2006

To help doctors give their patients the best possible care, ASCO asks its medical experts to develop recommendations for specific areas of cancer care. ASCO recently updated a clinical practice guideline about preventing nausea and vomiting. This patient guide is based on ASCO's recommendations.

As you read this guide, please keep in mind that every person treated for cancer is different. These recommendations are not meant to replace your or your doctors' judgment. The final decisions you and your doctors make will be based on your individual circumstances.

In 1999, ASCO published clinical practice guidelines for the use of antiemetics (drugs that prevent nausea and vomiting). These guidelines were updated in 2006 to reflect the addition of new medications. The recommendations in this patient guide were created by a panel of experts and describe the best care for preventing nausea and vomiting.

Information in ASCO's patient education materials is not intended as medical advice or as a substitute for the treating doctor's own professional judgment; nor does it imply ASCO endorsement of any product or company.

Emesis (vomiting or throwing up) is the act of expelling the contents of the stomach through the mouth. Nausea is the urge to vomit. Radiation therapy and some types of chemotherapy cause nausea and vomiting, although not all patients who receive these treatments will have these side effects.

The best way to manage nausea and vomiting caused by cancer therapy is to prevent it. Fortunately, many medications are available that can prevent nausea and vomiting.

Anticipatory emesis is vomiting that occurs before treatment in patients who have previously vomited after chemotherapy. The prevention and treatment of anticipatory vomiting depends on the patient. For example, patients who often have motion sickness or have vomited after previous chemotherapy treatment are more likely to experience anticipatory vomiting. Tell your doctor if you have experienced vomiting with previous chemotherapy treatment. The doctor may be able to recommend medication or behavioral therapy to help reduce vomiting.

Some types of chemotherapy are more likely to cause nausea and vomiting than other types. Table 1 lists the likelihood of each cancer drug to cause nausea and vomiting.

Table 1. The Risk of Nausea and Vomiting From Intravenous (IV) Chemotherapy

The recommended treatments for preventing nausea and vomiting are listed in Table 2.

Table 2. Recommendations for Preventing Nausea and Vomiting

The risks and recommended treatments of nausea and vomiting caused by radiation therapy are summarized in Table 3.

Table 3. Recommendations for Preventing Nausea and Vomiting Caused by Radiation Therapy

Nausea and vomiting can be prevented with the appropriate medications in nearly all patients undergoing cancer treatment. These medications should be taken as prescribed before treatment and continued after treatment as directed by your doctor because the risk of vomiting may continue for several days after treatment.

It is important to prevent nausea and vomiting. Consider asking the following questions of your doctor:

• Does my treatment carry a high risk of nausea and vomiting?



• What can be done to prevent nausea and vomiting?



• What are the instructions for taking these medications?



• Do these medications have side effects that I should know about?



• Where can I find more information?

Read the entire clinical practice guideline published in the June 20, 2006 Journal of Clinical Oncology (JCO).

Download a slide presentation about the guideline created for oncologists and other health-care professionals.

Cancer.Net (www.cancer.net) is the comprehensive, oncologist-approved cancer information website from ASCO. Visit Cancer.Net to find guides on more than 90 types of cancer, clinical trials information, coping resources, information on managing side effects, a live online chat series, medical illustrations, cancer information in Spanish, the latest cancer news, and much more. For more information about ASCO's patient information resources, call toll free 888-651-3038.

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© 2006 American Society of Clinical Oncology. For permissions information, contact permissions@asco.org.