Good News re Nausea Control
For most women, the most dreaded side effect of chemotherapy is hair loss (see yesterday's entry), followed by nausea and vomiting. Although little progress has been made in reducing hair loss, there has been a lot of improvement in nausea control. When I first began working in Oncology, we used to give people little basins as they left the Infusion Area, knowing that they likely would be vomiting before they reached their car. Now, it is much more common for people to never vomit through a course of chemotherapy, although a vague queasiness may be present. Unfortunately, there continue to be a very few people who, although surely helped by the available medications, are not helped enough. I have known a few women who had to return to the Unit a day or two after treatment for IV fluids because of "excessive" (which, actually any at all would be) vomiting.
This is a report from Cancer Net about a new medication that is effective when others fail.
Olanzapine May Manage Nausea and Vomiting From Chemotherapy When Other Treatments Fail
A recent study showed that the drug olanzapine (Zyprexa) helps manage nausea and vomiting from chemotherapy when the usual treatments for these side effects are not working. Nausea and vomiting is a common, but often manageable, side effect of chemotherapy. However, despite treatments given to prevent nausea and vomiting, about 30% to 40% of patients taking certain types of chemotherapy still have nausea and vomiting. When this happens, it is called breakthrough nausea and vomiting.
In this study, researchers compared olanzapine with the drug metoclopramide (Reglan) to find out which one helped prevent breakthrough nausea and vomiting for patients receiving types of chemotherapy that are most likely to cause nausea and vomiting. Metoclopramide is often used to help prevent breakthrough nausea and vomiting, although the research is not clear if it is helpful.
The 205 patients who participated in this study had never received chemotherapy and were given the standard drugs to prevent nausea and vomiting before starting their chemotherapy. These drugs helped prevent nausea and vomiting for most of the patients. However, 80 patients experienced breakthrough nausea and vomiting. Once these patients experienced breakthrough nausea and vomiting, they received either olanzapine or metoclopramide every day for three days. For the patients who received olanzapine, 71% (30 out of 42 patients) had no vomiting and 67% (28 out of 42 patients) had no nausea. For the patients who received metoclopramide, 32% (12 out of 38 patients) had no vomiting and 24% (9 out of 38 patients) had no nausea. These results mean that, in this study, olanzapine helped to prevent nausea and vomiting better than metoclopramide.