adverse effects. Nurses are in a position to identify patients who are at risk for NV and to manage their care using accepted practice guidelines. Although practice guidelines have been established, the nurse's role in assessment and implementation of care is critical in the prevention and management of chemotherapy-induced NV.

Maternal factors and breast cancer risk among young women.

The results from previous studies have provided evidence to support the hypothesised association between intrauterine oestrogen exposure and subsequent risk of breast cancer. Information has not been available to study this relationship for several perinatal factors thought to be related to pregnancy oestrogen levels. Data collected from the mothers of women in two population-based case-control studies of breast cancer in women under the age of 45 years (510 case mothers, 436 control mothers) who were diagnosed between 1983 and 1992 in three western Washington counties were used to investigate further the relationship between intrauterine oestrogen exposure and risk of breast cancer. A pregnancy weight gain of 25-34 pounds was associated with breast cancer risk (odds ratio [OR] = 1.5; 95% confidence interval [CI] 1.1, 2.0); however, women whose mothers gained 35 pounds or more were not at increased risk. Use of antiemetic medication in women with any nausea and vomiting (OR = 2.9; 95% CI 1.1, 8.1) and use of diethylstilboestrol (DES) (OR = 2.3; 95% CI 0.8, 6.4) appeared to be positively associated with breast cancer risk. The results from this study provide limited support for the hypothesis that in utero oestrogen exposure may be related to subsequent breast cancer risk among young women.