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Belluomini L, Avancini A, Sposito M, Pontolillo L, Tregnago D, Trestini I, Insolda J, Carbognin L, Milella M, Bria E, Pilotto S. Integrating nutrition, physical exercise, psychosocial support and antiemetic drugs into CINV management: The road to success. Crit Rev Oncol Hematol 2024; 201:104444. [PMID: 39002789 DOI: 10.1016/j.critrevonc.2024.104444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/26/2024] [Accepted: 07/06/2024] [Indexed: 07/15/2024] Open
Abstract
Over the years, advancements in antiemetic drugs have improved chemotherapy-induced nausea and vomiting (CINV) control. However, despite the antiemetics therapies, in a relevant number of adult patients (∼30 %), CINV is still persistent, leading to several complications, such as electrolyte imbalances, anorexia, and treatment discontinuation. Supportive care interventions have gained credibility in cancer care, helping to improve patients' psycho-physical condition, quality of life, and managing symptoms, including CINV. Physical exercise and tailored nutritional counseling have demonstrated benefits in reducing the severity of nausea and vomiting. Psychological intervention has been postulated as a key approach in controlling anticipatory nausea/vomiting, as well as acupuncture/acupressure has been shown to decrease nausea and vomiting after chemotherapy treatments. In the current review, we aim to provide a clinical update on current prophylactic and delayed antiemetic guidelines for CINV and an overview of the non-pharmacological interventions tested for alleviating CINV in patients with cancer.
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Affiliation(s)
- Lorenzo Belluomini
- Section of Innovation Biomedicine, Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Italy.
| | - Alice Avancini
- Section of Innovation Biomedicine, Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Italy.
| | - Marco Sposito
- Section of Innovation Biomedicine, Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Italy.
| | - Letizia Pontolillo
- UOC Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Medical Oncology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Daniela Tregnago
- Section of Innovation Biomedicine, Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Italy.
| | - Ilaria Trestini
- Dietetic Service, Hospital Medical Direction, University and Hospital Trust (AOUI) of Verona, Italy.
| | - Jessica Insolda
- Section of Innovation Biomedicine, Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Italy.
| | - Luisa Carbognin
- UOC Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Medical Oncology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Michele Milella
- Section of Innovation Biomedicine, Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Italy.
| | - Emilio Bria
- UOC Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Medical Oncology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Sara Pilotto
- Section of Innovation Biomedicine, Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Italy.
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Alves RDB, de Rebouças CV, Yamada AMTD, Cruz FJSM. Prevalence of anticipatory nausea and vomiting in breast cancer patients undergoing highly emetogenic chemotherapy. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230937. [PMID: 38716933 PMCID: PMC11068401 DOI: 10.1590/1806-9282.20230937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/30/2023] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Anticipatory nausea and vomiting are unpleasant symptoms observed before undergoing chemotherapy sessions. Less is known about the occurrence of symptoms since the advent of the new neurokinin-1 antagonist. METHODS This prospective cohort study was performed at a single Brazilian Institution. This study included breast cancer patients who received doxorubicin and cyclophosphamide chemotherapy and an appropriate antiemetic regimen (dexamethasone 10 mg, palonosetron 0.56 mg, and netupitant 300 mg in the D1 followed by dexamethasone 10 mg 12/12 h in D2 and D4). Patients used a diary to record nausea, vomiting, and use of rescue medication in the first two cycles of treatment. The prevalence of anticipatory nausea and vomiting was assessed before chemotherapy on day 1 of C2. RESULTS From August 4, 2020, to August 12, 2021, 60 patients were screened, and 52 patients were enrolled. The mean age was 50.8 (28-69) years, most had stage III (53.8%), and most received chemotherapy with curative intent (94%). During the first cycle, the frequency of overall nausea and vomiting was 67.31%, and that of severe nausea and vomiting (defined as grade>4 on a 10-point visual scale or use of rescue medication) was 55.77%. Ten patients had anticipatory nausea and vomiting (19.23%). The occurrence of nausea and vomiting during C1 was the only statistically significant predictor of anticipatory nausea and vomiting (OR=16, 95%CI 2.4-670.9, p=0.0003). CONCLUSION The prevalence of anticipatory nausea is still high in the era of neurokinin-1 antagonists, and failure of antiemetic control in C1 remains the main risk factor. All efforts should be made to control chemotherapy-induced nausea or nausea and vomiting on C1 to avoid anticipatory nausea.
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Affiliation(s)
- Rafaela de Brito Alves
- Faculty of Medicine of ABC, Brazilian Institute for Cancer Control – Santo André (SP), Brazil
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Yamamoto Y, Yamamoto S, Tsuge T, Urano K, Matsuura K. Analysis of Nausea and Vomiting Frequency Following Opioid Dose Escalation and Its Risk Factors: A Single-Center Retrospective Observational Study. J Palliat Med 2024; 27:301-306. [PMID: 37733255 DOI: 10.1089/jpm.2023.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Background and Objective: Opioid-induced nausea and vomiting (OINV) is known to develop not only upon opioid introduction but also during opioid dose escalation, but the actual details are unclear. The aim of this study was to investigate the frequency of OINV in opioid dose escalation at a single center and to identify risk factors. Methods: A retrospective analysis of the medical records of hospitalized patients with cancer who underwent increased intake of oral oxycodone extended-release tablets at Komaki City Hospital between January 2016 and December 2019 was performed. Associations between the incidence of OINV and multiple factors were analyzed, including patient demographics, opioid daily dose, comorbidities, history of nausea after opioid introduction, and prophylactic antiemetic drugs. Results: Of the 132 patients analyzed, 56 (42.4%; grades 1 and 2, 36 and 20, respectively) developed opioid-induced nausea after opioid dose escalation, 26 (19.7%; grades 1 and 2, 19 and 7, respectively) developed opioid-induced vomiting, 58 (43.9%) had either opioid-induced nausea or vomiting. Thirty-five of 60 patients (55.0%) developed OINV among those who received prophylactic antiemetic drugs at opioid dose escalation. Performance status (≥2) (odds ratio [OR]: 2.36, 95% confidence interval [95% CI]: 1.15-4.84, p = 0.02) and history of nausea for opioid introduction (OR: 2.92, 95% CI: 1.20-7.10, p = 0.02) were detected as risk factors for the development of OINV. Conclusion: This study revealed a high incidence of OINV during opioid dose escalation, indicating that careful monitoring is required as at the time of opioid introduction. Further validation by a prospective study is required.
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Affiliation(s)
| | - Seiji Yamamoto
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Taiga Tsuge
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
- Department of Pharmacy, Ena Hospital, Ena, Gifu, Japan
| | - Kimihiko Urano
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Katsuhiko Matsuura
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
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Ay A, Boztepe H, Özbay SÇ, Yılmaz P, Karadavut B, Burhanoğulları D, Akyüz C. Determining the factors affecting chemotherapy-induced nausea and vomiting in children with cancer. J Pediatr Nurs 2023; 73:e426-e434. [PMID: 37845092 DOI: 10.1016/j.pedn.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/07/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE We evaluated the factors affecting chemotherapy-induced nausea and vomiting (CINV) in children with cancer. DESIGN AND METHODS This cross-sectional study was conducted with 62 children aged 9 to 18 years old with a solid tumor who received chemotherapy for the first time, and their parents. Data were collected using a data collection form, the State-Trait Anxiety Inventory for Children, the Beck Anxiety Inventory, the Spielberger State-Trait Anxiety Inventory, and the Baxter Retching Faces Scale. Data were analyzed using Spearman's correlation and logistic regression analyses. RESULTS Risk factors related to the child, treatment, and parent were examined. Child-related factors were determined as diagnosis (odds ratio [OR] = 5.5), time since diagnosis (OR = 1.9, OR = 4.7), pretreatment anxiety of the child (r = 0.439, r = 0.422), and past experience of nausea and vomiting before treatment (OR = 1.2). Treatment-related factors involved anti-emetic prophylaxis (OR = 4.9, OR = 9.2). Parent-related factors included pretreatment anxiety of the parent (r = 0.271, r = 0.287), accommodation (OR = 5.5), not eating (OR = 1.2, OR = 1.3), and bad smell (OR = 1.2), which were described amongst parents' as factors that trigger CINV. CONCLUSIONS The occurrence of CINV is significantly affected by child-, treatment-, and parent-related risk factors. PRACTICE IMPLICATIONS Pediatric nurses should create an environment for children and their parents to reduce their anxiety and provide basic knowledge and skills about the management of CINV.
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Affiliation(s)
- Ayşe Ay
- Department of Nursing, Faculty of Health Sciences, Başkent University, Ankara, Turkey.
| | - Handan Boztepe
- Department of Nursing, Faculty of Health Sciences, Atılım University, Ankara, Turkey
| | | | - Pınar Yılmaz
- Department of Pediatric Oncology, Oncology Hospital, Hacettepe University, Ankara, Turkey
| | - Burcu Karadavut
- Department of Pediatric Oncology, Oncology Hospital, Hacettepe University, Ankara, Turkey
| | - Dilek Burhanoğulları
- Department of Pediatric Oncology, Oncology Hospital, Hacettepe University, Ankara, Turkey
| | - Canan Akyüz
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Wayant C, Fitzgerald K, Hemmerich C, Geng Y, Freyer D, Roth M. Prevalence of Adverse Event Reporting in Adolescents and Young Adults Enrolled in Cancer Clinical Trials. JCO Oncol Pract 2023; 19:1048-1052. [PMID: 37748116 PMCID: PMC10667017 DOI: 10.1200/op.23.00201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/04/2023] [Accepted: 08/18/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Survival for adolescents and young adults (AYAs) with cancer has improved over the past few decades, and targeted approaches are needed to further improve outcomes. Limited reports suggest that AYAs tolerate cancer treatment differently than older and younger patients. Lack of adverse event (AE) data prevents the optimization of treatment regimens for AYAs by maximizing drug delivery and minimizing treatment-related toxicity. The extent to which the frequency and severity of AEs are reported for AYAs in cancer trials is unknown. METHODS Using a retrospective, observational design we reviewed all phase II/III clinical trials published in 2021 that included cancer-directed therapy and enrolled at least one patient age 15-39 years diagnosed with one of the five common AYA cancers: breast cancer, colorectal cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, or melanoma. The primary outcome was to determine the proportion of phase II/III trials that report AEs for the AYA population. RESULTS Of 2,540 publications identified, 182 were included in the final analysis. No studies reported AE data for AYAs separate from older adults. Given the lack of reporting of AEs by age, it was not possible to assess differences in AE frequency or severity or whether AEs were associated with differences in dose reductions, treatment delays, or discontinuation for AYAs. CONCLUSION Reporting of AEs for AYAs with cancer is absent in the public domain. Failure to account for differences in treatment tolerance between AYAs and older adults may lead to undertreatment or overtreatment and delay progress toward further improving outcomes for AYAs.
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Affiliation(s)
- Cole Wayant
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Kyle Fitzgerald
- Department of Biomedical Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Christian Hemmerich
- Department of Biomedical Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Yimin Geng
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA
- Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David Freyer
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA
- Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
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Bishnoi IR, Kavaliers M, Ossenkopp KP. Immune activation attenuates memory acquisition and consolidation of conditioned disgust (anticipatory nausea) in rats. Behav Brain Res 2023; 439:114250. [PMID: 36503043 DOI: 10.1016/j.bbr.2022.114250] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/25/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Anticipatory nausea is a classically conditioned response to cues (e.g. contexts) that have been previously paired with a nauseating stimulus, such as chemotherapy in humans. In rodents, anticipatory nausea can be modeled by pairing a novel context with lithium chloride (LiCl), which leads to conditioned disgust behaviours (such as gaping) when exposed to the context alone. Growing evidence suggests that selective immune activation attenuates various forms of learning and memory. The present study investigated the effects of the endotoxin lipopolysaccharide (LPS) on LiCl-induced anticipatory nausea across critical stages of associative memory including acquisition, consolidation, and extinction. Adult male Long Evans rats were subject to intraperitoneal (i.p.) LiCl (127 mg/kg) or vehicle control (NaCl) paired with a 30 min conditioning trial in a distinct context for a total of 4 trials. To study acquisition, rats were administered either LPS or NaCl (200 μg/kg, i.p.) 90 mins before the conditioning trials. To study consolidation, different rats were administered either LPS or NaCl (200 μg/kg, i.p.) immediately after the conditioning trials. These trials were followed by 4 drug-free extinction trials within the same context. LPS significantly reduced conditioned gaping behaviours by the 4th conditioning trial and on the 1st drug-free extinction trial when administered 90 mins before or immediately after the conditioning trials. LPS had no significant effect on extinction. The present study provides strong evidence for the attenuating effects of LPS exposure on the acquisition and consolidation of LiCl-induced anticipatory nausea.
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Affiliation(s)
- Indra R Bishnoi
- Graduate Program in Neuroscience, University of Western Ontario, London, Canada; Department of Psychology, University of Western Ontario, London, Canada.
| | - Martin Kavaliers
- Graduate Program in Neuroscience, University of Western Ontario, London, Canada; Department of Psychology, University of Western Ontario, London, Canada; Department of Psychology and Neuroscience Program, University of Guelph, Guelph, Canada
| | - Klaus-Peter Ossenkopp
- Graduate Program in Neuroscience, University of Western Ontario, London, Canada; Department of Psychology, University of Western Ontario, London, Canada
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Barušić AK. The emerging role of olanzapine in paediatric CINV control: A review. Medicine (Baltimore) 2022; 101:e32116. [PMID: 36550859 PMCID: PMC9771166 DOI: 10.1097/md.0000000000032116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a serious side effect of chemotherapy that negatively impacts the quality of life of oncological patients and is associated with the emetogenic risk specific to administered chemotherapy. Current practice guidelines on the use of antiemetics in CINV include the option of adding olanzapine to antiemetic regimens in the management of adult CINV. The use of olanzapine in pediatric CINV has been restricted to children with poor CINV control. Research on the use of olanzapine in pediatric CINV has been limited. The aim of this review was to evaluate current evidence on the effective and safe antiemetic use of olanzapine in pediatric CINV of any type following chemotherapy of any emetogenicity. Ovid MEDLINE, Embase, CENTRAL databases were searched for any literature on the use of olanzapine in pediatric CINV published from 2015 to 2022. Studies that reported on the olanzapine-containing antiemetic regimen in peadiatric CINV control specifically were included. Search restrictions were placed on research published in English. The search generated 43 records that were assessed for eligibility. Out of 10 identified eligible studies a third were RCT. Findings of this review suggest that adding olanzapine to antiemetic regimen in pediatric CINV control is a worthwhile consideration. Further research is needed to establish the efficacy and safety of antiemetic olanzapine use in pediatric CINV.
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Affiliation(s)
- Anabella Karla Barušić
- The datasets generated during and/or analyzed during the current study are publicly available. The Psychoncology Team, Department of Child & Adolescent Psychological Medicine, University Collage Hospital, London, UK
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Optimizing treatment management of trastuzumab deruxtecan in clinical practice of breast cancer. ESMO Open 2022; 7:100553. [PMID: 35964548 PMCID: PMC9375150 DOI: 10.1016/j.esmoop.2022.100553] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction The antibody-drug conjugate trastuzumab deruxtecan (T-DXd) targets human epidermal growth factor receptor 2 (HER2) and has been evaluated in patients with HER2-positive unresectable/metastatic breast cancer in the phase II DESTINY-Breast01 trial (NCT03248492; DS8201-A-U201) and the randomized phase III DESTINY-Breast03 trial (NCT03529110; DS8201-A-U302). Approximately 20 additional studies are ongoing in breast cancer, including HER2-low breast cancer, and other solid tumor types within the DESTINY trial program. T-DXd has demonstrated a generally manageable safety profile, with low-grade hematologic and gastrointestinal adverse events (AEs) among the most common; interstitial lung disease (ILD)/pneumonitis has been observed in patients receiving T-DXd and can be severe. This review discusses the management of common AEs and AEs of special interest in patients with HER2-positive unresectable/metastatic breast cancer, including nausea and vomiting, neutropenia, infusion-related reactions, alopecia, fatigue, ILD/pneumonitis, and left ventricular dysfunction. Methods Expert opinions, institutional protocols, and strategies to help optimize AE management and maximize the potential benefits of T-DXd in patients with breast cancer from five oncologists treating patients with T-DXd in North America and Europe are discussed. Results Prophylaxis for nausea and vomiting and proactive management of ILD/pneumonitis are especially important in treating patients with T-DXd. Management strategies for other T-DXd-related AEs of interest (e.g. neutropenia, infusion-related reactions, alopecia, fatigue, and left ventricular dysfunction) are also discussed. Conclusions This review provides context for understanding the usage, monitoring, and management practices of other health care providers and institutions with experience using T-DXd to help with safe and effective management of T-DXd-related AEs, particularly since the duration of T-DXd treatment may be quite long. Proper management of T-DXd-related AEs will allow optimal exposure and benefit from T-DXd and will help avoid premature discontinuation or improper dose reductions. Adverse events (AEs) related to trastuzumab deruxtecan (T-DXd) are frequent but most commonly low grade and manageable. Nausea and vomiting are among the most common treatment-emergent AEs. Interstitial lung disease/pneumonitis is an important AE; proactive monitoring, diagnosis, and management are key. Optimizing management of AEs with prophylaxis and effective therapies allows for maximizing the benefit from T-DXd therapy.
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Bernanke A, Sette S, Hernandez N, Zimmerman S, Murphy J, Francis R, Reavis Z, Kuhn C. Male and female rats exhibit comparable gaping behavior but activate brain regions differently during expression of conditioned nausea. Behav Pharmacol 2022; 33:291-300. [PMID: 35621171 PMCID: PMC9354039 DOI: 10.1097/fbp.0000000000000676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Twenty-five to fifty percent of patients undergoing chemotherapy will develop anticipatory nausea and vomiting (ANV), in which symptoms occur in anticipation of treatment. ANV is triggered by environmental cues and shows little response to traditional antiemetic therapy, suggesting that unique neural pathways mediate this response. Understanding the underlying neural mechanisms of this disorder is critical to the development of novel therapeutic interventions. The purpose of the present study was to identify brain areas activated during ANV and characterize sex differences in both the behavior and the brain areas activated during ANV. We used a rat model of ANV by pairing a novel context with the emetic drug lithium chloride (LiCl) to produce conditioned nausea behaviors in the LiCl-paired environment. We quantitated gaping, an analog of human vomiting, after acute or repeated LiCl in a unique environment. To identify brain regions associated with gaping, we measured c-fos activation by immunochemical staining after these same treatments. We found that acute LiCl activated multiple brain regions including the supraoptic nucleus of the hypothalamus, central nucleus of the amygdala, nucleus of the solitary tract and area postrema, none of which were activated during ANV. ANV activated c-fos expression in the frontal cortex, insula and paraventricular nucleus of the hypothalamus of males but not females. These data suggest that therapies such as ondansetron which target the area postrema are not effective in ANV because it is not activated during the ANV response. Further studies aimed at characterizing the neural circuits and cell types that are activated in the conditioned nausea response will help identify novel therapeutic targets for the treatment of this condition, improving both quality of life and outcomes for patients undergoing chemotherapy.
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Affiliation(s)
- Alyssa Bernanke
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
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Jahn F, Wörmann B, Brandt J, Freidank A, Feyer P, Jordan K. The Prevention and Treatment of Nausea and Vomiting During Tumor Therapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:382-392. [PMID: 35140010 PMCID: PMC9487713 DOI: 10.3238/arztebl.m2022.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 03/29/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Nausea and vomiting are common and distressing side effects of tumor therapy. Despite prophylaxis, 40-50% of patients suffer from nausea, and 20-30% from vomiting. Antiemetic prophylaxis and treatment are therefore of great importance for improving patients' quality of life and preventing sequelae such as tumor cachexia. METHODS The recommendations presented here are based on international and national guidelines, updated with publications retrieved by a selective search in the PubMed and Cochrane Library databases, with special attention to randomized controlled trials and meta-analyses that have appeared in the past 5 years since the German clinical practice guideline on supportive therapy was published. RESULTS Risk-adjusted prevention and treatment is based on the identification of treatment-related and patient-specific risk factors, including female sex and younger age. Parenteral tumor therapy is divided into four risk classes (minimal, low, moderate, high), and oral tumor therapy into two (minimal/low, moderate/high). In radiotherapy, the radiation field is of decisive importance. The antiemetic drugs most commonly used are 5-HT3-RA, NK1-RA, and dexamethasone; olanzapine has proven beneficial as an add-on or rescue drug. The use of steroids in patients being treated with drug combinations including checkpoint inhibitors is discussed controversially because of the potentially reduced therapeutic response. Benzodiazepines, dimenhydrinate, and cannabinoids can be used as backup antiemetics. Acupuncture/acupressure, ginger, and progressive muscle relaxation are pos - sible alternative methods. CONCLUSION Detailed, effective, risk profile-adapted algorithms for the prevention and treatment of nausea and vomiting are now available for patients undergoing classic chemotherapy regimens or combined radiotherapy and chemotherapy. Optimal symptom control for patients undergoing oral tumor therapy over multiple days in the outpatient setting remains a challenge.
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Affiliation(s)
- Franziska Jahn
- Department of Hematology and Oncology, University of Halle-Wittenberg, Halle (Saale),*Universitätsklinikum Halle Universitätsklinik und Poliklinik für Innere Medizin IV Hämatologie/Onkologie, Ernst-Grube-Str. 40 06120 Halle, Germany
| | - Bernhard Wörmann
- Charité Center for ambulant health, Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Virchow, Berlin
| | - Juliane Brandt
- Department of Hematology, Oncology, and Rheumatology, Heidelberg University Hospital
| | - Annette Freidank
- Pharmacy and Patient Advice Center, Universitätsmedizin Marburg—Campus Fulda
| | | | - Karin Jordan
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam
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Abstract
Among the side effects of anticancer treatment, chemotherapy-induced nausea and vomiting (CINV) is one of the most feared given its high prevalence, affecting up to 40% of patients. It can impair patient’s quality of life and provoke low adherence to cancer treatment or chemotherapy dose reductions that can comprise treatment efficacy. Suffering CINV depends on factors related to the intrinsic emetogenicity of antineoplastic drugs and on patient characteristics. CINV can appear at different times regarding the administration of antitumor treatment and the variability of risk according to the different antitumor regimens has, as a consequence, the need for a different and adapted antiemetic treatment prophylaxis to achieve the desired objective of complete protection of the patient in the acute phase, in the late phase and in the global phase of emesis. As a basis for the recommendations, the level of emetogenicity of anticancer treatment is considered and they are classified as high, moderate, low and minimal emetogenicity and these recommendations are based on the use of antiemetic drugs with a high therapeutic index: anti 5-HT, anti-NK and steroids. Despite having highly effective treatments, clinical reality shows that they are not applied enough, so evidence-based recommendations are needed to show the best options and help in decision-making. To cover all the antiemetic prophylaxis options, we have also included recommendations for oral treatments, multiday regimens and radiation-induced emesis prevention.
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Tan JY, Molassiotis A, Suen LKP, Liu J, Wang T, Huang HR. Effects of auricular acupressure on chemotherapy-induced nausea and vomiting in breast cancer patients: a preliminary randomized controlled trial. BMC Complement Med Ther 2022; 22:87. [PMID: 35331208 PMCID: PMC8953362 DOI: 10.1186/s12906-022-03543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Auricular acupressure (AA) has been viewed as a promising approach to managing chemotherapy-induced nausea and vomiting (CINV) but relevant research evidence has been inconclusive. This study aimed to examine the effects of AA on CINV in breast cancer (BC) patients undergoing chemotherapy. METHODS A preliminary randomized controlled trial was conducted in 114 BC patients. Participants were randomly allocated to a true AA group (n = 38), a sham AA group (n = 38), and a standard care group (n = 38). All the participants were provided with standard antiemetic treatment and care, while the true AA group and the sham AA group received an additional 5-day true AA and a 5-day sham AA, respectively. Acute and delayed CINV were assessed by using the MASCC Antiemesis Tool (MAT), anticipatory nausea and vomiting were measured by the Index of Nausea, Vomiting, and Retching (INVR), and patients' quality of life (QoL) was evaluated by the Functional Assessment of Cancer Therapy-Breast (FACT-B). RESULTS Both the true and sham AA groups reported improved CINV outcomes than the standard care group, with the true AA demonstrating larger effects than the sham comparison. The true and sham AA groups had higher complete response (CR) rates of CINV when compared with the standard care group, with the difference in the CR of acute CINV achieving statistical significance (p = 0.03). Both the true and sham AA groups demonstrated lower incidence and severity of acute CINV compared with the standard care group with the among-group difference reaching statistical significance for the occurrence (p = 0.04) and severity (p = 0.001) of acute nausea. No significant differences in anticipatory CINV and QoL were found among the groups. CONCLUSION The use of AA plus standard antiemetic treatment and care was superior to the use of standard antiemetic treatment and care alone in managing CINV among BC patients receiving chemotherapy. The antiemetic effects of AA were identified to be more profound in improving acute CINV, particularly acute nausea. The antiemetic effects of AA were deemed to be a mixture of specific treatment effects and placebo effects, and the placebo effects were very large and even reached clinical significance. TRIAL REGISTRATION ClinicalTrials.gov; NCT02403037 ; Registered March 31, 2015.
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Affiliation(s)
- Jing-Yu Tan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR. .,College of Nursing and Midwifery, Charles Darwin University, Casuarina Campus, Ellengowan Drive, Brinkin, NT, 0810, Australia.
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Lorna K P Suen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR.,School of Nursing, Tung Wah College, Homantin, Kowloon, Hong Kong SAR
| | - Jian Liu
- Department of Breast Oncology, Fujian Provincial Cancer Hospital, Fuma Road, Jinan District, Fuzhou, 340014, Fujian, China
| | - Tao Wang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR.,College of Nursing and Midwifery, Charles Darwin University, Casuarina Campus, Ellengowan Drive, Brinkin, NT, 0810, Australia.,The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Wusi Road, Gulou District, Fuzhou, 350003, Fujian, China
| | - Hui-Rong Huang
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, 817 Mid Road, Taijiang District, Fuzhou, 350004, Fujian, China
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Bianchini G, Arpino G, Biganzoli L, Lonardi S, Puglisi F, Santini D, Lambertini M, Pappagallo G. Emetogenicity of Antibody-Drug Conjugates (ADCs) in Solid Tumors with a Focus on Trastuzumab Deruxtecan: Insights from an Italian Expert Panel. Cancers (Basel) 2022; 14:cancers14041022. [PMID: 35205771 PMCID: PMC8870408 DOI: 10.3390/cancers14041022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Four antibody-drug conjugates (ADCs) are approved for the treatment of solid tumors, improving the therapeutic index. Despite their high selectivity, nausea and vomiting are the most frequently observed side effects. A deeper understanding of the potential risk for nausea and vomiting is crucial, as they can affect patients’ quality of life and treatment adherence. Prophylaxis with the potential combination of antiemetic therapy with complementary non-pharmacological approaches are even more important, considering that ADC therapies are generally given continuously until disease progression or the occurrence of toxicities. Abstract In the past decade, nine antibody-drug conjugates (ADCs) have been approved for the treatment of various tumors, four of which specifically for solid malignancies. ADCs deliver the cytotoxic payload to the cancer site, thereby improving chemotherapy efficacy while reducing systemic drug exposure and toxicity. With their high selectivity, ADCs are associated with a manageable side-effect profile, with nausea and vomiting being among the most frequent toxicities, although this may vary according to the respective ADC and the associated payload. Information about the emetic risk of the new ADC compounds is limited. Three virtual focus groups of Italian oncologists were held to raise awareness on the importance of an antiemetic prophylaxis regimen to prevent and mitigate ADC-associated emesis and its sequelae. After reviewing published evidence and guidelines, the three expert panels shared their experience on the early use of ADCs gained through the participation in specific clinical trials and their clinical practice. The following issues were discussed: antiemetic therapy during trastuzumab deruxtecan treatment, with a protocol adopted at the San Raffaele Hospital (Milan, Italy); the use of steroids; the management of anticipatory nausea during trastuzumab deruxtecan therapy; nutritional counselling; and effective doctor–patient communication. The experts acknowledged that recommendations should be drug-specific, and formulated opinion-based advice intended to guide physicians in their daily practice until further evidence emerges.
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Affiliation(s)
- Giampaolo Bianchini
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Correspondence: ; Tel.: +39-02-2643-3169
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Laura Biganzoli
- Medical Oncology Department, Department of Oncology, Hospital Santo Stefano, 59100 Prato, Italy;
| | - Sara Lonardi
- Oncology Unit 3, Department of Oncology, Veneto Institute of Oncology IRCCS, 35128 Padova, Italy;
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Daniele Santini
- Medical Oncology, University Campus Bio-Medico, 00128 Roma, Italy;
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy;
- Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Giovanni Pappagallo
- School of Clinical Methodology, IRCCS “Sacro Cuore-Don Calabria” Hospital, 37024 Negrar di Valpolicella, Italy;
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14
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AKDENİZ KUDUBEŞ A, BEKTAŞ M. Developing the Nausea and Vomiting Thermometer Scale in children with cancer. Turk J Med Sci 2022; 52:166-174. [PMID: 34544217 PMCID: PMC10734878 DOI: 10.3906/sag-2005-88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/22/2022] [Accepted: 01/01/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND This study aimed to develop the Nausea and Vomiting Thermometer Scale (NVTS) in children with cancer. METHODS This methodological study was conducted on 250 children with cancer at the research and training university hospital in Turkey between September 2019 and January 2020. The t-test, the ROC analysis, the Diagnostic index, and the Youden index were used for determining the scale of the cutting point. The regression analysis, the intra-class correlation coefficient, and the BlandAltman analysis were used for the data analysis. RESULTS The scale-level content validity index was .94, which was coherent. As a result of the ROC analysis, the cut-off point was determined as three points. The NVTS showed good reliability, with an intra-class correlation coefficient of .99. In the linear regression analysis, a model was created for chemotherapy drugs, nausea and vomiting type, vomiting status, and the number of children with cancer who vomited explained 44.9% of their nausea and vomiting status. The results of the Bland-Altman analysis showed that the correlation coefficient between the differences and the means was insignificant.
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Affiliation(s)
- Aslı AKDENİZ KUDUBEŞ
- Department of Pediatric Nursing, Faculty of Health Sciences, Bilecik Şeyh Edebali University, Bilecik,
Turkey
| | - Murat BEKTAŞ
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylül University, İzmir,
Turkey
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15
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Khani A, Eishy Oskuyi A, Asghari R, Khalkhli HR, Sharifi H. Olanzapine enhances the effect of conventional drugs in chemotherapy inducing nausea and vomiting: A randomized clinical trial. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:356-362. [PMID: 35919648 PMCID: PMC9301225 DOI: 10.22088/cjim.13.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/31/2020] [Accepted: 02/27/2021] [Indexed: 11/08/2022]
Abstract
Background Chemotherapy inducing nausea and vomiting (CINV) is one of the significant side effects of anti-cancer treatment, and its full prevention is a potential challenge. This study was done to specify the effect of olanzapine in this setting. Methods In this randomized, double-blind, clinical trial study, olanzapine was compared with a placebo in combination with dexamethasone and granisetrone in patients with cancer. Patients in the intervention group received dexamethasone , granisetron and olanzapine. Patients in the control group received a placebo instead of olanzapine. Overall, acute nausea and vomiting prevention were the primary and secondary end points; complete response (no nausea,no vomiting) in the delayed period of chemotherapy was the third end point. Response to treatment was evaluated by the Functional Living Index Emesis (FLIE) questionnaire completion in the first, the third and the fifth of chemotherapy. Results Percentage reduction in mean±SD nausea and vomiting in the overall phase (0-120 hours) of intervention group compared to the control group respectively were 29.94±2.06, 69.75±2.32 [(57.93% reduction (p<0.001)]. For the acute phase (0-24 hours) were 26.08±2.36, 51.85±2.24 [(47.21% reduction (p<0.001)], for the delayed phase (24-120 hours), were 31.26±2.57, 67.91±2.12 ,[(55.11% reduction;(p<0.001)] respectively. Conclusion Olanzapine, along with dexamethasone and granisetron, significantly reduced vomiting and nausea in patients undergoing chemotherapy. No adverse event of olanzapine was observed in the patients.
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Affiliation(s)
- Atefe Khani
- Department of Pharmacology, Pharmacy Faculty, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Eishy Oskuyi
- Department of Internal Medicine, Faculty of Medicine, Urmia University of Medical Sciences, Urmia-Iran
| | - Rahim Asghari
- Department of Internal Medicine, Faculty of Medicine, Urmia University of Medical Sciences, Urmia-Iran
| | | | - Hamdollah Sharifi
- Department of Pharmacology, Pharmacy Faculty, Urmia University of Medical Sciences, Urmia, Iran,Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran,Correspondence: Hamdollah Sharifi, Department of Pharmacology, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, 5715799313, Iran. E-mail: , Tel: 0098 443275499, Fax: 0098 4433469935
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16
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Zucco GM, Doty RL. Multiple Chemical Sensitivity. Brain Sci 2021; 12:46. [PMID: 35053790 PMCID: PMC8773480 DOI: 10.3390/brainsci12010046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/09/2023] Open
Abstract
Multiple Chemical Sensitivity (MCS), a condition also known as Chemical Sensitivity (CS), Chemical Intolerance (CI), Idiopathic Environmental Illness (IEI) and Toxicant Induced Loss of Tolerance (TILT), is an acquired multifactorial syndrome characterized by a recurrent set of debilitating symptoms. The symptoms of this controversial disorder are reported to be induced by environmental chemicals at doses far below those usually harmful to most persons. They involve a large spectrum of organ systems and typically disappear when the environmental chemicals are removed. However, no clear link has emerged among self-reported MCS symptoms and widely accepted objective measures of physiological dysfunction, and no clear dose-response relationship between exposure and symptom reactions has been observed. In addition, the underlying etiology and pathogenic processes of the disorder remain unknown and disputed, although biologic and psychologic hypotheses abound. It is currently debated whether MCS should be considered a clinical entity at all. Nevertheless, in the last few decades MCS has received considerable scientific and governmental attention in light of the many persons reporting this illness. In this review, we provide a general overview of the history, definition, demographics, prevalence, and etiologic challenges in defining and understanding MCS.
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Affiliation(s)
- Gesualdo M Zucco
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, 35100 Padova, Italy
| | - Richard L Doty
- Smell and Taste Center, Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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17
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Doobay M, Cross-Mellor SK, Wah DTO, Kavaliers M, Ossenkopp KP. Toxin-induced aversive context conditioning: Assessing active aversive behaviors conditioned to the context of an automated activity monitor. Physiol Behav 2021; 240:113559. [PMID: 34416259 DOI: 10.1016/j.physbeh.2021.113559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
Lithium chloride (LiCl) is an emetic drug that has been used to create animal models of anticipatory nausea and conditioned place aversion. In this study we examined escape behaviours from a context in which rats experienced the aversive effects of LiCl treatments. The experiment had two phases: acquisition of context conditioning, which consisted of pairing a distinct context with the pharmacological effects of a moderate dose of the toxin LiCl, and extinction of context conditioning, which consisted of placement in the distinct context in a drug free state. During context conditioning, 16 adult male Long-Evans rats were injected intraperitoneally with 96 mg/kg lithium chloride (LiCl; n = 8) or 0.9% saline (NaCl; n = 8) and placed individually in an automated locomotor activity apparatus for 30 min every other day for 4 days. During the extinction phase, rats were placed in the apparatus for 30 min every other day without injections during a 4 day extinction phase. A significant Drug x Trial interaction was found for the time spent in vertical position in the open field apparatus during trials 1-3 of the extinction phase. The LiCl treated rats exhibited significantly increased rearing behavior, relative to the control rats, indicative of conditioned aversion. The results of this study suggest that escape behavior (vertical activity) occurs in rats experiencing the aversive conditioned effects of LiCl in a distinct context. In the context of current theoretical accounts, the LiCl-conditioned increase in apparent escape behaviors can be considered a reflection of anticipatory nausea.
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Affiliation(s)
- Minakshi Doobay
- Department of Psychology, University of Western Ontario Canada
| | | | - Deanne T O Wah
- Department of Psychology, University of Western Ontario Canada
| | - Martin Kavaliers
- Department of Psychology, University of Western Ontario Canada; Graduate Program in Neuroscience, University of Western Ontario Canada
| | - Klaus-Peter Ossenkopp
- Department of Psychology, University of Western Ontario Canada; Graduate Program in Neuroscience, University of Western Ontario Canada.
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18
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The Effect of Concealing the Hydration Fluid on Anticipatory Nausea-Vomiting in Pediatric Hematology-Oncology Patients Undergoing Chemotherapy Treatment: A Randomized Controlled Study. J Pediatr Nurs 2021; 59:181-187. [PMID: 33932648 DOI: 10.1016/j.pedn.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of this study was to assess the effectiveness of concealing the hydration fluid bottle in order to reduce the experience of anticipatory nausea and vomiting before chemotherapy treatment in pediatric hematology oncology patients undergoing chemotherapy treatment. DESIGN AND METHODS The study was carried out as a randomized controlled clinical trial. The study was conducted sixty-two pediatric oncology patients who underwent chemotherapy in a hospital in Ankara, Turkey. The patients were randomly alloceted to an intervention group (n = 32) or a control group (n = 30). Patients in the intervention group concealing the hydration fluid bottle throughout the duration of hydration; patients in the control group received routine procedure (No concealment intervention) during hydration degree of nausea and vomiting were measured by the Baxter Retching Faces (BARF) scale. RESULTS This study found no differences in the characteristics of the patients or in degree of nausea and vomiting between groups at enrollment. After concealing the hydration fluid bottle during the hydration, BARF scores were lower in the intervention group (p < .001). CONCLUSION Concealing the hydration fluid had significant effects on degree of nausea and vomiting in pediatric oncology patient who received hydration before chemotherapy. APPLICATION TO PRACTICE This approach can be added as routine care as an effective non pharmacological intervention for pediatric oncology patient with receiving chemotherapy.
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19
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Kus T, Aktas G, Ozcelik M, Dirikoc M, Sakalar T, Oyman A, Tanriverdi O, Yavuzsen T, Unal S, Cinkir HY, Bahceci A, Alkan A, Turhal S, Abali H. Association of illness perception with chemotherapy-induced nausea and vomiting: a Turkish Oncology Group (TOG) study. Future Oncol 2021; 17:1933-1942. [PMID: 33599548 DOI: 10.2217/fon-2020-0939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chemotherapy-induced nausea and vomiting (CINV) may be linked to the psychological status of cancer patients. Therefore, the authors aimed to better understand the underlying risk factors for CINV using the Brief Illness Perception Questionnaire. A total of 238 patients were recruited during three cycles of chemotherapy. Patient, disease and treatment characteristics were noted at the onset of chemotherapy. The Brief Illness Perception Questionnaire was administered face-to-face prior to chemotherapy. The relationship between illness perceptions and CINV was analyzed using Spearman's rank correlation. Positive illness perception parameters, including personal and treatment control, were negatively correlated, whereas negative illness perception parameters, including consequences, timeline, identity, concern and emotions, were positively correlated with CINV after adjusting for age, sex and emetogenic potential of chemotherapy (p < 0.001). Illness perception may be an underlying risk factor for CINV.
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Affiliation(s)
- Tulay Kus
- Department of Medical Oncology, School of Medicine, Gaziantep University, Gaziantep, TR-27310, Turkey
| | - Gokmen Aktas
- Department of Medical Oncology, School of Medicine, Kahramanmaras Sütçü İmam University, Kahramanmaraş, TR-46100, Turkey
| | - Melike Ozcelik
- Department of Medical Oncology, Umraniye Education & Research Hospital, University of Health Sciences, Istanbul, TR-34000, Turkey
| | - Merve Dirikoc
- Department of Medical Oncology, Ankara Numune Education & Research Hospital, Ankara, TR-06010, Turkey
| | - Teoman Sakalar
- Department of Medical Oncology, Kahramanmaras Necip Fazıl State Hospital, Kahramanmaraş, TR-46100, Turkey
| | - Abdilkerim Oyman
- Department of Medical Oncology, Umraniye Education & Research Hospital, University of Health Sciences, Istanbul, TR-34000, Turkey
| | - Ozgur Tanriverdi
- Department of Medical Oncology, Mugla Sitki Kocaman University, Mugla, TR-48000, Turkey
| | - Tugba Yavuzsen
- Department of Medical Oncology, Dokuz Eylul University, Izmir, TR-35000, Turkey
| | - Sinan Unal
- Department of Medical Oncology, Dokuz Eylul University, Izmir, TR-35000, Turkey
| | - Havva Yesil Cinkir
- Department of Medical Oncology, School of Medicine, Gaziantep University, Gaziantep, TR-27310, Turkey
| | - Aykut Bahceci
- Department of Medical Oncology, Dr Ersin Arslan Education & Research Hospital, Gaziantep, TR-27310, Turkey
| | - Ali Alkan
- Department of Medical Oncology, Mugla Sitki Kocaman University, Mugla, TR-48000, Turkey
| | - Serdar Turhal
- Department of Oncology, Anadolu Medical Center, Istanbul, TR-3400, Turkey
| | - Huseyin Abali
- Department of Medical Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Adana, TR-01170, Turkey
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Hope TA, Abbott A, Colucci K, Bushnell DL, Gardner L, Graham WS, Lindsay S, Metz DC, Pryma DA, Stabin MG, Strosberg JR. NANETS/SNMMI Procedure Standard for Somatostatin Receptor-Based Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE. J Nucl Med 2020; 60:937-943. [PMID: 31263080 DOI: 10.2967/jnumed.118.230607] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
With the recent approval of 177Lu-DOTATATE for use in gastroenteropancreatic neuroendocrine tumors, access to peptide receptor radionuclide therapy is increasing. Representatives from the North American Neuroendocrine Tumor Society and the Society of Nuclear Medicine and Molecular Imaging collaborated to develop a practical consensus guideline for the administration of 177Lu-DOTATATE. In this paper, we discuss patient screening, maintenance somatostatin analog therapy requirements, treatment location and room preparation, drug administration, and patient release as well as strategies for radiation safety, toxicity monitoring, management of potential complications, and follow-up. Controversies regarding the role of radiation dosimetry are discussed as well. This document is designed to provide practical guidance on how to safely treat patients with this therapy.
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Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California .,Department of Radiology, San Francisco VA Medical Center, San Francisco, California
| | | | - Karen Colucci
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - David L Bushnell
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa.,Iowa City VA Medical Center, Iowa City, Iowa
| | - Linda Gardner
- Department of Nuclear Medicine, University of California, Los Angeles, Los Angeles, California
| | - William S Graham
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Sheila Lindsay
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - David C Metz
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel A Pryma
- Division of Nuclear Medicine & Clinical Molecular Imaging, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Kube T, Rozenkrantz L, Rief W, Barsky A. Understanding persistent physical symptoms: Conceptual integration of psychological expectation models and predictive processing accounts. Clin Psychol Rev 2020; 76:101829. [PMID: 32062101 DOI: 10.1016/j.cpr.2020.101829] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 01/11/2023]
Abstract
Persistent physical symptoms (PPS) are distressing, difficult to treat, and pose a major challenge to health care providers and systems. In this article, we review two disparate bodies of literature on PPS to provide a novel integrative model of this elusive condition. First, we draw on the clinical-psychological literature on the role of expectations to suggest that people with PPS develop dysfunctional expectations about health and disease that become increasingly immune to disconfirmatory information (such as medical reassurance) through cognitive reappraisal. Second, we invoke neuroscientific predictive processing accounts and propose that the psychological process of 'cognitive immunization' against disconfirmatory evidence corresponds, at the neurobiological and computational level, to too much confidence (i.e. precision) afforded to prior predictions. This can lead to an attenuation of disconfirming sensory information so that strong priors override benign bodily signals and make people believe that something serious is wrong with the body. Combining these distinct accounts provides a unifying framework for persistent physical symptoms and shifts the focus away from their causes to the sustaining mechanisms that prevent symptoms from subsiding spontaneously. Based on this integrative model, we derive new avenues for future research and discuss implications for treating people with PPS in clinical practice.
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Affiliation(s)
- Tobias Kube
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA; Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany; Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany.
| | - Liron Rozenkrantz
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
| | - Arthur Barsky
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA; Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
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22
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[Biosimilars and the nocebo effect]. Z Rheumatol 2019; 79:267-275. [PMID: 31802197 DOI: 10.1007/s00393-019-00729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Biosimilars have been approved for use in Germany for many years and in the meantime also in rheumatology but only a few years ago. Biosimilars, which are biotechnologically manufactured products the same as reference biologicals, have actually now achieved a substantial proportion of the market in some regions but there are still doubters among patients and physicians who fear a loss of quality even if there is no evidence for this. A part of this problem can be explained by the nocebo effect but which furthermore also has a substantial medical importance. This effect is described and explained in this article. Psychosocial and context-related factors, such as the relationship between patient and physician, previous experience with treatment and treatment expectations can either improve or impair the efficacy of treatment interventions. These phenomena are commonly known as placebo and nocebo effects. As placebo and nocebo effects can influence the development of symptoms, the frequency of undesired events and the efficacy of treatment, it is decisive to know these effects and to develop strategies for prevention in order to optimize the treatment results. Although in recent years experimental studies have achieved substantial progress in the clarification of the psychosocial and neurobiological mechanisms of placebo effects, detailed mechanisms of nocebo effects are still widely unexplored. An improved understanding of these mechanisms promises the development of user-friendly strategies for the clinical care to improve treatment results and patient satisfaction.
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Ryan A, Noonan B. Exploring Nurses' Understanding of Anticipatory Nausea and Vomiting in Patients With Cancer. Oncol Nurs Forum 2019; 46:738-745. [PMID: 31626618 DOI: 10.1188/19.onf.738-745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore nurses' self-reported understanding of anticipatory nausea and vomiting (ANV) in patients with cancer. PARTICIPANTS & SETTING 12 oncology RNs were recruited from University Hospital Limerick in Ireland. METHODOLOGIC APPROACH Data were collected via semistructured interviews and analyzed using a qualitative content analysis approach with a focus on the manifest content. FINDINGS The following themes were identified. IMPLICATIONS FOR NURSING Although oncology nurses may understand the importance of assessing and treating patients on an individual basis throughout the course of treatment, formal ANV assessments are warranted to ensure the implementation of best practice. The findings of the current study can guide oncology nurses' approach to the assessment and management of ANV.
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Ho KY, Lam KKW, Chung JOK, Xia W, Cheung AT, Ho LK, Chiu SY, Chan GCF, Li HCW. Systematic review of the effectiveness of complementary and alternative medicine on nausea and vomiting in children with cancer: a study protocol. BMJ Open 2019; 9:e031834. [PMID: 31628132 PMCID: PMC6803108 DOI: 10.1136/bmjopen-2019-031834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Nausea and vomiting are two most common symptoms reported by children with cancer when they undergo active treatment. However, pharmacological treatment is not sufficient to manage these two symptoms, with over 40% of children still experience nausea and vomiting after receiving antiemetics. There has been an exponential growth of studies to demonstrate the effectiveness of different complementary complementary medicine (CAM) to control nausea and vomiting during cancer treatment. Appropriate application of CAM enhances the effectiveness of antiemetics, thus reducing the symptom burden on children as well as improving their general condition and quality of life during cancer treatment. Nevertheless, it remains unclear which CAM is the best approach to help children to prevent or reduce nausea and vomiting during and after cancer treatment. This paper describes a protocol for identifying, analysing and synthesising research evidence on the effectiveness of CAM on nausea and vomiting in children with cancer. METHODS AND ANALYSIS A total of 10 databases will be searched to identify appropriate literature: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CINAHL, PsycINFO, LILACS, OpenSIGLE, the Chinese Biomedical Literature Database, the Chinese Medical Current Contents and the Chinese National Knowledge Infrastructure. All randomised controlled trials which meet the inclusion criteria will be included. The primary outcome is the changes in nausea and vomiting either assessed by self-reported and/or objective measures. Review Manager 5.3 will be used to synthesise the data, calculate the treatment effects, perform any subgroup analysis and assess the risk of bias. ETHICAL AND DISSEMINATION The results will be presented at international conferences and published in peer-reviewed journals. As no individual data will be involved in this review, ethical approval is not required. PROSPERO REGISTRATION NUMBER CRD42019135404.
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Affiliation(s)
- Ka Yan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | | | - Wei Xia
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Ankie Tan Cheung
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Long Kwan Ho
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Sau Ying Chiu
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Godfrey Chi Fung Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
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Dadkhah B, Anisi E, Mozaffari N, Amani F, Pourghasemian M. Effect of Music Therapy with Periorbital Massage on Chemotherapy-Induced Nausea and Vomiting In Gastrointestinal Cancer: A Randomized Controlled Trail. J Caring Sci 2019; 8:165-171. [PMID: 31598509 PMCID: PMC6778310 DOI: 10.15171/jcs.2019.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction: Music and massage therapy are among the approaches of complementary medicine. Patients with cancer have been hugely encouraged in recent years to use complementary medicine to relieve chemotherapy-induced nausea and vomiting. The present study was conducted to determine the effect of music and periorbital massage therapy on chemotherapy-induced nausea and vomiting in patients with gastrointestinal cancers. Methods: The present single-blind clinical trial study was conducted on 60 patients with gastrointestinal cancer undergoing chemotherapy who were randomly assigned to control and music plus massage therapy groups. Two interventions were concurrently carried out on patients in music plus massage therapy group while receiving chemotherapy medication, but the control group received no intervention. Rhodes questionnaire was used to assess nausea and vomiting before and 24 hours after chemotherapy. Data were analyzed using descriptive and analytical statistical tests (Chi-square and t-tests). Results: Music plus periorbital massage therapy significantly reduced nausea and vomiting in patients undergoing chemotherapy compared to the control group. Conclusion: According to the results, using music plus periorbital massage improves nausea and vomiting in patients undergoing chemotherapy, and can be considered as a complementary medicine method in conjunction with other medicinal therapies to relieve symptoms of patients with cancer.
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Affiliation(s)
- Behrouz Dadkhah
- Department of Nursing, Faculty of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Elham Anisi
- Department of Nursing, Faculty of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Naser Mozaffari
- Department of Nursing, Faculty of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Firouz Amani
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mehdi Pourghasemian
- Department of Internal Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Saneei Totmaj A, Emamat H, Jarrahi F, Zarrati M. The effect of ginger (Zingiber officinale) on chemotherapy-induced nausea and vomiting in breast cancer patients: A systematic literature review of randomized controlled trials. Phytother Res 2019; 33:1957-1965. [PMID: 31225678 DOI: 10.1002/ptr.6377] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 01/08/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer and is the leading cause of mortality due to all types of cancers among the female population worldwide. Results of clinical trials investigating the effect of ginger on chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients are inconsistent. This study was aimed at obtaining a comprehensive overview of the current evidence regarding the effectiveness of ginger as an antiemetic modality for controlling CINV in breast cancer patients. All published randomized controlled trials in English were systematically searched on Google Scholar, PubMed, Scopus, and Cochrane search databases up to June 2018. The outcome variable of interest was severity and the frequency of nausea and vomiting in patients. A total of 50 studies were found through search databases. After excluding duplicates, the 42 remaining studies were screened, and finally, nine trials were included, which were published between 2012 and 2017. Two studies have examined the effect of ginger on the frequency of nausea, five studies on the frequency of vomiting, seven studies on the severity of nausea, and three studies on severity of vomiting. A study evaluated the effectiveness of ginger in improving dietary intake in CINV. Our investigation suggests that ginger may reduce nausea in the acute phase of chemotherapy in patients with breast cancer. The effect of ginger on nausea and vomiting in other conditions requires more high-quality clinical trials.
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Affiliation(s)
- Ali Saneei Totmaj
- Nutrition Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Emamat
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Jarrahi
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mitra Zarrati
- Nutrition Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Kyvsgaard N, Mikkelsen TS, Thastum M, Christensen AE, Wehner PS, Nysom K, Herlin T. Increased methotrexate intolerance in juvenile idiopathic arthritis compared to acute lymphoblastic leukaemia in children. PLoS One 2019; 14:e0219539. [PMID: 31295288 PMCID: PMC6622540 DOI: 10.1371/journal.pone.0219539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 06/27/2019] [Indexed: 12/23/2022] Open
Abstract
Objectives To analyse the internal consistency of an adaption of the methotrexate intolerance severity score (MISS); and to describe and compare the level of methotrexate intolerance evaluated by the MISS in Danish children with juvenile idiopathic arthritis (JIA) or acute lymphoblastic leukaemia (ALL), treated with low-dose methotrexate (MTX). Methods Cross-sectional study of children diagnosed with JIA or ALL, treated with low-dose MTX, aged 9 years or above, and cognitively intact. The patient’s parents completed the MISS. MTX intolerance was defined as a total MISS score above 6. Results We enrolled 120 children with JIA and 23 children with ALL. The MISS had a good internal consistency in the JIA group. The median MISS score was higher in the JIA group than in the ALL group (JIA: 8; ALL: 1; p<0.0001); and the JIA group had a larger proportion of MTX intolerant children than the ALL group (JIA: 73/120; ALL: 4/23; p<0.001). Within both the JIA group and the ALL group, the MISS total score was not significantly correlated with age, MTX dose or the duration of low-dose MTX treatment. Conclusion In the JIA group the level of MTX intolerance was higher and more attributed to anticipatory, associative and behavioural symptoms than in the ALL group. The MISS may help to uncover whether MTX intolerance is present and which aspects are affected in the individual patient, thus guiding intervention. The MISS may also be applicable within leukaemia care.
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Affiliation(s)
- Nini Kyvsgaard
- Paediatric and Adolescent Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Torben Stamm Mikkelsen
- Paediatric and Adolescent Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Anne Estmann Christensen
- Department of Paediatric Rheumatology, H.C. Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Peder Skov Wehner
- Department of Pediatric Hematology and Oncology, H.C. Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Karsten Nysom
- Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Troels Herlin
- Paediatric and Adolescent Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Abstract
The role of psychological mechanisms in the treatment process cannot be underestimated, the well-known placebo effect unquestionably being a factor in treatment. However, there is also a dark side to the impact of mental processes on health/illness as exemplified by the nocebo effect. This phenomenon includes the emergence or exacerbation of negative symptoms associated with the therapy, but arising as a result of the patient's expectations, rather than being an actual complication of treatment. The exact biological mechanisms of this process are not known, but cholecystokinergic and dopaminergic systems, changes in the HPA axis, and the endogenous secretion of opioids are thought to be involved. The nocebo effect can affect a significant proportion of people undergoing treatment, including cancer patients, leading in some cases to the cessation of potentially effective therapy, because of adverse effects that are not actually part of the biological effect of treatment. In extreme cases, as a result of suggestions and expectations, a paradoxical effect, biologically opposite to the mechanism of the action of the drug, may occur. In addition, the nocebo effect may significantly interfere with the results of clinical trials, being the cause of a significant proportion of complications reported. Knowledge of the phenomenon is thus necessary in order to facilitate its minimalization and thus improve the quality of life of patients and the effectiveness of treatment.
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Abstract
Thankfully, many more women are now surviving cancer due to advances in awareness, surveillance, and treatment. In fact, many oncology clinicians now consider cancer a chronic illness. This has meant that a growing number are living with the physical and psychological consequences of the disease. The psychological impact and emotions experienced by survivors are varied. Some reactions are more common than others, including the onset of depression, anxiety, and sexual dysfunction and feelings of abandonment, isolation, grief, and fear of recurrence. Body image and sexuality are also commonly impacted by cancer, particularly by women who experience treatment-induced menopause. Existential and spiritual concerns can also cause psychological consequences. In time, however, many women adjust to life as a cancer patient and find new meaning and purpose in their lives. The aim of this article is to highlight the key psychological issues faced by women who are in the chronic or survivorship phase of their cancer experience. The article also aims to emphasize the need for ongoing evaluation of the psychological status of these women during regular follow-up appointments. This will ensure that patient-centered supportive care is optimized.
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Affiliation(s)
- S Burney
- Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne , Australia
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Abstract
Nausea and vomiting result from complex interactions between afferent and efferent pathways of the gastrointestinal tract, central nervous system, and autonomic nervous system. Afferent pathways from the vagus nerve, vestibular system, and chemoreceptor trigger zone project to nucleus tractus solitarius, which in turn relays signals to the central pattern generator to initiate multiple downstream pathways resulting in symptoms of nausea and vomiting. There is increasing evidence that the central pathway of chronic nausea is different from that of acute nausea and vomiting-and closely resembles that of neuropathic pain. This improved understanding of chronic nausea has resulted in a paradigm shift with regard to management strategy. Although conventional therapies such as antiemetics and prokinetics are commonly used to manage acute nausea and vomiting, they are historically not as effective in treating chronic nausea. Recently, neuromodulator agents, such as tricyclic antidepressants, gabapentin, olanzapine, mirtazapine, and benzodiazepines, and cannabinoids have been shown to be efficacious in the treatment of nausea and vomiting, and may be useful in the treatment of chronic symptoms. There is a need to study these agents, especially in the management of chronic functional nausea. Improved understanding of the central and peripheral circuitry of nausea and vomiting symptoms will allow for enhanced utilization of the currently available medications, and the development of novel therapeutic options.
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Petrie KJ, Rief W. Psychobiological Mechanisms of Placebo and Nocebo Effects: Pathways to Improve Treatments and Reduce Side Effects. Annu Rev Psychol 2019; 70:599-625. [PMID: 30110575 DOI: 10.1146/annurev-psych-010418-102907] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Placebo effects constitute a major part of treatment success in medical interventions. The nocebo effect also has a major impact, as it accounts for a significant proportion of the reported side effects for many treatments. Historically, clinical trials have aimed to reduce placebo effects; however, currently, there is interest in optimizing placebo effects to improve existing treatments and in examining ways to minimize nocebo effects to improve clinical outcome. To achieve these aims, a better understanding of the psychological and neurobiological mechanisms of the placebo and nocebo response is required. This review discusses the impact of the placebo and nocebo response in health care. We also examine the mechanisms involved in the placebo and nocebo effects, including the central mechanism of expectations. Finally, we examine ways to enhance placebo effects and reduce the impact of the nocebo response in clinical practice and suggest areas for future research.
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Affiliation(s)
- Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand;
| | - Winfried Rief
- Division of Clinical Psychology, University of Marburg, 35032 Marburg, Germany;
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Akechi T. Psycho-oncology: History, Current Status, and Future Directions in Japan. JMA J 2018; 1:22-29. [PMID: 33748519 PMCID: PMC7969909 DOI: 10.31662/jmaj.2018-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/11/2018] [Indexed: 11/11/2022] Open
Abstract
One of the most relevant risk factors for cancer is aging; thus, the number of patients who develop cancer and die is increasing in Japan. Cancer has been a leading cause of death since 1981, and more than one-fourth of Japanese people die of cancer. More than 1,000,000 and 37,000 Japanese people develop cancer and die every year, respectively, making it a major health problem in Japan. Psycho-oncology is a relatively new medical field that was established in the 1970s in Western countries and introduced in Japan in the 1980s. Psycho-oncology was developed for investigating two issues neglected in previous medical research: the impact of behavioral and psychosocial factors on cancer morbidity and mortality and the psychological influence of cancer on patients, their families, and medical staff. Because of progress made in cancer treatment, cancer diagnosis is not necessarily equivalent to a death sentence. However, approximately half of patients with cancer die, and many patients with cancer and their families need appropriate care for psychological distress. The most common psychiatric problems patients with cancer experience are adjustment disorders, major depression, and/or delirium. In addition, the suicide rate in Japan for individuals within 1 year of a cancer diagnosis is more than 20 times higher than that for individuals without cancer. Physical symptoms, such as pain and nausea/vomiting, can be closely associated with psychological function. Mental health professionals, particularly psycho-oncologists, are expected to work with other cancer professionals to manage patients' distress. The present review focuses on patients with cancer' psychological distress and physical symptoms that are closely associated with psychological function and provides an overview of the current status of psycho-oncology in Japan. The future perspective of psycho-oncology is also discussed.
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Affiliation(s)
- Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Psycho-oncology and Palliative Medicine, Nagoya City University Hospital, Nagoya, Japan
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Implementing Integrative Nursing in a Pediatric Setting. CHILDREN-BASEL 2018; 5:children5080103. [PMID: 30065186 PMCID: PMC6111245 DOI: 10.3390/children5080103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Abstract
Pediatric blood and marrow transplantation (BMT) is one of the most challenging allopathic treatments a patient and family can be faced with. A large Midwest academic health center, and leader in pediatric BMT, made the decision in 2013 to incorporate integrative nursing as the care delivery model. Nurses trained in advanced nursing practice and specialized in integrative health and healing performed a deep-dive needs assessment, national benchmarking, a comprehensive review of the literature, and ultimately designed a comprehensive integrative program for pediatric patients and their families undergoing BMT. Four years after implementation, this paper discusses lessons learned, strengths, challenges and next phases of the program, including a research agenda. The authors conclude that it is feasible, acceptable and sustainable to implement a nurse-led integrative program within an academic health center-based pediatric BMT program.
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Hughes N, Stark D. The management of adolescents and young adults with cancer. Cancer Treat Rev 2018; 67:45-53. [PMID: 29753962 DOI: 10.1016/j.ctrv.2018.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022]
Abstract
Adolescents and Young Adults (AYA) with cancer are young people developing serious illness when at the interface between the responsibilities of paediatric and adult cancer services. Personally, they are in a period of transition both biologically and in major social roles (Sawyer et al., 2018) [1]. For these and other reasons they present a unique set of clinical challenges in their management. Over the last 20 years the requirement for specific services to address their needs has been identified and this has become a growing field of research. Despite this survival rates still lag behind those of children and older adults with cancer (Gatta et al., 2009) [2]. Why do AYA patients have worse outcomes? The observation is that the reason is multifactorial with path to diagnosis, unique cancer biology, uncertainty of treatment protocol, compliance issues and poor recruitment to clinical trials all playing a part. In this review we will discuss the unique challenges faced by healthcare professionals when managing AYA patients who are commonly and accurately described as being in an 'interface' position.
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Affiliation(s)
- Nicola Hughes
- Leeds Institute of Cardiovascular and Molecular Medicine, University of Leeds, UK.
| | - Dan Stark
- Leeds Institute of Cancer and Pathology, St James's Institute of Oncology, Beckett Street, Leeds, UK
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A review of the literature on the relationships between genetic polymorphisms and chemotherapy-induced nausea and vomiting. Crit Rev Oncol Hematol 2017; 121:51-61. [PMID: 29279099 DOI: 10.1016/j.critrevonc.2017.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/25/2017] [Accepted: 11/16/2017] [Indexed: 02/07/2023] Open
Abstract
Despite current advances in antiemetic treatments, between 30% to and 60% of oncology patients experience chemotherapy-induced nausea (CIN) and 13% to 33% report chemotherapy-induced vomiting (CIV). Inter-individual differences are observed in the occurrence and severity of chemotherapy-induced nausea and vomiting (CINV). This review summarizes and critiques studies on associations between occurrence and severity of CINV and polymorphisms in serotonin receptor, drug metabolism, and drug transport pathway genes. Sixteen studies evaluated the associations between the occurrence and/or severity of CINV and single nucleotide polymorphisms (SNPs). Across these studies, three SNPs in 5-hydroxytryptamine receptor (5-HT3R) genes, two alleles of the cytochrome P450 family 2 subfamily D member 6 (CYP2D6) gene, and three SNPs in ATP binding cassette subfamily B member 1 (ABCB1) gene were associated with the occurrence and severity of CINV. Given the limited number of polymorphisms evaluated, additional research is warranted to identify new mechanisms to develop more targeted therapies.
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Wang X, Zhang ZY, Powers D, Wang J, Lu S, Arora S, Hughes L, Christensen J, Kansra V. Bioequivalence of Intravenous and Oral Rolapitant: Results From a Randomized, Open-Label Pivotal Study. J Clin Pharmacol 2017; 57:1600-1606. [PMID: 28906561 DOI: 10.1002/jcph.966] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/17/2017] [Indexed: 11/09/2022]
Abstract
Rolapitant, a selective and long-acting neurokinin-1 receptor antagonist, is approved in an oral formulation for the prevention of delayed chemotherapy-induced nausea and vomiting in adults. The objective of this pivotal study was to assess the bioequivalence of a single intravenous infusion of rolapitant versus a single oral dose of rolapitant. In this randomized, open-label phase 1 study, healthy volunteers were administered rolapitant as a 180-mg oral dose or a 30-minute 166.5-mg intravenous infusion. Blood samples for pharmacokinetic analysis were collected predose and at points up to 912 hours postdose. Criteria for bioequivalence of the intravenous dose versus the oral dose were met if the 90% confidence intervals (CIs) for the ratios of the geometric least-squares means (GLSMs) for the area under the plasma concentration-time curve (AUC) from time 0 to the time of the last quantifiable concentration (AUC0-t ) and AUC from time 0 extrapolated to infinity (AUC0-∞ ) for rolapitant were within 0.80-1.25. Mean rolapitant systemic exposure and half-lives were similar in the oral (n = 62) and intravenous (n = 61) rolapitant groups. The 90%CIs of the ratio of GLSMs were within the 0.80-1.25 range for AUC0-t (0.94-1.09) and AUC0-∞ (0.93-1.10). The incidence of treatment-emergent adverse events, all mild or moderate in severity, was similar in the intravenous and oral groups. A 166.5-mg intravenous infusion of rolapitant met the bioequivalence criteria based on AUC to a 180-mg oral dose and was well tolerated.
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Anestin AS, Dupuis G, Lanctôt D, Bali M. The Effects of the Bali Yoga Program for Breast Cancer Patients on Chemotherapy-Induced Nausea and Vomiting: Results of a Partially Randomized and Blinded Controlled Trial. J Evid Based Complementary Altern Med 2017; 22:721-730. [PMID: 28470117 PMCID: PMC5871279 DOI: 10.1177/2156587217706617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Complementary and alternative medicine has been shown to be beneficial in reducing chemotherapy-induced nausea and vomiting. However, conclusive results are lacking in order to confirm its usefulness. The purpose of this study was to determine whether a standardized yoga intervention could reduce these adverse symptoms. This was a partially randomized and blinded controlled trial comparing a standardized yoga intervention with standard care. Eligible patients were adults diagnosed with stages I to III breast cancer receiving chemotherapy. Patients randomized to the experimental group participated in an 8-week yoga program. There was no significant difference between the experimental and control groups on chemotherapy-induced nausea and vomiting after 8 weeks. Results suggest the yoga program is not beneficial in managing these adverse symptoms. However, considering preliminary evidence suggesting yoga’s beneficial impact in cancer symptom management, methodological limitations should be explored and additional studies should be conducted.
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Affiliation(s)
| | - Gilles Dupuis
- 1 Universite du Quebec a Montreal, Montreal, Quebec, Canada
| | | | - Madan Bali
- 2 Yoga Bliss Studio, Montreal, Quebec, Canada
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Inui N. Antiemetic therapy for non-anthracycline and cyclophosphamide moderately emetogenic chemotherapy. Med Oncol 2017; 34:77. [PMID: 28365889 DOI: 10.1007/s12032-017-0937-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
Although antiemetic management in cancer therapy has improved, chemotherapy-induced nausea and vomiting remain common and troubling adverse events. Chemotherapeutic agents are classified based on their emetogenic effects, and appropriate antiemetics are recommended according to this categorization. Chemotherapy categorized as moderately emetogenic is associated with a wide spectrum of emetic risks. Combined anthracycline and cyclophosphamide regimens have been recently reclassified as highly emetogenic chemotherapy regimen. This review focuses on antiemetic pharmacotherapy in patients receiving non-anthracycline and cyclophosphamide-based moderately emetogenic chemotherapy regimens. Combination therapy with a 5-hydroxytryptamine-3 receptor agonist, preferably palonosetron, and dexamethasone is the standard therapy in moderately emetogenic chemotherapy, although triple therapy with add-on neurokinin-1 receptor antagonist is used as an alternative treatment strategy. Among moderately emetogenic chemotherapy regimens, carboplatin-containing chemotherapy has considerable emetic potential, particularly during the delayed phase. However, the additional of a neurokinin-1 receptor antagonist to the standard antiemetic therapy prevents carboplatin-induced nausea and vomiting. For regimens including oxaliplatin, the benefit of adding neurokinin-1 receptor antagonist requires further clarification.
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Affiliation(s)
- Naoki Inui
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. .,Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
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A prospective, observational, multicenter study on risk factors and prophylaxis for low emetic risk chemotherapy-induced nausea and vomiting. Support Care Cancer 2017; 25:2707-2714. [PMID: 28341971 DOI: 10.1007/s00520-017-3679-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The incidence of and the risk factors for nausea and vomiting in patients undergoing low emetic risk chemotherapy (LEC) are unclear. The aim of the study was to provide information on these topics by performing a multicenter, observational, prospective study. METHODS The study consisted of patients who were administered first-time LEC that was consistent or inconsistent with current guidelines. Using the visual analog scale, patients recorded their daily food intake and the occurrence and severity of nausea over a 5-day treatment period. RESULTS The overall incidence of chemotherapy-induced nausea and vomiting did not differ significantly between patients undergoing guideline-consistent (n = 89) or guideline-inconsistent (n = 121) prophylaxis (30.3 vs. 22.3%, respectively; P = 0.19). Logistic regression analysis identified a history of nausea and LEC other than taxanes as independent risk factors associated with nausea and vomiting in patients undergoing LEC. The mean daily visual analog scale scores for nausea severity and a decrease in food intake were <25 mm throughout the entire observation period. CONCLUSIONS Guideline-consistent prophylaxis appeared to control nausea and vomiting effectively in patients undergoing LEC. However, patients with a history of nausea and receiving LEC other than taxanes should be carefully observed and treatment should be adjusted according to their symptoms.
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Fujii Y, Ida H, Shimokuni T, Haraguchi F. Treatment of nausea with innovative antiemetics. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23809000.2017.1301778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Prevalence and Risk Factors for Symptoms of Methotrexate Intolerance in Pediatric Inflammatory Bowel Disease. Inflamm Bowel Dis 2017; 23:298-303. [PMID: 28107279 DOI: 10.1097/mib.0000000000001014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Methotrexate (MTX) intolerance is defined as gastrointestinal and behavioral symptoms occurring before or after MTX administration that may lead to treatment discontinuation. The aim of this study was to determine prevalence of MTX intolerance in pediatric inflammatory bowel disease (IBD) using the Methotrexate Intolerance Severity Score developed in rheumatology and to identify risk factors for MTX intolerance. METHODS Patients with pediatric IBD followed in the IBD clinic of Sainte Justine Hospital who had received MTX for IBD between 2004 and 2016 and were still actively on MTX were invited to fill out the Methotrexate Intolerance Severity Score questionnaire. A cutoff score of ≥6 points was used to define MTX intolerance, with at least one point for anticipatory, associative or behavioral items. RESULTS Among 102 pediatric patients with IBD, 32 (31%) patients reported symptoms of MTX intolerance. Using a multivariable logistic regression model, factors that were associated with having symptoms of MTX intolerance were female sex (odds ratio 4.31 [95% confidence interval, 1.37-13.60], P = 0.01), receiving a dose of MTX higher than 20 mg/wk at the time of the questionnaire (odds ratio 4.06 [95% confidence interval, 1.30-12.70], P = 0.02), and having active disease according to Physician's Global Assessment (odds ratio 3.44 [95% confidence interval, 1.15-10.26], P = 0.03). Prophylactic prescription of antiemetics and folic acid did not prevent symptoms of MTX intolerance. CONCLUSIONS Symptoms of MTX intolerance are frequent in pediatric IBD. The Methotrexate Intolerance Severity Score questionnaire could help better recognition of these symptoms. Identification of risk factors could have important implications for the success of treatment.
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Hügle B, Scheuern A, Dollinger S, Fischer N, Haas JP. Cathechol-O-methyltransferase Val158Met polymorphism is associated with nocebo effects, but not with methotrexate intolerance in patients with juvenile idiopathic arthritis. Scand J Rheumatol 2017; 46:502-503. [DOI: 10.1080/03009742.2016.1275775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- B Hügle
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - A Scheuern
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - S Dollinger
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - N Fischer
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - J-P Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
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Gasalla P, Begega A, Soto A, Dwyer DM, López M. Functional brain networks underlying latent inhibition of conditioned disgust in rats. Behav Brain Res 2016; 315:36-44. [PMID: 27491591 DOI: 10.1016/j.bbr.2016.07.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/12/2016] [Accepted: 07/30/2016] [Indexed: 02/08/2023]
Abstract
The present experiment examined the neuronal networks involved in the latent inhibition of conditioned disgust by measuring brain oxidative metabolism. Rats were given nonreinforced intraoral (IO) exposure to saccharin (exposed groups) or water (non-exposed groups) followed by a conditioning trial in which the animals received an infusion of saccharin paired (or unpaired) with LiCl. On testing, taste reactivity responses displayed by the rats during the infusion of the saccharin were examined. Behavioral data showed that preexposure to saccharin attenuated the development of LiCl-induced conditioned disgust reactions, indicating that the effects of taste aversion on hedonic taste reactivity had been reduced. With respect to cumulative oxidative metabolic activity across the whole study period, the parabrachial nucleus was the only single region examined which showed differential activity between groups which received saccharin-LiCl pairings with and without prior non-reinforced saccharin exposure, suggesting a key role in the effects of latent inhibition of taste aversion learning. In addition, many functional connections between brain regions were revealed through correlational analysis of metabolic activity, in particular an accumbens-amygdala interaction that may be involved in both positive and negative hedonic responses.
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Affiliation(s)
- Patricia Gasalla
- Department of Psychology, University of Oviedo, Oviedo, Spain; School of Psychology, Cardiff University, UK.
| | - Azucena Begega
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Alberto Soto
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | | | - Matías López
- Department of Psychology, University of Oviedo, Oviedo, Spain
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Limebeer CL, Rock EM, Puvanenthirarajah N, Niphakis MJ, Cravatt BF, Parker LA. Elevation of 2-AG by monoacylglycerol lipase inhibition in the visceral insular cortex interferes with anticipatory nausea in a rat model. Behav Neurosci 2016; 130:261-6. [PMID: 26974857 DOI: 10.1037/bne0000132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Anticipatory nausea (AN) is a conditioned nausea reaction experienced by chemotherapy patients upon returning to the clinic. Currently, there are no specific treatments for this phenomenon, with the classic antiemetic treatments (e.g., ondansetron) providing no relief. The rat model of AN, contextually elicited conditioned gaping reactions in rats, provides a tool for assessing potential treatments for this difficult to treat disorder. Systemically administered drugs which elevate the endocannabinoids, anandamide (AEA) and 2-arachidonoyl glycerol (2-AG), by interfering with their respective degrading enzymes, fatty acid amide hydrolase (FAAH) and monoacyl glycerol lipase (MAGL) interfere with AN in the rat model. We have shown that MAGL inhibition within the visceral insular cortex (VIC) interferes with acute nausea in the gaping model (Sticht et al., 2015). Here we report that bilateral infusion of the MAGL inhibitor, MJN110 (but neither the FAAH inhibitor, PF3845, nor ondansetron) into the VIC suppressed contextually elicited conditioned gaping, and this effect was reversed by coadministration of the CB1 antagonist, AM251. These findings suggest that 2-AG within the VIC plays a critical role in the regulation of both acute nausea and AN. Because there are currently no specific therapeutics for chemotherapy patients that develop anticipatory nausea, MAGL inhibition by MJN110 may be a candidate treatment. (PsycINFO Database Record
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Affiliation(s)
| | - Erin M Rock
- Department of Psychology, University of Guelph
| | | | - Micah J Niphakis
- Skaggs Institute for Chemical Biology, Scripps Research Institute
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Abstract
OPINION STATEMENT Nausea and vomiting result from continuous interactions among gastrointestinal, central nervous system, and autonomic nervous system. Despite being closely associated, central pathways of nausea and vomiting appear to be at least partly different and nausea is no longer considered only a penultimate step of vomiting. Although our understanding of central pathways of nausea has improved over the last one decade, it is still very basic. Afferent pathways from gastrointestinal tract via vagus, vestibular system, and chemoreceptor trigger zone project to nucleus tractus solitarius which, in turn, relays the signal to central pattern generator initiating multiple downstream pathways. This central nausea pathway appears to be under constant modulation by autonomic nervous system and cerebral cortex. There is also some evidence that central pathway of chronic nausea is different from that of acute nausea and closely resembles that of neuropathic pain. This improved understanding has modified the way we can approach the treatment of acute and chronic nausea. While conventional therapies such as antiemetics (antiserotoninergic, antihistaminic, antidopaminergic) and prokinetics are commonly used to manage acute nausea, they are not as effective in improving chronic nausea. Recently, neuromodulators such as tricyclic antidepressants, gabapentin, olanzapine, benzodiazepines, and cannabinoids have been shown to have antinausea effect. There is a need to study the utility of these drugs in managing chronic functional nausea. Improving our understanding of central and peripheral circuitry of nausea will allow us to better utilize the currently available drugs and develop new therapeutic options.
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Affiliation(s)
- Prashant Singh
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Braden Kuo
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, GI Unit 55 Fruit St., Blake 4, Boston, MA, 02114, USA.
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Moysés AMB, Durant LC, Almeida AMD, Gozzo TDO. Integrative review of factors related to the nursing diagnosis nausea during antineoplastic chemotherapy. Rev Lat Am Enfermagem 2016; 24:e2812. [PMID: 27737380 PMCID: PMC5068908 DOI: 10.1590/1518-8345.1176.2812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 06/15/2016] [Indexed: 11/21/2022] Open
Abstract
Objective to identify factors related to the nursing diagnosis nausea among cancer patients undergoing chemotherapy. Method integrative review conducted in four electronic databases (PUBMED, EMBASE, CINAHL and LILACS) using the key words: neoplasia, antineoplastic agents and nausea. Results only 30 out of 1,258 papers identified met the inclusion criteria. The most frequent related factors were: being younger than 50 years old, motion sickness, being a woman, emetogenic potential of the chemotherapy, anxiety, conditioned stimulus, and expecting nausea after treatment. Conclusion this review's findings, coupled with the incidence of nausea among cancer patients undergoing chemotherapy, reveal an important difference between evidence found and that used by NANDA International, Inc. Even though it provides an appropriate definition of related factors, it does not mention chemotherapy, despite the various studies addressing the topic using different designs and presenting various objectives and outcomes.
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Affiliation(s)
- Aline Maria Bonini Moysés
- MSc, RN, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Lais Corsino Durant
- Master's student, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Ana Maria de Almeida
- PHD, Associate Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Thais de Oliveira Gozzo
- PHD, Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Abstract
Evidence-based practice is integral to the delivery of effective and efficient nursing care. However, translating evidence into practice remains a challenge in health care. To overcome this challenge, the Oncology Nursing Society developed a program, the ONS Foundation Institute for Evidence-Based Practice Change, to provide nurses with the tools they need to translate evidence-based practice to their units. This article reviews the process of implementing the evidence-based practice of guided imagery for pain management on a medical oncology inpatient unit at a comprehensive cancer center.
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Affiliation(s)
- Peggy Burhenn
- Department of Clinical Practice and Education, City of Hope National Medical Center, Duarte, CA
| | - Jill Olausson
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
| | - Griselda Villegas
- Department of Nursing, City of Hope National Medical Center, Duarte, CA
| | - Kathy Kravits
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
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Dupuis LL, Roscoe JA, Olver I, Aapro M, Molassiotis A. 2016 updated MASCC/ESMO consensus recommendations: Anticipatory nausea and vomiting in children and adults receiving chemotherapy. Support Care Cancer 2016; 25:317-321. [PMID: 27510314 DOI: 10.1007/s00520-016-3330-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to update the 2011 recommendations for the prevention and treatment of anticipatory nausea and vomiting in children and adults receiving chemotherapy. METHODS The original systematic literature search was updated. Randomized studies were included in the evidence to support this guideline if they as follows: were primary studies published in a journal in full text (i.e., abstracts, letters, book chapters, and dissertations were excluded); published in English; evaluated an intervention for the prevention or treatment of anticipatory nausea and vomiting; reported the proportion of patients experiencing complete control of anticipatory nausea and vomiting consistently and; included at least ten participants per study arm for comparative studies and at least ten participants overall for noncomparative studies. RESULTS Eighty-eight new citations were identified. Of these, nine were brought to full-text screening; none met inclusion criteria. The guideline panel continues to recommend that anticipatory nausea and vomiting are best prevented through optimization of acute and delayed phase chemotherapy-induced nausea and vomiting control. Benzodiazepines and behavioral therapies, in particular progressive muscle relaxation training, systematic desensitization and hypnosis, continue to be recommended for the treatment of anticipatory nausea and vomiting. CONCLUSIONS No new information regarding interventions aimed at treating or preventing ANV that met criteria for inclusion in this systematic review was identified. The 2015 MASCC recommendations affirm the content of the 2009 MASCC recommendations for the prevention and treatment of anticipatory nausea and vomiting.
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Affiliation(s)
- L Lee Dupuis
- Department of Pharmacy and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. .,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
| | - Joseph A Roscoe
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Ian Olver
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Matti Aapro
- IMO Clinique de Genolier, Genolier, Switzerland
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Balaban CD, Yates BJ. What is nausea? A historical analysis of changing views. Auton Neurosci 2016; 202:5-17. [PMID: 27450627 DOI: 10.1016/j.autneu.2016.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 12/27/2022]
Abstract
The connotation of "nausea" has changed across several millennia. The medical term 'nausea' is derived from the classical Greek terms ναυτια and ναυσια, which designated the signs and symptoms of seasickness. In classical texts, nausea referred to a wide range of perceptions and actions, including lethargy and disengagement, headache (migraine), and anorexia, with an awareness that vomiting was imminent only when the condition was severe. However, some recent articles have limited the definition to the sensations that immediately precede emesis. Defining nausea is complicated by the fact that it has many triggers, and can build-up slowly or rapidly, such that the prodromal signs and symptoms can vary. In particular, disengagement responses referred to as the "sopite syndrome" are typically present only when emetic stimuli are moderately provocative, and do not quickly culminate in vomiting or withdrawing from the triggering event. This review considers how the definition of "nausea" has evolved over time, and summarizes the physiological changes that occur prior to vomiting that may be indicative of nausea. Also described are differences in the perception of nausea, as well as the accompanying physiological responses, that occur with varying stimuli. This information is synthesized to provide an operational definition of nausea.
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Affiliation(s)
- Carey D Balaban
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Bill J Yates
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Gupta RG, Schafer C, Ramaroson Y, Sciullo MG, Horn CC. Role of the abdominal vagus and hindbrain in inhalational anesthesia-induced vomiting. Auton Neurosci 2016; 202:114-121. [PMID: 27396693 DOI: 10.1016/j.autneu.2016.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/28/2022]
Abstract
The incidence of postoperative nausea and vomiting (PONV) can be as high as 80% in patients with risk factors (e.g., females, history of motion sickness). PONV delays postoperative recovery and costs several hundred million dollars annually. Cell-based assays show that halogenated ethers (e.g., isoflurane) activate 5-HT3 receptors, which are found on gastrointestinal vagal afferents and in the hindbrain - key pathways for producing nausea and vomiting. This project evaluated the role of the vagus and activation of the hindbrain in isoflurane-induced emesis in musk shrews, a small animal model with a vomiting reflex, which is lacking in rats and mice. Sham-operated and abdominal vagotomized shrews were exposed to 1 to 3% isoflurane to determine effects on emesis; vagotomy was confirmed by lack of vagal transport of the neuronal tracer Fluoro-Gold. In an additional study, shrews were exposed to isoflurane and hindbrain c-Fos was measured at 90min after exposure using immunohistochemistry. There were no statistically significant effects of vagotomy on isoflurane-induced emesis compared to sham-operated controls. Isoflurane exposure produced a significant increase in c-Fos-positive cells in the nucleus of the solitary tract and vestibular nuclei but not in the area postrema or dorsal motor nucleus. These results indicate that the abdominal vagus plays no role in isoflurane-induced emesis and suggest that isoflurane activates emesis by action on the hindbrain, as shown by c-Fos labeling. Ultimately, knowledge of the mechanisms of inhalational anesthesia-induced PONV could lead to more targeted therapies to control PONV.
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Affiliation(s)
- Ragini G Gupta
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Claire Schafer
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Michael G Sciullo
- Biobehavioral Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Charles C Horn
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Biobehavioral Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA; Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States.
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