A prospective observational study of chemotherapy-related nausea and vomiting in routine practice in a UK cancer centre.

OBJECTIVE: The aim of the study was to assess levels of chemotherapy-induced nausea and vomiting (CINV) in routine practice. MATERIALS AND METHODS: The study was an observational prospective evaluation using patient self-reports. One hundred and two patients with cancer in a single cancer centre in UK receiving their first chemotherapy treatment participated in the study and were followed up over four cycles, providing a total of 272 assessments of nausea and vomiting. Data was collected with the use of the MASCC Antiemesis Tool (MAT), which is an eight-item short clinical scale assessing acute and delayed nausea and vomiting after chemotherapy. RESULTS: Results indicated that acute vomiting was experienced by 15.7% of the patients in cycle 1 and delayed vomiting by 14.7%, while acute nausea was present in 37.3% of the patients and delayed nausea in 47.1%, increasing over the subsequent cycles. Moderately emetogenic and highly emetogenic chemotherapy had the highest incidence of CINV, whereas patients receiving highly emetogenic chemotherapy showed significant levels of delayed nausea. Acute symptoms were more easily controlled than delayed symptoms. DISCUSSION: The data suggest that, while vomiting is well controlled, nausea remains a significant problem in practice, and optimal management of CINV is yet to be achieved. Understanding more clearly the biological basis of nausea will assist in managing this complex symptom more effectively in practice.

Cisplatin and emesis: aspects of treatment and a new trial for delayed emesis using oral dexamethasone plus ondansetron beginning at 16 hours after cisplatin.

The marked progress in controlling emesis caused by cisplatin characterizes the current status of antiemetic treatment for all chemotherapy. Cisplatin has provided a model for antiemetic studies. Strategies for controlling cisplatin-induced emesis are at least as successful when applied to other chemotherapy and persistent problems such as delayed emesis and the emesis associated with consecutive-day chemotherapy are also similar to or less severe than those observed with cisplatin. The purpose of this report is twofold: first to outline briefly therapy for cisplatin-induced emesis as illustrated by several new studies, and, second, to report on a new trial that incorporates some different strategies in the control of delayed emesis after cisplatin.

Helping children cope when a family member has cancer.

A cancer diagnosis impacts the entire family unit, but children are especially vulnerable. In the past, families and professionals did not share information or allow for children to express their feelings or to be involved. Children have the right to know and the need to know the truth. Interventions should be based on both the developmental stage of the child and the stage of the illness. Approaches by disease phase and developmental stage are discussed. Goals include maintaining family stability, preparing children for what may happen, allowing for flexible communication, and preventing serious psychosocial sequelae.

Assessing and managing venous irritation associated with vinorelbine tartrate (Navelbine)

PURPOSES/OBJECTIVES: To determine the effect of duration of infusion time on venous irritation in patients receiving vinorelbine tartrate (Navelbine, Burroughs Wellcome Co., Research Triangle Park, NC) in combination with cisplatin or mitomycin. DESIGN: Prospective and descriptive. SETTING: Five outpatient hematology/oncology units in southern Louisiana and Mississippi. SAMPLE: 96 patients receiving vinorelbine in combination with cisplatin or mitomycin through a peripheral vein. METHOD: Nurses completed the Venous Irritation Record (VIR), on which they documented the incidence of irritation reactions on the day of infusion as well as 24 hours and one to two weeks later. MAIN RESEARCH VARIABLES: Incidence and severity of venous irritation as well as the duration of administration. FINDINGS: Significantly lower incidence of venous irritation at 6-10 minute infusion rate was observed (p < 0.05). No difference in incidence was observed when vinorelbine was given with a vesicant (mitomycin) or a nonvesicant (cisplatin) drug. CONCLUSIONS: Although venous irritation is a problem associated with peripherally administered vinorelbine, it does not necessitate central line placement. Incidence of this problem can be reduced with a shorter duration of administration. The VIR was feasible, easy to use, and could be adapted for other drugs and other toxicities. The National Cancer Institute Common Toxicity Criteria are not adequate for grading venous irritation reactions. IMPLICATIONS FOR NURSING PRACTICE: Vinorelbine should be administered in accordance with the manufacturer's recommendations as a 6-10 minute infusion. Determination of this rate came as a result of clinical nursing research. Nurses involved in clinical trials can and should play a role in describing emergent toxicities and investigating methods to prevent or minimize those toxicities.

Positive thinking: an unfair burden for cancer patients?

This presentation challenges the purveyors of the importance of "positive thinking" in the cure of cancer. Psychological support should allow the patient to come to terms with his or her situation in a way that works for that individual within a caring and realistic environment. In no way should psychological support add an extra burden to an already devastated patient. By forcing "positive mental attitude", health-care professionals are not allowing patients to face reality. Promoters of the "cure" that comes with positive thinking are quoted, as well as authors who question the promoters' intent and outcome. It is felt that "positive thinking" may be appropriate as one of many successful coping strategies. To attribute more to it or, worse, to insist that patients believe in its power to cure may be courting emotional disaster.

Cancer incidence and mortality among African Americans.

In the future, the largest proportional increase in the population will be among minority groups. To date, there are a number of studies which document the disparities in cancer incidence and survival existing between white Americans and minorities, especially African Americans. African Americans have the highest cancer incidence and mortality rates in the United States. Much of this difference can be directly related to socioeconomic status. There are also cultural differences which result in differing attitudes towards health care. In the future, interventions designed to encourage cancer prevention and screening behaviors must seek to overcome the barriers to access in a culturally sensitive fashion.