Management of Nausea

Identification and Treatment of Underlying Causes

• The National Comprehensive Cancer Network recommends first determining potential causes of nausea, which may include gastroenteritis or gastroesophageal reflux, medication-induced nausea, gastric outlet obstruction, constipation, opioid use, and hypercalcemia or other metabolic disturbances 1
• Constipation is present in 50% of advanced cancer patients and is common with opioid use, according to the National Comprehensive Cancer Network 1, 2

First-Line Pharmacologic Management

• The National Comprehensive Cancer Network recommends using dopamine receptor antagonists, such as metoclopramide, for nonspecific nausea and vomiting, with the strongest evidence for nonchemotherapy nausea 1, 3
• Prochlorperazine, haloperidol, and olanzapine are also effective options for first-line management, as recommended by the National Comprehensive Cancer Network 1, 2, 4

Management of Persistent Nausea

• The National Comprehensive Cancer Network suggests adding 5-HT3 receptor antagonists, such as ondansetron, for persistent nausea, particularly effective for medication-induced nausea 1, 2, 5
• Anticholinergic agents, antihistamines, corticosteroids, benzodiazepines, and cannabinoids may be considered as additional agents for persistent nausea, as recommended by the National Comprehensive Cancer Network 1, 2, 4

Refractory Nausea Management

• The National Comprehensive Cancer Network recommends following specific antiemesis guidelines for chemotherapy-induced nausea and vomiting, and considering continuous or subcutaneous infusion of antiemetics 1, 2, 4
• Combination therapy, alternative therapies such as acupuncture or hypnosis, and palliative sedation may be considered for truly refractory cases, as suggested by the National Comprehensive Cancer Network 1, 2

Special Considerations

• For bowel obstruction, the Journal of Clinical Oncology recommends considering surgical intervention, stenting, decompression percutaneous gastrostomy tube, nasogastric tube, or octreotide 3