ABSTRACT
Chemotherapy-induced nausea and vomiting (CINV) are still two of the most feared side effects of cancer therapy. Although major progress in the prophylaxis of CINV has been made during the past 40 years, nausea in particular remains a significant problem. Older patients have a lower risk of CINV than younger patients, but are at a higher risk of severe consequences of dehydration and electrolyte disturbances following emesis. Age-related organ deficiencies, comorbidities, polypharmacy, risk of drug-drug interactions, and lack of compliance all need to be addressed in the older patient with cancer at risk of CINV. Guidelines provide evidence-based recommendations for the prophylaxis of CINV, but none of these guidelines offer specific recommendations for older patients with cancer. This means that the recommendations may lead to overtreatment in some older patients. This review describes the development of antiemetic prophylaxis of CINV focusing on older patients, summarizes recommendations from antiemetic guidelines, describes deficiencies in our knowledge of older patients, summarizes necessary precautions, and suggests some future perspectives for antiemetic research in older patients.
Subject(s)
Antineoplastic Agents , Nausea , Neoplasms , Vomiting , Aged , Antiemetics/therapeutic use , Antineoplastic Agents/adverse effects , Humans , Nausea/chemically induced , Nausea/drug therapy , Nausea/prevention & control , Neoplasms/complications , Neoplasms/drug therapy , Vomiting/chemically induced , Vomiting/drug therapy , Vomiting/prevention & controlABSTRACT
This review summarizes the current knowledge of radiation-induced nausea and vomiting (RINV), which occurs in ap-proximately 50% of patients undergoing radiotherapy. Poor control of the symptoms may result in dehydration and electrolyte disturbances leading to delay or even disruption of the planned schedule, which in turn results in decreased disease control. Patients report RINV as distressing symp-toms, and under-treatment is a major problem. Evidence-based antiemetic guidelines have been developed, but lack of adherence is a barrier to improvement of symptom control and quality of life during radiotherapy.
Subject(s)
Antiemetics , Nausea , Radiotherapy , Vomiting/prevention & control , Antiemetics/therapeutic use , Humans , Nausea/prevention & control , Quality of Life , Radiotherapy/adverse effects , ResearchABSTRACT
Nausea and vomiting are a persistent burden on cancer patients undergoing antineoplastic therapy, and adherence to guideline-specific prophylactic therapy is essential to minimise the risk. Nausea is more challenging to prevent than vomiting. This review summarises the choices of relevant drugs. Olanzapine is effective against nausea, but sedation can be a problem. There seems to be no major differences in effect or tolerability between different serotonin receptor antagonists and different neurokinin receptor antagonists. Consequently, the choice of drug should be based on price, risk of interactions and simple administration.
