Chemotherapy Nausea and Vomiting – Demystified… Kiley Loh Nausea and vomiting are one of the most well known chemotherapy side effects, and probably one of the most feared by patients. Why is that? Well, it is extremely unpleasant, can be fairly common (depending on what treatment you’re on), and the experience is often shared with loved ones and friends. Why is it unpleasant? It kills appetite, along with whatever quality of life you’re hoping for during treatment, making you destined to spend your day at home having apparently tasteless chicken broth, mashed whatever, sleeping or watching your choice of bad day time TV. Judge Judy or Dr Phil anyone? We have however come a long way with treating chemotherapy nausea and vomiting. Gone were the bad old days where chemotherapy patients were shoved into a dark room in hospital, pumped with rehydrating fluids and hope they would come out okay in a few days. Better understanding through research in why and how chemotherapy nausea and vomiting comes about has led to better treatment options and hence much more tolerable anti-cancer treatments. Various patterns of chemotherapy nausea and vomiting have been described. It can occur very early on (within the first few hours) to a few days after chemotherapy. Interestingly, even the thought of chemotherapy can trigger nausea and vomiting which probably reflects a learnt condition from previously nasty chemotherapy nausea and vomiting experiences. Researchers have identified a particular area in the brainstem (the part between the brain and the spinal cord) that is responsible for coordinating the vomiting reflex, called the “vomiting centre”. Chemotherapy triggers the vomiting centre through the “chemotherapy trigger zone”, an area in the brainstem close-by. How it does so is not entirely clear but as far as we know, it can do so either directly, through nerves or certain chemicals called neurotransmitters. Understanding these concepts essentially forms the basis on how we treat chemotherapy nausea and vomiting. In addition to known general anti-nausea medications, various medications have been developed to specifically treat chemotherapy nausea and vomiting. The two most important breakthroughs are the 5-HT3 (5-hydroxytryptamine) and NK-1 (neurokinin-1) receptor antagonists. I will spare you the medical details to preserve your attention here. They essentially block neurotransmitters (released in response to chemotherapy) from potentially activating the “chemotherapy trigger zone”. These medications have been a real success and substantially reduced the rates of chemotherapy nausea and vomiting. It is worthwhile knowing that not all chemotherapy agents are equal in their risk of causing nausea and vomiting. The “chuck factor” differs between the agents and combinations. Some can be treated with general anti-nausea medications, whilst others need the addition of specialized medications like the 5-HT3 and NK-1 receptor antagonists described above. So, don’t be surprise when you find your anti-nausea cocktail is different compared to your chemo day centre buddy’s. Chemotherapy nausea and vomiting is still around but at least it is now rarely a “to hell and back” experience. In fact, it is often only mild and absent in many patients due to better treatments. Finally, with ongoing research in this area, better things are still to come. Who knows, chemotherapy nausea and vomiting might just be something of the past…
Posted on: Tue, 18 Jun 2013 06:59:28 +0000
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