Overcoming Nausea from Cancer Treatment
Feeling nauseous, or as if you have to vomit, is one of the most common side effects of chemotherapy. Fortunately, it can usually be controlled—with medicines, with certain non-traditional therapies, and even with some common sense.
An article just published in the journal Cancer compared the effectiveness of two of the most commonly used medicines to control nausea and vomiting: granisetron and ondansetron. According to a study by Dr. Auro del Giglio, of the ABC Foundation School of Medicine in Sao Paulo, Brazil and colleagues, these two drugs are equally effective in their ability to minimize nausea and vomiting following chemotherapy.
The researchers reviewed 14 major studies published between 1990 and 1999 that compared the effectiveness of the two drugs. A total of 6,467 patients were included in the various studies. In the end, they found no significant differences favoring either granisetron or ondansetron.
"The choice of one medication over another within each institution can be guided by cost considerations and/or physician preferences," they concluded.
Another study, published earlier in the year in The New England Journal of Medicine, focused on the actual timing of giving anti-nausea medicine, rather than on the medicine itself. Dr. Fausto Roila, of Policlinico Hospital in Perugia, Italy and colleagues studied 705 patients in 23 cancer treatment centers to determine whether the early treatment of nausea and vomiting (within the first 24 hours after chemotherapy) prevented later "delayed onset" symptoms.
They gave 618 of the patients a combination of ondansetron and dexamethasone during the first 24 hours after chemotherapy, which was effective in preventing 89.9 percent of the patients from vomiting and 70.8 percent of the patients from nausea during that critical first day. Importantly, even when these medications were discontinued after the first day, only 9 of the patients experienced subsequent nausea or vomiting.
Conversely, those patients who were not given these preventive medicines during the first 24 hours after chemotherapy experienced a much higher rate of subsequent symptoms. Only 23.3 percent (with dexamethasone alone) and 40.9 percent (with the combination of both ondansetron and dexamethasone) were protected against delayed-onset nausea and vomiting.
The researchers concluded that controlling nausea during the first 24 hours after chemotherapy was crucial, and had a major impact on alleviating these symptoms in subsequent days.
A particularly difficult challenge involves breast cancer patients undergoing bone marrow transplants (high-dose chemotherapy), where nausea and vomiting are major concerns yet strong medicines cannot be tolerated. However, an intriguing report published in The Journal of the American Medical Association suggested that electroacupuncture—using acupuncture needles with a small electric charge flowing through them—may help to prevent nausea and vomiting.
Dr. Joannie Shen of the National Institutes of Health in Bethesda, Maryland and colleagues gave 37 patients electroacupuncture at two classic acupuncture points, in addition to basic anti-nausea medication that was acceptable to bone marrow transplant patients at that time. Thirty-four other patients were given traditional (non-electric) acupuncture plus anti-nausea medications, and 34 were given just the anti-nausea medications.
During a follow-up period of 5 days, the electroacupuncture group had a median number of 5 episodes of vomiting per patient, compared to 10 for those receiving traditional acupuncture, and 15 for those using drug therapy alone.
As a result of these findings, the researchers suggested that acupuncture—either electric or traditional—might be useful in some patients for whom medications simply will not alleviate their nausea and vomiting.
Another non-traditional strategy being explored to alleviate treatment-related nausea and vomiting is a marijuana patch. The American Cancer Society recently awarded a grant of $361,000 to a New York researcher to see if cannabinoids—the active ingredient in marijuana—could be delivered through a skin patch to help relieve these symptoms.
Audra Stinchcomb, RPh, of the Albany College of Pharmacy, is basing her research on the success of nicotine patches used by smokers to kick their habits. "It is well known that the active components of marijuana have powerful inhibitory effects on nausea, vomiting, and lack of appetite, all of which are common problems for cancer patients," Stinchcomb said.
Although cannabinoids are already available to cancer patients in pill form with the drug Dronabinol, the nausea and vomiting commonly caused by chemotherapy can make it difficult for some patients to tolerate the pill long enough for the active ingredients to work. The patch would therefore be a perfect solution, delivering a consistent dose of the drug through the skin regardless of the illness of the patient.
While medications—and even acupuncture or marijuana patches—may prove helpful in controlling or eliminating nausea and vomiting after chemotherapy, there are some basic steps that you can undertake yourself. The American Cancer Society recommends:
SOURCES:
Cancer, December 2000; 89:2301-2308
New England Journal of Medicine, May 25, 2000; 342:1554-1559
The Journal of the American Medical Association, December 6, 2000; 284:2755-2761
The American Cancer Society (http://www.cancer.org)
The National Cancer Institute (http://www.nci.nih.org)
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