Chemotherapy-Induced Nausea and Vomiting: Research Proposal

Literature Review

The review of the literature concerning chemotherapy-induced nausea and vomiting (CINV) shows that researchers have been mainly concerned about three aspects. Researchers and practitioners are trying to identify cancer treatments that are associated with fewer incidents of CINV. Also, they are trying to develop efficient treatments (including but not confined to medication and alternative medicine) to manage CINV. Some of the studies are associated with preventive measures, while others focus on treating the symptoms. Finally, some researchers and practitioners are concentrating on the pathopsychophysiology of CINV. Understanding these elements can help researchers to come up with effective treatment strategies and guidelines.

With regard to the research project that will be conducted and the role of a literature review in work, the choice of the search strategy to be used in order to back up with appropriate evidence the arguments concerning intervention proposed by the author of the research was an important factor. In order to find sources containing information relevant to the intervention discussed, different databases offering materials that have appeared in scholarly medical journals were used. Furthermore, the use of references included in articles on the topic as a springboard to search for further information also appeared to be a helpful tool. In the end, all sources connected with the topics were analyzed, and those that presented information closely interrelated with the proposed intervention were chosen for the review.

Cancer Treatment and CINV

Cancer is often regarded as one of the most serious illnesses that can be diagnosed, and it is challenging to cure. However, numerous effective treatment strategies and medications can help patients live longer lives or even heal completely. Chemotherapy is a common element of cancer treatment. Nausea and vomiting are some of the most unpleasant side effects associated with chemotherapy, which makes these symptoms a certain kind of measure to evaluate treatment effectiveness. In general, it is noted that adjuvant radiochemotherapy is effective as it has a positive impact on patients’ health.

CINV Pathophysiology

Researchers may providing some details concerning the pathophysiology of CINV when they address various management strategies. However, some authors concentrate on the description of the peculiarities of the symptoms as well as factors affecting their intensity. For instance, Janelsins et al. (2013) focus on the pathopsychophysiology of CINV. Among the most significant points covered by the authors, they have managed to single out specific features of different types of such conditions as CINV.

In addition, the researchers paid increased attention to a range of causes related to the occurrence of such symptoms as nausea and vomiting in patients with cancer. According to one of the ideas expressed by the group of researchers being discussed, there is an important point related to the pathophysiology of such symptoms as vomiting and nausea; in fact, it often happens that the given symptoms occur even before the use of the corresponding agents.

Among additional reasons that may lead to the given symptoms, the researchers are singling out certain stimuli that may cause negative emotional reactions related to negative memories and a patient’s subconscious desire to avoid undergoing a painful treatment and feeling bad. There is a wide range of such stimuli, and the authors of the given research have paid closer attention to such negative stimuli as the smell of the hospital that may often cause anxiety and disturbance in patients and, therefore, lead to the occurrence of the discussed symptoms.

Another important factor is that the mental condition of cancer patients may have a significant impact on the process of treatment of the disease; thus, anxiety and an increased feeling of insecurity may also be regarded as additional threats when it comes to such symptoms as vomiting and nausea in cancer patients. In reference to the emotional disposition of patients suffering from different types of cancer (including gastric or stomach cancer), it is important to note that often it is extremely difficult for patients suffering from cancer to cope with the negative emotions that they might be experiencing prior to the treatment, and their expectations concerning the most likely outcomes of the treatment of their disease, with the help of chemotherapy and other methods, are quite negative as well.

Janelsins et al. (2013) propose that an understanding of factors related to CINV can help practitioners to develop strategies that will allow them to mitigate or avoid the occurrence of the symptoms under discussion. In the end, they note that the area is characterized by a wide range of knowledge gaps.

CINV Management

One area that has been researched quite well is associated with the analysis of measures to prevent and manage nausea and vomiting. There have been a few attempts to evaluate the effectiveness of NEPA and PALO in connection to the stated problem. NEPA is a new combination of such elements as netupitant, NK1, and the 5-HT3receptor antagonist (RA), palonosetron (PALO). A few studies report that the administration of NEPA and DEX is more efficient than the use of PALO alone in all types of nausea and vomiting.

Results retrieved by numerous researchers have shown that the use of NEPA has proved to be effective even in highly emetogenic chemotherapy. Among the particular authors who have studied the topic, a study by Navari (2013) evaluates the effectiveness of some elements, including PALO, NK1 RA, and 5-HT3 RA. The author claims that the particular agents that have been mentioned can be seen as quite effective when used in the management and prevention of nausea.

In discussing the particular agents that can be used in order to help those patients who suffer from cancer and experience negative consequences of treatment, the author touches upon the topic of Olanzapine and the range of physiological effects that it produces. The given drug, thought to be an anti-psychotic agent, can be regarded as one that is far more effective than other agents mentioned by the author of the given research when it comes to mitigating such symptoms as vomiting and nausea caused by the use of chemotherapy in the treatment of cancer patients. Another critical finding of this study is the author’s support for the assumption that the use of other elements such as ginger, cannabinoids, and gabapentin has not been proven to be effective as a part of the treatment of these symptoms in cancer patients.

Thus, according to the researcher, no clear and definite improvements that are associated with the use of the substances mentioned have been identified over the course of previous research in the field.

According to Krishnasamy et al. (2014), who studied nurses’ perceptions related to their level of knowledge concerning CINV prevention, there is one more problem when it comes to the treatment of the given symptoms—assessment tools used by nursing staff should be aligned with international standards, and there is an urgent need for a universal risk assessment tool to simplify CINV management. The common methods for the latter included the use of corticosteroids and antihistamines that are believed to be effective.

Alternative Treatment

Apart from the analysis of the efficacy of medication, a certain amount of attention is paid to alternative types of treatment. Thus, such an alternative method as acupuncture is widely used to treat CINV. Yeh et al. (2012) reported that more than 40% of children stated that CINV was regarded as the most distressing side-effect of their treatment. In their study, the researchers compared the efficacy of auricular acupuncture intervention and the use of sham auricular points. It was found that both types of intervention could be used as supplementary treatment strategies to manage nausea and vomiting induced by chemotherapy in children and adults. The difference between the two interventions’ efficacy was statistically insignificant.

Garcia et al. (2013) implemented a comprehensive review of the literature concerning the effects of acupuncture on symptoms associated with cancer treatment. The researchers screened 2,151 articles on the matter and found that acupuncture can be regarded as an effective supplementary method to treat CINV. It is stressed that it is still necessary to further research various treatment methods and biological mechanisms. It is also important to involve more diverse populations (within the available body of patients and acupuncturists).

Conclusion

In the end, the intensity and the number of incidents of CINV are often seen as a measurement of the effectiveness of overall cancer treatment or some of its components. To sum up, the measures proposed by the researchers, they mentioned some psychological factors apart from physiological ones to be addressed when developing a successful intervention. The particular interventions proposed can be divided into pharmacological and alternative methods. Alternative strategies are often used as supplementary measures that have proved to be safe and cost-effective. Apart from the use of natural ingredients such as ginger and oil, acupuncture is another effective method that can be widely used in different populations. Furthermore, patient and nurse training can also be considered to be essential additional elements of the efficient intervention.

As for research gaps, it is clear that larger samples should be used to identify the pathopsychophysiology of CINV. Therefore, there is a need for further research that takes into account such factors related to studies’ populations as ethnicity, age, and socioeconomic position. Furthermore, researchers are paying considerable attention to the development of pharmacological interventions, while a more comprehensive approach is not widely used.

The use of some natural components and practices has proved to be effective, but more studies should be implemented to develop effective strategies. The existing studies are often confined to a small sample or particular setting. Importantly, the topic of patient training has received little attention, but it has proved to be effective in many areas. Patients should be prepared to address certain symptoms, and health-care professionals should be able to provide the necessary information. It is possible to conclude that the research implemented has enabled health-care professionals to develop numerous effective strategies and methods to manage CINV, but there are still a lot of gaps yet to be addressed, and the present research is aimed to provide additional information on health outcomes for those treated with the help of 5-HT3 receptor antagonists and the practice of alternative medicine.

References

Garcia, M., McQuade, J., Haddad, R., Patel, S., Lee, R., Yang, P., … Cohen, L. (2013). Systematic review of acupuncture in cancer care: A synthesis of the evidence. Journal of Clinical Oncology, 31(7), 952-960.

Janelsins, M., Tejani, M., Kamen, C., Peoples, A., Mustian, K., &Morrow, G. (2013). Current pharmacotherapy for chemotherapy-induced nausea and vomiting in cancer patients. Expert Opinion on Pharmacotherapy, 14(6), 757-766.

Krishnasamy, M., So, W. K. W., Yates, P., de Calvo, L. E. A., Annab, R., Wisniewski, T., & Aranda, S. (2014). The nurse’s role in managing chemotherapy-induced nausea and vomiting: An international survey. Cancer Nursing, 37(4), 27-35.

Navari, R. (2013). Management of chemotherapy-induced nausea and vomiting. Drugs, 73(3), 249-262.

Yeh, C., Chien, L., Chiang, Y., Lin, S., Huang, C., & Ren, D. (2012). Reduction in nausea and vomiting in children undergoing cancer chemotherapy by either appropriate or shamauricular acupuncture points with standard care. The Journal of Alternative and Complementary Medicine, 18(4), 334-340.