BC Cancer Professionals' Consensus on Nausea & Vomiting Management in Cancer Treatment, Study notes of Oncology

Download BC Cancer Professionals' Consensus on Nausea & Vomiting Management in Cancer Treatment and more Study notes Oncology in PDF only on Docsity! The information contained in these documents is a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at your own risk. Page 1 of 8 Symptom Management Guidelines: Nausea and Vomiting NCI GRADE AND MANAGEMENT | RESOURCES | CONTRIBUTING FACTORS | APPENDIX Definition(s) Nausea: Queasy sensation and/or urge to vomit Vomiting: The forceful expulsion of the contents of the stomach, duodenum, or jejunum through the oral cavity. Focused Health Assessment PHYSICAL ASSESSMENT SYMPTOM ASSESSMENT Vital Signs ● Frequency – as clinically indicated Weight ● Take current weight and compare to pre – treatment or last recorded weight Hydration Status ● Assess skin turgor, capillary refill, mucous membranes ● Amount and character of urine (Is patient urinating less than 400-500 ml per day? Is urine dark?) ● Level of consciousness? Abdominal Assessment ● Auscultate abdomen - assess presence and quality of bowel sounds ● Assess for abdominal pain, tenderness, distention Emesis Examination ● Inspect emesis for colour, consistency, quantity, odour and blood Functional Status  Activity level/ECOG or PPS *Consider contributing factors Normal ● Did you have nausea/vomiting prior to your treatment? ● Are you aware of any medications that you are taking that could cause nausea and vomiting (e.g. antibiotics) Onset  When did the nausea and/or vomiting begin?  How many episodes of vomiting in the last 24 hours? Provoking / Palliating ● What brings on the nausea and/or vomiting? ● Is there anything that makes the nausea/vomiting better? Or worse? Quality ● Describe the emesis ● Colour: (Visible blood, coffee ground, bile) ● Volume: Large Amount; (2+ cups), moderate amount (½ - 2 cups) small amount; (½ cup or less). ● Odour Region / Radiation - NA Severity / other Symptoms ● How bothered are you by this symptom? (On a scale of 0 – 10, with 0 being not at all and 10 being the worst imaginable) ● Have you been able to eat in the past 24 hours? ● Have you be able to tolerate fluids in the past 24 hours ● Do you have nausea with or without vomiting? ● Projectile vomiting? ● Have you had any other symptoms such as: Abdominal pain? Headache? Pain elsewhere? ● Passing gas? ● Constipation? - When was your last bowel movement? Blood/mucous in stool? ● Fever? - possible infection ● Dehydration?: Dry mouth, thirst, dizziness, weakness, dark urine? Treatment ● What medications or treatments have you tried? Has this been effective? Value  What do you believe is causing your nausea? The information contained in these documents is a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at your own risk. Page 2 of 8 NAUSEA AND VOMITING GRADING SCALE NCI CTCAE (Version 4.03) GRADE 1 (Mild) GRADE 2 (Moderate) GRADE 3 (Severe) GRADE 4 (Life Threatening) GRADE 5 Nausea Loss of appetite without alteration in eating habits Oral intake decreased without significant weight loss, dehydration or malnutrition Inadequate oral caloric or fluid intake; tube feedings, TPN or hospitalization may be indicated ─ ─ Vomiting 1-2 episodes (separated by 5 minutes) in 24 hours 3-5 episodes (separated by 5 minutes) in 24 hrs ≥ 6 episodes separated by 5 minutes) in 24 hrs; tube feeding, TPN or hospitalization indicated Life-threatening consequences; urgent intervention indicated Death *Step-Up Approach to Symptom Management: Interventions Should Be Based On Current Grade Level and Include Lower Level Grade Interventions As Appropriate NORMAL – GRADE 1 GRADE 2 OR Nausea and Vomiting NOT resolving after 24 hours NON – URGENT Prevention, support, teaching, & follow-up as clinically indicated URGENT: Requires medical attention within 24 hours Patient Care and Assessment ● Provide instructions on how to take antiemetics, including dose and schedule. ● Rule out other causes of nausea and vomiting Dietary Management Encourage: ● Eat small, bland meals served cool. ie rice, crackers, toast. ● Sip water and other fluids -Aim for 8-10 glasses/day (coconut water, diluted juice, sports drinks, broth. Suck on ice chips, frozen fruit) ● Maintain oral hygiene ● Restrict fluids with meals Nausea: try tea/smoothie made with grated ginger root, lemon zest or mint leaves, ginger candies, flat ginger ale. Vomiting: Avoid solid food for 30-60 minutes after vomiting has passed. Start eating and drinking slowly in this order: 1.Clear liquids (water, ice chips, watered down juice, broth, popsicles) 2. Dry starchy food (crackers, dry toast) 3. Protein rich foods (chicken, fish, eggs) 4. Dairy foods (yogurt, milk, cheese) Avoid: ● alcohol and tobacco ● Avoid lying down after eating-sit upright 30-60 minutes NOTE: If patient unable to tolerate adequate daily fluid intake, IV hydration or hypodermoclysis to replace lost fluid and electrolytes may be required For further Dietary Management See Oncology Nutrition Services in Resource Section The information contained in these documents is a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at your own risk. Page 5 of 8 Immunotherapy  Immunotherapy Alert Card  Please refer to protocol specific algorithms to guide management of immune mediated side effects. Patient Education Resources  Nausea & Vomiting handout  Practical tips to help manage nausea handout  Nutritional Guidelines for Anorexia handout  Increasing Fluid Intake handout  Resources about managing anxiety, progressive muscle relaxation, positive thinking, etc http://www.bccancer.bc.ca/health-info/coping-with-cancer/emotional-support/resources BC Inter- professional palliative symptom management guideline  https://www.bc-cpc.ca/cpc/symptom-management-guidelines/ Bibliography List  http://www.bccancer.bc.ca/health-professionals/clinical-resources/nursing/symptom- management Contributing Factors Cancer Treatments Chemotherapy: For emetogenicity of chemotherapeutic agent, See Appendix A and Cancer Drug Manual in Resources Section Immunotherapy/Biotherapy Radiation Therapy: Surgery/Anesthesia Medication ● Antibiotics ● Opioids &/or Opioid withdrawal ● NSAIDs ● SSRI antidepressants ● Iron supplements ● Anticonvulsants ● Bronchodilators Cancer Related : ● Cancer of the GI tract ● Brain metastases/Increased ICP ● Reduced GI motility, Bowel Obstruction, Chemotherapy induced (e.g. Vincristine) ● Constipation ● Vestibular dysfunction ● Anxiety, anticipatory nausea ● Hypercalcemia, hyperglycemia, hyponatremia ● Gastritis ● Infections ● Uremia ● Pain/Headache Risk Factors: ● Female ● Less than 50 years of age ● Decreased risk for patients with a high chronic alcohol intake Lack of regular alcohol use ● History of motion/morning sickness, chemotherapy induced emesis. The information contained in these documents is a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at your own risk. Page 6 of 8 Appendix A: Emetic Risk of Intravenous Antineoplastic Agents Adapted from ASCO Guidelines (2011) Emetic Risk of Antineoplastic Agents Administered Intravenously High Moderate Low Minimal  Carmustine ● Cisplatin ● Cyclophosphamide - greater than or equal to 1500mg/m2 ● Dacarbazine ● Dactinomycin ● Mechlorethamine ● Streptozotocin ● Azacitidine ● Alemtuzumab ● Bendamustine ● Carboplatin ● Clofarabine ● Cyclophosphamide less than 1500mg/m2 ● Cytarabine greater than 1000mg/m2 ● Daunorubicin* ● Doxorubicin* ● Epirubicin* ● Idarubicin* ● Ifosfamide ● Irinotecan ● Fluorouracil ● Panitumumab ● Bortezomib ● Pemetrexed ● Cabazitaxel ● Temsirolimus ● Cytarabine greater than or equal to 1000mg/m2 Topotecan ● Docetaxel ● Doxorubicin-Liposomal ● Etoposide ● Gemcitabine ● Ixabepilone ● Methotrexate ● Mitomycin ● Mitoxantrone ● Cladribine ● Bevacizumab ● Bleomycin ● Busulfan ● Cetuximab ● Fludarabine ● Pralatrexate ● Rituximab ● Vinblastine ● Vincristine ● Vinorelbine * These anthracyclines when combined with cyclophosphamide, are now designated as high emetic risk The information contained in these documents is a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at your own risk. Page 7 of 8 Date of Print: Revised: August 2018 Created: January, 2010