Antiemetic regimens in outpatients receiving cisplatin and non-cisplatin chemotherapy. A randomized trial comparing high-dose metoclopramide plus methylprednisolone with and without lorazepam

QoL evaluation of olanzapine for chemotherapy-induced nausea and vomiting comparing with 5-HT3 receptor antagonist

This study evaluated the efficacy of olanzapine in preventing chemotherapy-induced nausea and vomiting (CINV) and improving the quality of life (QoL) of patients with cancer during chemotherapy. Two hundred twenty-nine patients with cancer who received chemotherapy from January 2008 to August 2008 were enrolled, and they were randomised to receive olanzapine or a 5-HT3 receptor antagonist. The patients completed a CINV questionnaire once daily on days 1-5 and a QoL questionnaire on days 0 and 6. The complete response (CR) rates for nausea (76.85% versus 46.2%) and vomiting (84.3% versus 67.6%) were significantly higher in the olanzapine group than in the 5-HT3 receptor antagonist group for delayed CINV but not for acute CINV. The CR rates for nausea (76.85% versus 44.44%) and vomiting (85.95% versus 67.59%) were also significantly higher in the olanzapine group for the 5 days post-chemotherapy. After chemotherapy, global health status, emotional functioning, and insomnia were improved in the olanzapine group but worsened in the 5-HT3 receptor antagonist group, whereas cognitive functioning and appetite loss were unchanged. Moreover, olanzapine significantly improved global health status, emotional functioning, social functioning, fatigue, nausea/vomiting, insomnia, and appetite loss. Olanzapine improved the QoL of patients with cancer during chemotherapy, in part by reducing the incidence of delayed CINV.

Evidence-Based Treatment of Anxiety in Patients With Cancer

Anxiety is a dynamic response to perceived threat that is common among patients with cancer and fluctuates at critical points in the disease trajectory. A substantial minority of patients may experience clinically significant anxiety resulting from a range of potential etiologic factors. This review summarizes evidence-based recommendations for treatment of anxiety in oncology settings. Recommendations are based on the nature and time course of anxiety and the results of meta-analyses, systematic reviews, and individual trials in cancer populations. The evidence-based literature supports the use of psychosocial and psychopharmacologic treatments to prevent or alleviate anxiety symptoms. Conclusions are tempered by study heterogeneity and methodologic limitations and a lack of trials that included patients with clinically significant anxiety. In oncology settings, accessibility and acceptability of evidence-based treatments vary, and patients may seek a variety of resources to manage cancer concerns. Treatment planning should incorporate contributing factors to anxiety and patient preferences for psychiatric care.

Antiemetic activity of corticosteroids in patients receiving cancer chemotherapy: dosing, efficacy, and tolerability analysis

BACKGROUND

Chemotherapy and radiotherapy remain the standards of treatment for many patients with cancer, but these modalities are often limited by distressing side-effects, most notably chemotherapy-induced nausea and vomiting (CINV).

METHODS

This paper considers the role of corticosteroids in CINV prophylaxis. Clinical trial results and treatment guidelines indicate that even with the emergence of new serotonin and neurokinin receptor antagonists, corticosteroids continue to play an important role in antiemesis for oncology patients. Numerous clinical trial results have demonstrated that both dexamethasone and methylprednisolone are effective as monotherapy and in combination with older and more recently developed antiemetic agents in patients receiving a wide range of chemotherapeutic regimens used for treatment of different cancers.

CONCLUSIONS

With the increasing number of antineoplastic regimens and factors specific to individual patients, it is important to frequently review antiemetic treatment options and continually monitor therapeutic progress to establish the optimal therapy for each patient.