Review article : Emesis in the patient with advanced cancer

Abstract

The control of symptoms related to far advanced cancer has improved dramatically in recent years, making the passage of death more tolerable for such patients. The major impact of analgesic control now allows research efforts to focus on other distressing symptoms such as nausea and vomiting. The emetic process is a complex physiological and psychological one of multifactorial aetiology. Rapid improvement in our understanding of these processes is allowing the more rational use of known antiemetics and the development of new antiemetic agents. A rapid expansion of the literature of cytotoxic-induced emesis has pointed to new antiemetic agents and new schedules of administration.

This review emphasises the need to identify the cause of emesis before attempting indirectly to block the emetic process with antiemetic drugs. It also outlines the many areas where research could be applied to unravel some of the questions about which antiemetic to use, in what dose, and perhaps to identify the main site of emetic stimulus. More effective research is required, but the outlook for improved control of nausea and vomiting in the terminally ill patient is good.