Topic: Asco reporting
I apologize for my delay in reporting. I will be breaking up the info that I gathered and have interpreted for presentation, into different sections and will post accordingly.
Chemotherapy Induced Nausea and Vomiting (CINV) and current antiemetic treatments
Being that the standard chemotherapy treatment drugs of choice for Cholangiocarcinoma include Cisplatin, a highly emotogenic or nausea producing medication, the management of nausea and vomiting is very important. Also with this cancer, nausea can be a very debilitating symptom depending on where the tumor is located.
Currently for patients receiving Cisplatin as part of their regimen, there is a 3 drug pre-chemotherapy treatment. Patients may hear nurses refer to this as “pre-meds”. This includes drugs such as Dexamethasone, a steroid, and an Nk1 receptor antagonist such as Emend and also a 5-HT3 inhibitor such as Zofran.
Some patients receiving Cisplatin may experience what is referred to as “refractory” nausea and vomiting. This is when the anti-nausea medications prescribed no longer work. Olanzapine and Reglan are still shown to provide some relief.
I think that the most important information gained from this session though is that nausea and vomiting is under-managed. It was found that doctors and nurses were underestimating the severity of symptoms that patients were experiencing. This seemed to occur because there were particular patient and provider barriers. Patients were found to purposely under report their symptoms due to a desire to appear as a “good” patient. Also, nausea and vomiting were seen as an indication that their chemo was working. Providers assumed that their patients were being forthcoming at all times, and also doctors desired to limit medications so as to limit side effects for their patients.
What should be learned from this session is that as a patient, one must be very realistic about the severity of their symptoms. Nausea and vomiting can be very debilitating and demoralizing side effects. It can not only cause anxiety, depression, loss of weight, and contribute to a poor quality of life, unmanaged nausea and vomiting can impact the treatment regimen. Dose reduction and a host of other issues may arise. Open communication with the medical provider is an essential part of the treatment plan.