Treating nausea and vomiting in palliative care: a review

Paul Glare, Jeanna Miller, Tanya Nikolova, Roma TickooPain and Palliative Care Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USAAbstract: Nausea and vomiting are portrayed in the specialist palliative care literature as common and distressing symptoms affecti...

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Autores principales:	Glare P, Miller J, Nikolova T, Tickoo R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2011
Materias:	nausea vomiting palliative care Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/6c879e5222a14356984bebd40374d278
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spelling	oai:doaj.org-article:6c879e5222a14356984bebd40374d2782021-12-02T11:29:21ZTreating nausea and vomiting in palliative care: a review1178-1998https://doaj.org/article/6c879e5222a14356984bebd40374d2782011-09-01T00:00:00Zhttps://www.dovepress.com/treating-nausea-and-vomiting-in-palliative-care-a-review-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Paul Glare, Jeanna Miller, Tanya Nikolova, Roma TickooPain and Palliative Care Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USAAbstract: Nausea and vomiting are portrayed in the specialist palliative care literature as common and distressing symptoms affecting the majority of patients with advanced cancer and other life-limiting illnesses. However, recent surveys indicate that these symptoms may be less common and bothersome than has previously been reported. The standard palliative care approach to the assessment and treatment of nausea and vomiting is based on determining the cause and then relating this back to the “emetic pathway” before prescribing drugs such as dopamine antagonists, antihistamines, and anticholinergic agents which block neurotransmitters at different sites along the pathway. However, the evidence base for the effectiveness of this approach is meager, and may be in part because relevance of the neuropharmacology of the emetic pathway to palliative care patients is limited. Many palliative care patients are over the age of 65 years, making these agents difficult to use. Greater awareness of drug interactions and QTc prolongation are emerging concerns for all age groups. The selective serotonin receptor antagonists are the safest antiemetics, but are not used first-line in many countries because there is very little scientific rationale or clinical evidence to support their use outside the licensed indications. Cannabinoids may have an increasing role. Advances in interventional gastroenterology are increasing the options for nonpharmacological management. Despite these emerging issues, the approach to nausea and vomiting developed within palliative medicine over the past 40 years remains relevant. It advocates careful clinical evaluation of the symptom and the person suffering it, and an understanding of the clinical pharmacology of medicines that are available for palliating them.Keywords: nausea, vomiting, palliative careGlare PMiller JNikolova TTickoo RDove Medical Pressarticlenausea vomiting palliative careGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 6, Pp 243-259 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	nausea vomiting palliative care Geriatrics RC952-954.6
spellingShingle	nausea vomiting palliative care Geriatrics RC952-954.6 Glare P Miller J Nikolova T Tickoo R Treating nausea and vomiting in palliative care: a review
description	Paul Glare, Jeanna Miller, Tanya Nikolova, Roma TickooPain and Palliative Care Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USAAbstract: Nausea and vomiting are portrayed in the specialist palliative care literature as common and distressing symptoms affecting the majority of patients with advanced cancer and other life-limiting illnesses. However, recent surveys indicate that these symptoms may be less common and bothersome than has previously been reported. The standard palliative care approach to the assessment and treatment of nausea and vomiting is based on determining the cause and then relating this back to the “emetic pathway” before prescribing drugs such as dopamine antagonists, antihistamines, and anticholinergic agents which block neurotransmitters at different sites along the pathway. However, the evidence base for the effectiveness of this approach is meager, and may be in part because relevance of the neuropharmacology of the emetic pathway to palliative care patients is limited. Many palliative care patients are over the age of 65 years, making these agents difficult to use. Greater awareness of drug interactions and QTc prolongation are emerging concerns for all age groups. The selective serotonin receptor antagonists are the safest antiemetics, but are not used first-line in many countries because there is very little scientific rationale or clinical evidence to support their use outside the licensed indications. Cannabinoids may have an increasing role. Advances in interventional gastroenterology are increasing the options for nonpharmacological management. Despite these emerging issues, the approach to nausea and vomiting developed within palliative medicine over the past 40 years remains relevant. It advocates careful clinical evaluation of the symptom and the person suffering it, and an understanding of the clinical pharmacology of medicines that are available for palliating them.Keywords: nausea, vomiting, palliative care
format	article
author	Glare P Miller J Nikolova T Tickoo R
author_facet	Glare P Miller J Nikolova T Tickoo R
author_sort	Glare P
title	Treating nausea and vomiting in palliative care: a review
title_short	Treating nausea and vomiting in palliative care: a review
title_full	Treating nausea and vomiting in palliative care: a review
title_fullStr	Treating nausea and vomiting in palliative care: a review
title_full_unstemmed	Treating nausea and vomiting in palliative care: a review
title_sort	treating nausea and vomiting in palliative care: a review
publisher	Dove Medical Press
publishDate	2011
url	https://doaj.org/article/6c879e5222a14356984bebd40374d278
work_keys_str_mv	AT glarep treatingnauseaandvomitinginpalliativecareareview AT millerj treatingnauseaandvomitinginpalliativecareareview AT nikolovat treatingnauseaandvomitinginpalliativecareareview AT tickoor treatingnauseaandvomitinginpalliativecareareview
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Treating nausea and vomiting in palliative care: a review

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