ONCOLOGY 1

Ms. Stern is a 57-year-old female diagnosed with stage II Hodgkin’s lymphoma 4 weeks ago. She is put on combination chemotherapy of ABVD regimen (Doxorubicin, Bleomycin, Prednisone, and Procarbazine). She complains of severe nausea and vomiting. She does not want to continue with her medicine, as they are making her life even more miserable. She is also having some general malaise, and then had a bit of a sore throat. She has lost 30 lb(12.6kg) in a month. Her vitals are, Temperature: 38.5C(101.3F); PR: 88/min; RR: 18/min; BP: 109/68mm of Hg. The patient is on 92% pulse oximetry on room air. On examination the mouth is dry and she looks significantly cachectic with enlarged cervical lymph nodes and hepatomegaly. How can her vomiting be best managed?
A. Stop the chemotherapy drugs
B. Ondansetron
C. Metoclopramide
D. Tell patient that her nausea will get better with time
E. Prochlorperazine

Explanation:
Nausea and vomiting is one of the major undesirable effects of chemotherapy. It is the major reason for non-compliance and failure of chemotherapy regimes. Patients should be thoroughly educated about nausea and vomiting before the chemotherapy begins. As far as pharmacological treatment is concerned, a 5-HT3 receptor antagonist Ondansetron is very promising in reducing chemotherapy-induced emesis and is available in a tablet form also. The other steps that should be taken in such patients include small frequent meals, avoiding bland foods, appropriate food presentation, and giving patient what he wants to eat.

Nausea and vomiting is a major hindrance to patient's compliance to chemotherapy so telling him to bear it is not the best option.

Metoclopramide and prochlorperazine are the classical agents that can be give to such patients either alone or in combination with ondansetron though they are not the best drugs for chemotherapy-induced emesis.

Expected side effects like nausea and vomiting are not the indications to stop chemotherapy.