Management of nausea and vomiting in the cancer patient

NAUSEA and vomiting are among the most common and distressing problems that the physician is called on to resolve in the cancer patient, particularly if the patient is undergoing chemotherapy or radiation therapy. If left unchecked, nausea and vomiting will result in depressed nutritional intake, serious metabolic derangements, deterioration of the patient's mental and physical condition, and possible rejection of potentially useful treatment of the malignant disease. Thus, control of these symptoms is essential for the patient's well-being and survival. Mechanisms of the Vomiting Reflex The coordination of the complex vomiting reflex is accomplished through the "vomiting center," located in the dorsolateral reticular formation of the medulla. Afferent input to this region comes from a number of sources. The viscera of the upper gastrointestinal (GI) tract send impulses through the vagii and sympathetic nerves. Radiation therapy, GI involvement with malignant disease, and some drugs may induce vomiting through this pathway.