About nausea and vomiting in cancer patients
Prepare management plans and treatment of nausea and vomiting of the key aspects and important in the treatment plans for patients with cancer, although cancer patients do not all suffer from nausea or vomiting are inevitable during periods of treatment, but that a large proportion closer than fifty percent under Amadaafathma varying levels, making them one of the most side effects of treatments for tumors negative and disturbing to patients that even many of terrorizing the treatments for fear of them, which calls for the need to take appropriate preventive measures to avoid the occurrence and treatment of their influence the right time, as it may result in delay from the control of these exhibitors to the complications of multiple and more severe , such as changes that may occur Maúah body fluid balance and imbalance, leading to drought and nutrient deficiency, and severe loss of appetite, and esophagus of complications, and risk positions herniation surgery and the slow recovery of the wounds, in addition to fatigue and mental confusion, and the effects of discouraging on the quality of the patient's life, disability and ability to receive treatment, and of course the negative impact is exacerbated when there is intense and continuing their unit for extended periods.
Although the nausea and vomiting go hand in hand in most cases, but they are different and separate two presentations, Valgthian feeling of tender comes in the form of waves in the back of the throat, or stomach or both, and may not result in vomiting, and usually accompanied by a set of symptoms, such as increased secretion of saliva headaches and dizziness and light, and difficulty swallowing, and changes warmly skin, rapid pulse, and it is more painful than vomiting.
While vomiting can be defined as a set of abdominal muscle contractions, and coerces the stomach forced to dump their contents through the mouth, and may not be accompanied by nausea, the patient may also suffer from nausea only, without nausea or vomiting or both in the same time, and perhaps most painful case the patient's particular upheaval is dry or empty the stomach or esophagus without causing vomiting, and can be defined as occurrence of frequent contractions and spasms diaphragm and abdominal muscles and muscles of the stomach, in an attempt to get out anything without vomiting.
Etiology
There are many causes of nausea and vomiting in patients with cancer, including cancer itself, of course, and side effects of treatments different, and are considered some of the chemotherapy drugs, in particular a more causes of nausea and vomiting, common, in addition to radiation therapy for the digestive system, liver or the brain, and other causes include:
Imbalances in the balance of body fluids and salts (such as hypercalcaemia hypercalcemia), or drought or excessive presence of water and body tissues.
Growth and throw the channels of the digestive system, liver or brain.
Constipation.
Infection or blood poisoning.
Kidney problems or other ailments.
Anxiety and nervous tension and psychological.
Nausea and vomiting in chemotherapy
Controls the central nervous system of nausea and vomiting, which controls the portion of the functions autonomic nervous system sick, while the longer vomiting reflection is subject to the nerve center last trunk of the brain called the vomiting center, and there are several incentives paid to a vomiting, such as smell or taste, anxiety, and pain, as well as physical movement, in addition to physical changes due to infections or irritations, or poor blood flow.
When you receive drugs and chemicals are being raised vomiting center the arrival of an alert message through one of two ways:
An alert from a particular region called the future of the brain chemical excitation (chemoreceptor trigger zone), which in turn stimulates the vomiting center.
And raise the alert from the gastrointestinal tract (esophagus, stomach, and small intestine and the large).
Where the destruction of various drugs to the cells lining the small intestine, is stimulated nerves of the gastrointestinal tract, whereupon the launch of a chemical works Kmersal to the vomiting center brain and is called Recipients of serotonin (serotonin receptors), and it seems that the presence of this Article canal tract is the main reason to raise the vomiting response reaction.
Factors of nausea and vomiting
There are many factors that determine the vulnerability of the patient's nausea and vomiting when receiving chemotherapy, including:
Property Type the user, where some species have caused more nausea and vomiting than others, and some species do not they cause.
Dose intake, where high doses cause nausea and vomiting more than if they were low.
Scheduling of drug use, as when you receive doses of the drug that causes nausea and vomiting, periods of time close, less than the time required to recover before the start of the next dose.
Manner of dealing with real estate, for example, when intravenous drugs may occur nausea and vomiting in early and faster than if it was by the oral route, since intravenous drug absorption is faster.
Personal factors and the differences between patients, with different responses to chemotherapy treatment from patient to patient, and some patients do not suffer from any effects of nausea and vomiting.
Types of nausea and vomiting
Classified as nausea and vomiting associated with chemotherapy to receive five types:
Expectant (Anticipatory) and severe (acute) and late (Delayed), and breakthrough (breakthrough),
And intractable (refractory).
Expectant
And usually appears after the patient received the first stages of treatment, and the resulting reaction after the suffering of the patient's nausea and vomiting in the course of treatment earlier, and usually occurs before the direct receiving doses of drugs, chemicals or during handling, as expected the patient and bracing for the incidence of nausea and vomiting As in the previous time, and arises in most cases Ktefaal with stimuli in the environment surrounding when you receive treatment, such as odors or location in the treatment room, and for example, when the patient starts chemotherapy for the first time and he inhales the smell of alcohol, may suffer from symptoms of nausea and vomiting the next time you smell the scent of alcohol alone, and as already said you will not suffer all cancer patients from nausea or vomiting, such as periods of receiving chemotherapy or during, and determined the pace and pattern of occurrence is usually after receiving a number of treatment cycles, and there several factors which can predict any of the patients will suffer from type expectant, of which we mention the following:
Severity of the condition following the last treatment session.
Feeling cold or heat after the last chemotherapy was addressed.
A case of motion sickness in the past and the frequency.
Dizziness or sweating, and dizziness or feeling weak after receiving chemotherapy.
And a high degree of anxiety and phobia in the patient.
Drug type and dose of chemotherapy used, where the drugs vary in the degree of nausea and vomiting caused.
Acute
And usually appears during the period ranging from several minutes to several hours after receiving the dose, and ends during the four and twenty hours the first, and intense vomiting, usually after five or six hours.
Late
And usually occurs after 24 hours have elapsed from receiving therapeutic doses, and is associated with some types of drugs and not others, such as real estate Sakulovosvamaid and doxorubicin, and intensifying usually after periods ranging between 48 and 72 hours in some cases, and continues for a period ranging from 6 to 7 days.
Breakthrough
The sense that it occurs despite receiving treatments necessary to prevent, requiring additional treatments.
Intractable
And shows this kind after receiving a course of treatment and one or more of the chemical drugs, which means that treatments are covered to prevent it is no longer viable, and the patient is unresponsive to treatments nausea and vomiting.
Classification of chemotherapy drugs
Chemical drugs vary in the extent of ability to cause nausea and vomiting when you do not receive any treatments aimed at controlling them and avoided, and are classified into five grades according to the degree of this disparity, where the first class of drugs includes at least influence, while the fifth class includes the most influential, and of course impacts can vary depending on the use of the property, either alone or in combination in common with other drugs, in addition to dose intake, where it is natural to increase the likelihood of nausea or vomiting at high doses.
And in the following paragraphs an overview of this category, and the table below for the classification of most of chemical drugs, and some of the drugs in terms of how the immune cause of nausea and vomiting when you are not receiving treatments for nausea associated with:
Score 1 (low)
They include chemical drugs that cause nausea and vomiting in 10% of patients when not receiving any treatments for them, and of these drugs:
Blomaysan (Bleomycin), Basulvan (Busulfan), Wlodaraben (Fludarabine), Hedroksiauria (Hydroxyurea), low doses of methotrexate (Methotrexate), Bientostaten (Pentostatin).
Degree 2 (low)
They include chemical drugs that cause nausea and vomiting in the proportion of between 10% to 30% of patients when not receiving any treatments for them, and of these drugs:
Low doses of Alsaetharaben (Cytarabine), Dotxorobaisin (Doxorubicin), Aitoboseid (Etoposide), Floroyurassel (Fluorouracil), moderate doses of methotrexate (Methotrexate), Matomaysan (Mitomycin).
Score 3 (moderate)
And here include chemical drugs that cause nausea and vomiting in the proportion of between 30% to 60% of patients when not receiving any treatments, including:
Real Estate Alasparajnz (Asparaginase), low doses of the drug Alsaakulovosvamaid (Cyclophosphamide), or when taken by mouth, Eiberobaisin (Epirubicin), moderate doses of the drug Dotxorobaisin (Doxorubicin), drug Aydarobaisin
(Idarubicin), drug Ivosvamaid (Ifosfamide), moderate to high doses of the drug methotrexate (Methotrexate), Matozantron (Mitoxantrone).
Score 4 (high)
And here include drugs that cause nausea and vomiting in the proportion of between 60% to 90% of patients when not receiving any treatments,
Including:
High doses of Albasolvan (Busulfan) and Alsaetharaben (Cytarabine) and Aldoxworobaisin (Doxorubicin) and methotrexate (Methotrexate), carboplatin (Carboplatin), carmustine (Carmustine), moderate doses of Alsaakulovosvamaid (Cyclophosphamide), oral procarbazine (Procarbazine).
Degree 5 (high)
Include drugs that cause nausea and vomiting in greater than 90% of patients when not receiving any treatments for them,
And from these drugs:
High doses of Rmustan (Carmustine) and Alsaakulovosvamaid (Cyclophosphamide), moderate to high doses of cisplatin (Cisplatin), dacarbazine (Dacarbazine), Mikloraithamin (Mechlorethamine).
Nausea and vomiting when radiation therapy
The extent to which the emergence of nausea and vomiting when receiving radiation therapy in the treatment position, and the frequency and amount of radiation received, when the field of radiation therapy includes a large part of the digestive tract, especially the small intestine, increase the likelihood of nausea and vomiting, and suffered for about 50% of patients who receive radiation treatments to the abdominal cavity and standard radiation doses (180 to 200 Sntejraa), and it often begins during periods ranging from one to two hours after the radiation session, and continues for several hours.
When you receive while the radiation of the entire body, as was the case when the bone marrow transplant, are suffering the proportion of between 57% to 90% of patients from nausea and vomiting that are not received preventive treatment, and of course it becomes more unity in these patients after receiving a common combination of radiation therapy and high doses of chemotherapy, and on the other hand increases susceptibility to nausea and vomiting when receiving high-dose therapeutic radiation doses instead of the fragmented multiple time periods.
On the treatment of nausea and vomiting
Pharmacological treatments
There is a wide margin of anti-nausea drugs (antiemetics), and used a first line treatment and is essential, and effective in controlling nausea and vomiting and to prevent their occurrence by direct to receive treatments.
And of course there is no one drug is useful for all cases entirely, due to the different extent of the response of patients to different treatments, in addition to the difference in approach to the impact of chemical drugs on the brain vomiting center, and the factors that should be taken into account to choose the best treatment plan for patients:
The necessity of selecting anti-nausea drug by the way the impact of chemotherapy drug used on the vomiting center in the brain.
Cause the drug used for chemotherapy nausea and vomiting in the absence of an effective treatment for them.
Extent of the suffering of the patient's nausea and vomiting in the past and how the use of anti-nausea drugs.
The patient's response to anti-nausea drugs.
And in general, and to achieve the best preventive treatment is given drugs, anti-nausea before starting to receive chemotherapy, and continue to be dealt with accordingly to the extent of causing drug chemotherapy used for vomiting, and are usually dealt with these drugs on a regular basis throughout the course of chemotherapy, and in some cases are taken only as needed, and as the case may be sufficient to address drug and one anti-nausea, or are given a combination of two drugs or more is usual, due to the different ways to raise the vomiting center brain and the different drugs, anti-nausea in the suppression of the types of the excitement.
And of course some of these drugs and the necessary short-term time eating at frequent intervals, and some of the other long-term periods can be taken apart, it is important to keep rates stable in blood up to maintain their effectiveness.
Following is an overview of anti-nausea drugs, the most heavily traded:
Dexamethasone (Dexamethasone)
And a drug steroid and names traded Dhikadron (Decadron), and Hiksadrol (Hexadrol), and is taken by mouth in the form of capsules or syrup, or injected intravenously, and is administered usually in common with another drug anti-nausea, and the side effects common feeling of lightness and increased activity and lack of calm and mental confusion, and is used in high doses to treat some types of tumors and low-dose contraceptive for nausea, and of course different side effects in both cases.
Dai Vinhidramen (Diphenhydramine)
And rolling his name Benadryl (Benadryl), and addresses the drink by mouth or injected intravenously, and is usually given every six to eight hours, and common side effects of drowsiness and dizziness.
Jeransteron (Granisetron)
And the name rolling Kitre (Kytril), in the form of rivets or drink by mouth or injected intravenously, and are dealt with usually half an hour before the date of receiving the dose of chemotherapy, and is the headache of the most important side effects common, and is commonly include diarrhea and constipation .
Lorazepam (Lorazepam)
And is also called Otefan (Ativan), and addresses by mouth in the form of rivets or injected intravenously or intramuscularly, and is soothing that is given is usually common with the other reason for the nausea, and the side effects common feeling drowsy and the large number of forgetfulness and lack of stability, kinetic and low blood pressure.
Ondansetron (Ondansetron)
And his name rolling Zovran (Zofran), and addresses by mouth in the form of capsules or syrup, or injected intravenously, and are dealt with usually half an hour before the date of receiving the dose of chemotherapy, then every four to eight hours after that and until the end of nausea, higher doses or once daily, and common side effects of headache and constipation.
Brokhlurbayrazen (Prochlorperazine)
And the name rolling Kombazin (Compazine), and addresses by mouth in the form of capsules or capsules, slow-acting, or injected intravenously or intramuscularly, or in the form of suppositories, and is used alone usually when you expect nausea mild, and the side effects common feeling sleepy and low blood pressure, nervous tension and hyperactivity, as well as muscle spasms and neck spasms, which calls for the need to add drug Benadryl (Benadryl) to avoid it.
Brometakizn (Promethazine)
And is also called Vnjan (Phenergan), and addresses by mouth in the form of rivets, or injected intravenously or intramuscularly, or in the form of suppositories, and is administered usually every four to six hours, and the side effects common feeling sleepy and dizziness, dizziness, and fatigue and blurred vision, and sense of lightness and insomnia, and cause convulsions, muscle spasms neck, necessitating the need to add drug Benadryl (Benadryl) to avoid such.
Non-drug treatments:
Although the drug anti-nausea remain essential in the treatment plans, but it is noticeable the high percentage of patients, these drugs do not seem effective in the treatment of type expectant management of nausea and vomiting, and noted that the best way to handle this type depends on changing the mental and psychological the patient in different ways, such as urging him to read aloud to the Holy Quran when you start taking doses, or the distraction of thinking about treatment (and especially the children) while taking medicines to raise concerns, for example, or mind games or visual, such as video games or other, or exercises imaginary or relaxation exercises , and the processing is more successful when discrimination of early nausea and vomiting, expectant, and direct Btgnnbhma.
Nausea and vomiting in advanced tumors
Different cases of nausea and vomiting in advanced stages of tumors from those resulting from chemotherapy or radiation, and several factors may work together, causing the occurrence, especially when the use of sedatives and analgesics and anti-depressants, or medicines for the treatment of pain in advanced tumors, and is constipation one of the most common causes, in addition to other causes, such as tumors of the stomach or colon, and the presence of abnormal levels of various substances with blood or drought, or stomach ulcers.
And may not be anti-nausea effective in cases of nausea and vomiting, chronic in tumors developed, and may need to be managed in different ways, and while ensuring that the constipation is causing Statute of nausea or vomiting, can be described laxatives different treatment, especially if the patient receives pain relievers.
Classification table of drugs, chemical and immunological terms of the extent of causing nausea and vomiting when not in use for two treatments:
(And please go to guide cancer drugs to see the release of each drug separately).
| Property Name | No effect | Low | Moderate | High |
| asparaginase | X |
| X |
|
| bleomycin | X |
|
|
|
| busulfan |
| X |
|
|
| carboplatin |
|
|
| X |
| carmustine |
|
|
| X |
| chlorambucil |
| X |
|
|
| cisplatin |
|
|
| X |
| cladribine |
| X |
|
|
| cyclophosphamide |
|
| X | X |
| cytarabine |
|
| X | X |
| dacarbazine |
|
|
| X |
| dactinomycin |
|
| X | X |
| daunorubicin |
|
| X | X |
| dexamethasone | X |
|
|
|
| docetaxel |
| X | X |
|
| doxorubicin |
|
| X | X |
| epirubicin |
|
| X | X |
| etoposide |
| X |
|
|
| fludarabine | X | X |
|
|
| fluorouracil |
| X |
|
|
| gemcitabine |
| X |
|
|
| hexamethylmelamine |
|
| X |
|
| hydroxyurea |
| X |
|
|
| idarubicin |
|
| X | X |
| ifosfamide |
|
| X | X |
| irinotecan |
| X |
|
|
| leucovorin |
| X |
|
|
| levamisole |
| X |
|
|
| lomustine |
|
| X | X |
| mechlorethamine | X |
|
| X |
| melphalan | X |
|
|
|
| mercaptopurine | X |
|
|
|
| methotrexate |
| X | X | X |
| mitomycin |
| X |
|
|
| mitoxantrone |
|
| X |
|
| paclitaxel |
| X |
|
|
| pegaspargase |
|
| X |
|
| pamidronate |
|
|
|
|
| pentostatin |
|
| X | X |
| prednisone | X |
|
|
|
| procarbazine |
|
| X | X |
| streptozocin |
|
|
| X |
| tamoxifen | X |
|
|
|
| teniposide |
| X |
|
|
| 6-thioguanine |
| X |
|
|
| thiotepa |
|
| X |
|
| topotecan |
|
| X |
|
| tretinoin |
| X |
|
|
| vinblastine | X |
|
|
|
| vincristine | X |
|
|
|
| vinorelbine | X |
|
|
|
| 17-1A monoclonal antibody | X |
|
|
|
| aldesleukin | X |
|
|
|
| erythropoietin (epoetin alfa) | X |
|
|
|
| filgrastim | X |
|
|
|
| interferon | X |
|
|
|
| rituximab | X |
|
|
|
| sargramostim | X |
|
|
|
| trastuzumab | X |
|
|
|
