Current perspectives in the management of nausea and vomiting in oncology patients: The New Zealand experience

Abstract

Background. Following the introduction of the 5HT3 (serotonin) receptor antagonists into New Zea land we wished to determine the current role that these and other antiemetic agents have in the preven tion and treatment of nausea and vomiting in oncol ogy patients.

Method. Surveys were posted to all medical and radiotherapy oncologists in New Zealand in July 1994 asking for their current approaches and recommen dations to preventing or treating many of the com mon causes of nausea and vomiting that oncology patients may experience.

Results. Surveys were posted to 32 oncologists, with replies received from 23 (72%). These results indicate that the 5HT3 antagonists ondansetron and granisetron are now used as primary therapy to prevent nausea and vomiting associated with highly emetogenic chemotherapy and radiotherapy regimes, and may be used either as single agents or in combi nation with a corticosteroid. In less emetogenic re gimes agents such as metoclopramide, prochlorpera zine, or domperidone are effective, and they may also be used in combination with a corticosteriod. When treating other causes of nausea and vom iting, antiemetic agents are usually only used if it is not possible to correct the underlying cause of these symptoms, if an antiemetic agent is required metoclo pramide, prochlorperazine, domperidone, or cycli zine are usually effective. Where nausea is caused by drugs such as nonsteroidal antiinflammatory agents (NSAIA) treatment options would include stopping the offending agent and changing to another agent if necessary, if this is not possible then agents such as metoclopramide or prochlorperazine are usually ef fective.

Conclusion. The 5HT3 receptor antagonists are used to control nausea and vomiting in chemo therapy and radiotherapy regimes with a moderate to high emetogenic potential. For chemotherapy and radiotherapy regimes with a lower emetogenic potential metoclopramide or domperidone are used to control nausea and vomiting. For other causes of nausea and vomiting that cannot be corrected by specific treatment strategies metoclopramide, dom peridone, prochlorperazine, or cyclizine are usually effective.