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October 11, 2018

Nausea and vomiting: Not just a possible symptom, a dreaded reality for some

By Meghan Knoedler

Michelle was the matriarch of a big Italian family. Her life revolved around taking care of others and her love language was food. When she was diagnosed with stage IV breast cancer, her life and family activities suddenly screeched to a halt.

Her oncologist and health care team acted quickly and put her on chemotherapy, the first line treatment.

Unfortunately, Michelle was one of the 20 percent of patients who suffer severe chemotherapy-induced nausea and vomiting, despite medicines to relieve that side effect. Those intimately familiar with nausea and vomiting say it is even worse than pain. As one patient described it, it feels as if “your muscles are being shredded apart ... over and over again.” For those that suffer, it feels unrelenting, exhausting, and like there is no end in sight.

Despite the obvious misery she was experiencing, Michelle didn’t consider this side-effect to be “suffering.”  She downplayed the severity of her nausea and vomiting for fear her oncologist would take her off the chemotherapy. Michelle wanted to do anything she could to stay on the chemotherapy while it was still working to give her as much time as possible.

Michelle was restricted in her inability to see family and friends. She said, “What am I supposed to do? Puke in front of them?” By the time she was connected with her palliative care team, the adverse effects had become very severe. Despite that, they were relentless in their efforts to find a regimen that would even minimally improve her quality of life.

Aminah Jatoi, M.D.

Chemotherapy-induced nausea and vomiting research has largely focused on recent “wins,” now being able to control this for 80 percent of patients. However, the remaining 20 percent are suffering, and their story is isolating, lonely, and painful.

A research team from Mayo Clinic, led by senior author and medical oncologist, Aminah Jatoi, M.D., sought to understand the voices of this 20 percent of patients. Their study, recently published in Supportive Care in Cancer, used semi-structured interview methodology conducted by a trained physician, and qualitative analytic methods to analyze the interviews. Michelle’s story supports their findings that are broken down into two major themes:

  1. Chemotherapy-induced nausea and vomiting is severe and multidimensional, and
  2. Symptoms are underreported.

Dr. Jatoi urges, “These vivid data should motivate investigators to continue conducting clinical trials for chemotherapy-induced nausea and vomiting and should remind health care providers about the importance of patient education on the availability of therapy for breakthrough symptoms.”

She continues, “Despite advances in palliative care, a subgroup of patients continues to experience multifaceted symptoms stemming from chemotherapy-induced nausea and vomiting — sometimes with severe and far-reaching consequences. We will continue to work with patients to improve patient education. Also, promising is the better antiemetic therapy to help alleviate nausea and vomiting in the 20 percent of patients who remain symptomatic.”

According to the Journal of National Cancer Care Network, NCCN Guidelines Insights: Antiemesis, there are many treatment options for chemotherapy-induced nausea, vomiting breakthrough symptoms. If you, or a loved one, are still experiencing symptoms, speak with your care team. There is help. While we continue our research to find a cure, there is hope for an improved quality of life.

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This research was supported by the Mayo Clinic Cancer Center and Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

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Tags: Aminah Jatoi, cancer, chemotherapy, News

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