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Palliative cancer care - nausea & vomiting - Management
What simple measures may help nausea and vomiting in palliative care?

  • Make sure the person has access to a large bowl, tissues, and water.
  • The sight and smell of food or drink may provoke nausea:
    • Provide the person with a calm environment away from where food is usually prepared or consumed.
    • If the person is usually responsible for cooking, make alternative arrangements.
    • Make sure meals are small and palatable.
    • Carbohydrate meals are often better tolerated.
    • Offer cool, fizzy drinks (citrus flavours are often preferred).
  • Consider parenteral hydration if appropriate (in all people but those at the very end of life).
  • Consider the use of complementary therapies; relaxation and acupressure bands may be useful to relieve symptoms.
  • Consider the use of cognitive behavioural therapy for anticipatory nausea or vomiting.
  • In general, avoid nasogastric suction.
Basis for recommendation
  • This recommendation is based on palliative care literature from textbooks [Twycross and Wilcock, 2001; Doyle et al, 2004; Regnard and Hockley, 2004] and published journal articles [Wright, 2005; Mannix, 2006]:
  • Evidence from a small observational study (n = 54) of hospice patients suggested that acupressure has benefit in controlling nausea and vomiting [Wright, 2005]. Although the study had methodological weaknesses which limit the findings, the risk of this technique is probably low; acupressure bands are safe and easy to administer [Ernst et al, 2006].
  • CKS could not find studies relating to acupuncture or relaxation for people experiencing nausea and vomiting in general palliative care; the trials and reviews that were found related to chemotherapy-related nausea and vomiting (treatment of which is not covered in this CKS topic) and people experiencing nausea and vomiting who were not receiving palliative care (e.g. motion sickness, pregnancy, post-operative):
    • A review provides positive evidence that relaxation is effective for preventing nausea before, during, and after chemotherapy and is usually a low-risk intervention [Ernst et al, 2006]. In view of this, CKS extrapolated this evidence to recommend consideration of relaxation therapies for people receiving palliative care, since this may provide benefit with little chance of harm.
    • A paper written by a consultant in palliative care medicine suggests that although studies in the palliative care setting are lacking, case reports suggest that acupuncture can be helpful [Mannix, 2006]. In the absence of stronger evidence relating to the general palliative care population and considering the potential (albeit rare) adverse effects of acupuncture, CKS could not extrapolate this tentatively positive evidence on acupuncture for chemotherapy-induced nausea [Ernst et al, 2006] to make a recommendation.

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