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Chemotherapy-induced nausea and vomiting (CINV) is one of the most common and most feared side effects of chemotherapy.
Chemotherapy-induced nausea and vomiting (CINV) is one of the most common and most feared side effects of chemotherapy. When CINV occurs, it may decrease treatment compliance and result in nutritional deficiencies or dehydration, reduced performance status, and decreased quality of life. Preventing and controlling CINV is imperative for optimizing the care of patients receiving chemotherapy. Although there are numerous treatments in the oncology arsenal, including antiemetics, there are also steps that patients can take to decrease their risk of CINV and manage it when it occurs. We examine five Web resources that can help patients learn about CINV and cope with this debilitating side effect. Some include resources that healthcare providers may also find useful.
Chemotherapy Side Effects, Radiation Side Effects, Postoperative Side Effects, Symptom Relief, and Treatment Options
CancerNausea.com is sponsored by an unrestricted grant from Genentech USA, Inc, and is endorsed by the European Oncology Nursing Society. The site’s tagline is “the site that helps patients help themselves,” which it achieves by providing patients with important information and tools to get a better handle on their CINV. In addition to informative articles on , the site includes several resources that patients may find especially useful. One such resource is a Symptom Diary, where patients can keep a detailed record of the frequency and severity of their nausea or vomiting following treatment using a simple questionnaire. Being able to present their physicians and nurses with a detailed record of their CINV experience may help patients improve communication with their healthcare providers, allowing better CINV-control strategies to be employed. The Symptom Diary can be downloaded as a PDF or Word document and is available in English, Spanish, German, and Italian, as is much of the information on the site.
Questions & Answers
Another useful resource is a list of Diet Do’s & Don’ts, outlining simple eating tips that patients can use to prevent CINV or dehydration if vomiting occurs. The list also includes a link to an article on Cancer.gov that provides a more comprehensive overview of eating before, during, and after cancer treatment. Patients with questions regarding CINV may find answers in the Website’s section, whereas those looking for guidance on communicating with their healthcare provider may find some of the tip sheets in the Tips and Facts section helpful. The site also includes a Glossary, Ensuring patients understand the medical vocabulary, and a Resources section that links to other credible Websites that provide cancer information.
Patients who prefer not to review the information online can print the Practical Guide for Patients, which is downloadable as a PDF and contains all of the same information. The site includes a Handbook for Nurses (downloadable as a PDF), which offers an overview of antiemetics and provides guidance on selecting the right one, but it was published in the United Kingdom in 2003 and doesn’t contain information on some newer therapies, such as palonosetron or the granisetron transdermal system.
2. American Cancer Society— Coping with Physical & Emotional Changes
The American Cancer Society Website includes a section for patients on coping with treatment, including CINV. The Nausea and Vomiting article in this section provides a comprehensive overview of CINV, reviewing its incidence, potential complications, risk factors, types (eg, acute, delayed, refractory), and treatments, including antiemetics and alternative strategies such as self-hypnosis and music therapy.
The article also provides nutritional information, including tips on how to prevent CINV, such as by eating a light snack before chemotherapy, and also covers nausea and vomiting resulting from radiation therapy. Patients seeking further information can click on links to countless other useful resources, such as guides to understanding chemotherapy or radiation therapy, as well as to various organizations that include patient support resources.
Patients interested in obtaining more nutrition-related information from the American Cancer Society can access several other articles under Managing Eating Problems Caused By Certain Treatments, which include tips based on treatment. There are articles geared for patients undergoing surgery, radiation therapy, or chemotherapy, as well as for those with weak immune systems from advanced cancers.
3. National Cancer Institute — Nausea and Vomiting PDQ
The National Cancer Institute’s (NCI) Nausea and Vomiting PDQ provides patients with a brief overview of nausea and vomiting and reviews its causes and treatments. All key terms in the articles are hyperlinked to an NCI dictionary, and clicking on any of these terms pulls up their definition in a small window to the side of the article. The section on Causes provides a bulleted list of risk factors for each type of nausea and vomiting, including anticipatory, acute, and delayed. It also discusses potential causes of nausea and vomiting in advanced cancer and in those undergoing radiation therapy. The section on Treatment reviews strategies and pharmacotherapies that can be used to treat each type of nausea, and includes a section on alternative therapies. A Health Professional Version of this PDQ is also available, and both this version and the patient version can be read in English or Spanish. Patients with questions about CINV or another cancer-related issue can call the NCI’s Cancer Information Service at (800) 4-CANCER (1-800-422-6237).
CancerConsultants.com provides patients with cancer with a host of information via its articles, newsfeeds, videos, and podcasts. Patients about to undergo chemotherapy or those suffering from CINV may find the Website’s Nausea and Vomiting Information Center especially useful. Here patients can access Headline Nausea and Vomiting News, which is a CINV-specific newsfeed; Nausea and Vomiting In Depth, which features an article geared toward alleviating patient fears regarding CINV; Nausea and Vomiting Management, which is set up in a question and answer format and provides an overview of CINV and its management, answering questions like “Are some treatments more likely to cause nausea and vomiting?”; and Nausea and Vomiting Tips, which includes an article that examines complimentary medicine.
Under Nausea and Vomiting Topics, patients will find links to articles from some of the aforementioned sections of the Nausea and Vomiting Information Center, as well as Clinical Trials information, which links to eCancerTrials.com, a site where patients can get up-to-date information on over 2000 clinical trials in oncology. They can also find links here to sign up for any of Cancer Consultants 32 cancer-specific newsletters or the Women’s Health newsletter; at the registration page, the Newsletter Archives are accessible. Patients may also find a link to the Cancer Support Community, where they may connect with other patients to share their experiences and ask or answer questions.
At the bottom of the Nausea and Vomiting Information Center, patients can click on buttons to access Women & Cancer Magazine, which covers health, wellness, prevention, and treatment issues in patients with cancer and survivors. There is also a link to the Website’s theCancerCareStore, where patients can purchase skin care products designed specifically for patients undergoing chemotherapy or radiation; books covering a broad range of cancer topics, including several nutritional guides; and a host of other products, such as baseball caps, visors, and wristbands.
5. We Are Macmillan Cancer Support
Macmillan Cancer Support is a registered charity in the United Kingdom. The organization seeks to fulfill its “We Change Lives” mission by providing patients with practical, emotional, and financial support, though the latter is only available to individuals living in the United Kingdom. Although the site is not geared to US patients, its Controlling nausea and vomiting (antiemetics) article includes information missed by some other sites on CINV, reviewing potential side effects of antiemetics and what to do if they occur. It also examines how antiemetics work and how they are administered. In addition, patients will find a list of simple steps that they can take to cope with their CINV; however, because this article is not geared specifically for patients receiving chemotherapy or radiation treatments, there is a note at the beginning of the article that indicates that patients receiving these treatments should read this article along with the site’s general information on these regimens.