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this case study, the outstanding question is, "What treatment
works best for controlling delayed nausea?" (Note: This
is a current research concern and a protocol designed to answer
this question was submitted to the National Cancer Institute in
October, 2000, by the author of this chapter, and is described below.)
Background
The control of treatment-induced
delayed nausea is a high priority for oncologists, but they are
hampered in this endeavor by a lack of information as to what
the optimal pharmaceutical treatment is, especially for highly
emetogenic chemotherapy regimens, such as those containing anthracyclines.
While there are well-accepted published guidelines (Gandara
et al., 1998; Gralla
et al., 1999) on what to give patients on the day of treatment
for the control of acute nausea and emesis from highly emetogenic
chemotherapy (i.e. a 5-HT3 receptor antagonist
antiemetic with a corticosteroid), there are no such guidelines
for the prophylactic control of delayed nausea. The lack of
published guidelines on what is the most efficacious antiemetic
to give patients on days 2 - 4 following highly emetogenic chemotherapy
is reflected in survey results from 27 oncologists who are affiliated
with the URCC CCOP research base.
We queried these physicians
on what antiemetic regimen they give new patients with breast
cancer scheduled to receive a first treatment of cyclophosphamide
and doxorubicin therapy. Their responses illustrated the problems
in this area.
- Not surprisingly,
the large majority, 25 of 27 respondents, follow the American
Society of Clinical Oncology guidelines (ASCO) (Gralla
et al., 1999), reporting that they give a 5-HT3
receptor antagonist antiemetic with a corticosteroid on the
day of treatment.
- No consensus emerged,
however, for the prophylactic control of nausea and emesis on
days 2 - 4 following treatment. There were nine different antiemetic
regimens used, none of which were endorsed by more than eight
respondents. Eighteen of the oncologists prescribed prochlorperazine
(Compazine), either alone or in combination with other drugs,
while 14 respondents prescribed a 5-HT3
receptor antagonist; again, either alone or in combination with
other drugs.
- In addition to the
differences in the medication or medications prescribed, there
was also no consensus as to whether the medications should be
taken regardless of symptoms in order to prevent nausea from
developing or to take the medications only on an as-needed basis
(p.r.n.).
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