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Q: Nursing problem, vomiting following chemo with 6 [1999-2003] research articles ( Answered 4 out of 5 stars,   0 Comments )
Subject: Nursing problem, vomiting following chemo with 6 [1999-2003] research articles
Category: Health
Asked by: tropical-ga
List Price: $25.00
Posted: 16 Aug 2003 07:29 PDT
Expires: 15 Sep 2003 07:29 PDT
Question ID: 245344
Description of the clinical nursing problem, nutritional deficit
caused by severe vomiting following chemotherapy and demonstrate why
there is a high dependency focus. Analysis of the problem including
current recommendations for nursing practice in relation this vomiting
together with a description of current research about this using six
recent, preferably Australian, research articles.

Request for Question Clarification by tehuti-ga on 16 Aug 2003 07:46 PDT
Are wanting someone to identify the six research articles for you, or
do you want a researcher to write to whole essay?

Clarification of Question by tropical-ga on 17 Aug 2003 06:01 PDT
Need 6 recent pref Australian research articles, with written
description of current research about the problem and analysis of the
problem [vomiting following chemotherapy] with the current
recommendations for nursing practice.

Clarification of Question by tropical-ga on 19 Aug 2003 03:26 PDT
OK - I change this. May I have recent research articles, including
some Australian pertaining to chemotherapy and vomiting, the resultant
consequences eg nutritional deficit caused by chemo and vomiting and
also nursing interventions. Don't worry about writing anything - just
articles will be fine.

Hope this makes your job easier as it will certainly make mine easier.


Request for Question Clarification by techtor-ga on 19 Aug 2003 10:25 PDT
Thanks for the kinds words on the last question, and the invitation to
this one. I did look around for resources, and what are most common in
my search results for nursing and chemotherapy are references to the
role of nurses in chemotherapy and oncology, mentioning vomiting but
not exactly saying what they should do in such situations.

I would assume the nurse would bring in a mop to clean up (I'm trying
to be humorous), but I'll see what else I could find.

Request for Question Clarification by techtor-ga on 19 Aug 2003 12:35 PDT
Oops, I've made a misleading error here. Rather than "references to
role of nurses in chemotherapy and oncology", they are actually
general references about chemotherapy and its side effects, while
there are other references, such as books (without any text shown)
that discuss the role of nurses in chemotherapy and oncology. My

Clarification of Question by tropical-ga on 20 Aug 2003 05:55 PDT
Thanks  Tehuti, As long as they are recent research articles
pertaining to chemo and vomiting [and by the way I wouldn't get a
bucket and mop as I am a sympathy purger!!! - I would be fighting them
for the bed n bowl!!!!]. I didn't mean to be off putting - I had
another question answered and unfortunately I didn't make myself clear
enough so I was endeavouring to make it easier for both of us.
PS If you are not in the mood to run a few words together any chance
of more than 6 articles so I can become a bit choosy? [fingers

Request for Question Clarification by tehuti-ga on 20 Aug 2003 07:41 PDT
Hello tropical,

I'm answering so you don't think I'm ignoring you, although I do not
have brilliant news.

I've found a few articles, but NOTHING from Australia in the time
frame you mention.  There is one article published this year in
Australia which looks at the efficacy and cost effectiveness of three
5-HT receptor antagonists, but only with respect to post-operative
nausea and vomiting.

Otherwise, I managed to get one article in full text which seems to
cover a lot of your remit. It discusses the pathophysiology of nausea
or vomiting; physiological consequences: impaired nutritional intake,
electrolyte imbalances and dehydration, pulmonary and gastrointestinal
complications and behavioral consequences. It looks at methods of
patient assessment and discusses pharmaceutical and non-pharmaceutical
management of the problem.

Other than that, I have references to:
- an article that looks at the currently available antiemetic
medications and reviews their uses in the treatment of
chemotherapy-induced nausea and vomiting;
- a pilot study pilot study on the use of progressive muscle
relaxation training to management nausea and vomiting;
- a study of the efficacy and cost benefits of a new oral antiemetic
- a news article that inadequate training of nurses in Europe
contributes to sub-optimal management of nausea and vomiting,
- an information sheet for medical professionals on nausea and
vomiting, which includes a bibliography.  It covers: Neurophysiology,
General Risk Factors And Etiologies, Anticipatory Nausea And Vomiting,
Acute / Delayed Emesis, Treatment Of Acute / Delayed Emesis, Nausea,
Vomiting, Constipation, And Bowel Obstruction In Advanced Cancer,
Alternative Management Of Nausea And Vomiting, Radiation Therapy

If any of this is along the lines of what you need, I can give you
what I have and/or continue to look, however, I'm not very confident
of getting the Australian connection.

Perhaps you might wish to let this stand a while, in case another
researcher has better luck. If not, you can reduce the price of the
question if you are willing to go for a partial answer.

Clarification of Question by tropical-ga on 20 Aug 2003 18:08 PDT
Thank you - I'll run with what you have as I too have been relatively unsuccessful.

Request for Question Clarification by tehuti-ga on 20 Aug 2003 18:34 PDT
Tropical, if you can bear with me, I'll get working on this in about 8
hrs time. It's 2.30 am in my neck of the woods, and I need to sleep. 
Anyway, what I've found so far is on a computer elsewhere!  I did put
in a plea to Australian researchers to see if they could come up with
something, but there has been no response.  I'll have a further dig
round tomorrow before I post an answer.  Best wishes, tehuti

Clarification of Question by tropical-ga on 20 Aug 2003 18:55 PDT
Hi Out There
This is the type of research I am interested. I probably should not
have narrowed it down to vomiting - I am actually doing Nutritional
Deficit which is resultant from vomiting/diarrhoea/inability to eat

This is an example and may help you - this one is pertaining to
mucositis - why say sore mouth when you can use a word that most don't

The Joanna Briggs Institute
About JBI [menu] - Publications - Services - Members Area - What's New
- Related Sites - Contact Us

Graphic Version |   Search this Site 



Systematic Review Protocol 


The prevention and treatment of 
oral mucositits in patients with cancer.



Criteria for considering studies for this review

Search strategy

Assessment of methodological quality

Data collection

Data synthesis



Mucositis is a common, debilitating complication of cancer
chemotherapy and radiotherapy, occurring in about 40% of patients
(Graham et al 1993). It results from the cytotoxic effects of
chemotherapeutic drugs and radiation on the oral mucosa. Mucositis
causes severe pain and distress, and may limit the tolerance to
chemotherapy, and hence its effectiveness. Furthermore, patients with
damaged oral mucosa and reduced immunity resulting from chemotherapy
and radiotherapy are prone to opportunistic microbial infections in
the mouth. Mucositis may be so severe that patients' food and fluid
intake, gum and dental condition, speech and self esteem are reduced,
further compromising patients' response to treatment and/or palliative
care. It is therefore extremely important that mucositis be prevented
whenever possible, or at least treated to reduce its severity and
sequelae. Currently there is a bewildering number of interventions to
choose from, but no high quality synthesis of the research evidence
for these interventions. Consequently there is a need for a systematic
review of the literature on treatment and prevention strategies for
chemotherapy- and radiotherapy-induced mucositis.

Several overviews (not systematic reviews) about caring for cancer
patients with mucositis have been identified during preliminary
searching of the electronic databases (Sonis and Haley 1996; Madeya ML
1996: Coleman 1995, Krishnasamy 1995). Mostly, these highlighted the
wide variety of interventions for prevention and treatment of this
condition, as well as the lack of research-based evidence for them.
Some of these overviews suggest guidelines for the assessment and
treatment of mucositis. Within the Cochrane collaboration there is a
review group called the Cochrane Oral Health Group. The aim of the
Oral Health Group is to review all the randomised controlled trials of
oral health, and prevention of mucositis is a minor sub section of
their interest. This review group appears to concentrate mainly on the
dental literature, and will be contacted soon so that we do not
duplicate their efforts.

The preliminary search of the literature identified numerous articles
about particular treatments for chemotherapy- or radiotherapy-induced
mucositis. Most of these concerned pharmacological treatments aimed at
reducing pain (eg. various methods of administering opioids),
inflammation (eg. topical glucocorticosteroids, NSAIDs) and infection
(locally applied antimicrobials). A limited number of studies
addressed other interventions to cope with the discomfort of mucositis
(eg. cryotherapy, acupuncture, relaxation, imagery), and its severity
(eg. diet therapy, vitamin E), or to reduce the likelihood of
infections (various oral hygiene protocols, mouthwashes). Articles on
prevention of mucositis considered agents like sucralfate which coat
the mucosa with a protective film, growth factors or nutrients to
stimulate the formation of new oral mucosal cells, and prophylactic
antimicrobials and immunoglobulin.

The articles uncovered in the preliminary search included many
clinical studies and randomised controlled trials, and numerous
observational studies. All these articles will be considered for
inclusion in the systematic review. The methods for conducting the
systematic review, and for assessing the quality of the evidence are
based on the work of the Cochrane Collaboration (Oxman 1994) and the
Centre for Reviews and Dissemination at the University of York (NHS
Centre for Reviews and Dissemination 1996).


To review all the available evidence on prevention and treatment
strategies for oral mucositis resulting from radiotherapy and/or
chemotherapy for cancer in adults.

The specific hypotheses to be tested are:

Interventions aimed at preventing oral mucositis are effective . 
Interventions aimed at treating oral mucositis are effective in terms
of reducing the severity, duration and deleterious sequelae of

Criteria for considering studies for this review

Types of participants

Adult patients with, or at risk of developing, oral mucositis
resulting from chemotherapy and/or radiotherapy for any cancer.

Types of intervention

All interventions aimed at preventing or treating oral mucositis
resulting from chemotherapy and/or radiotherapy for any cancer will be

Types of outcome measures

All outcome measures related to prevention/treatment of oral
chemo/radiotherapy-induced mucositis will be included. Outcome
measures of interest will be those related to the prevention or
treatment of oral mucositis, such as measurements of severity,
duration or complications.

Types of studies

This review will include any randomised or quasi-randomised controlled
trials that address the effectiveness of interventions to prevent or
treat chemotherapy- or radiotherapy-induced mucositis. In addition,
research on this topic utilising methods other than randomised
controlled trial, will be reviewed for possible inclusion in a
narrative summary.

Search strategy

The search will seek both published and unpublished studies. A two
step search method and optimal search strategy for MEDLINE, as
outlined by Dickersin et al (1994) will be used. An initial limited
search will be undertaken of all journals indexed in MEDLINE and
CINAHL for a one year period. An analysis of the text words contained
in the title, abstract and MeSH terms of relevant articles will be
undertaken to identify additional key words. For example, for MEDLINE
and CINAHL, mucositis, stomatitis, mouth disease* are all useful key
words, to be used with chemother*, radiation, radiother* and cancer.
However, each electronic database has its own indexing terms and
individual search strategies will be developed for each search.

The second search of databases will utilise all the key words. The
search for published studies will include the following sources,
looking back in time as far as possible:



Current Contents

Embase (for the European literature)


Social Science Citation Index

Cochrane Library


IDIS (Iowa Drug Information Service)

reference lists of identified studies and review papers

The search for unpublished studies will include the following sources:

Dissertation abstracts


Royal College of Nursing, Australia, research database

direct communication with key organisations and key researchers in the


Electronic searching usually results in the lists of articles with
details of title, author, source, and sometimes abstract. All
identified articles will be assessed on the basis of the abstract (or
title if abstract not available) by two reviewers, and full reports
will be retrieved for all studies which meet the inclusion criteria
for the review. Where doubt exists, the full article will be

Assessment of methodological quality

Methodological quality will be assessed using a checklist developed by
JBIEBN, and based on the work of the Cochrane Collaboration (Oxman
1994) and the Centre for Reviews and Dissemination at the University
of York (NHS Centre for Reviews and Dissemination 1996). The checklist
will be pilot tested prior to use. Two reviewers will independently
assess all the articles, and disagreements between reviewers will be
resolved by discussion with a third reviewer. Assessment of quality
will commence with experimental studies (randomised and
quasi-randomised trials), and will be extended to include research
utilising other methodologies in the absence of sufficient randomised
controlled trials.

Data collection

Data will be extracted independently by two reviewers using a data
extraction tool . Disagreements will be dealt with by a third
reviewer. The data extraction tool will be developed and pilot tested
before use. When necessary, the principal primary researcher will be
contacted to obtain missing information.

Data synthesis

Heterogeneity between comparable studies will be tested using the
standard chi-square test. Where possible, odds ratios and 95%
confidence limits will be calculated for each included study. If
appropriate with available data, results from comparable groups of
studies will be pooled in a meta-analysis. Based on this analysis, the
effectiveness and relative value of interventions will be estimated.
From the preliminary literature search it is likely that there will be
considerable statistical heterogeneity between studies due to the wide
variety of interventions of interest. Sub-group analysis will be
undertaken if a sufficient number of studies are identified that focus
on similar interventions to prevent or treat mucositis.

In studies where statistical pooling of results is inappropriate, the
findings will be considered for inclusion in the narrative summary.


Coleman S (1995) An overview of oral complications of adult patients
with malignant haematological conditions who have undergone
radiotherapy or chemotherapy. Journal of Advanced Nursing

Dickersin K, Scerer R and LeFebre C (1994) Identifying relevant
studies for systematic reviews. British Medical Journal 309:1286-91.

Graham KM, Pecoraro DA, Ventura M and Meyer CC (1993) Reducing the
incidence of stomatitis using a quality assessment and improvement
approach. Cancer Nurs 16(2):117-122.

Krishnasamy M (1995) Oral problems in advanced cancer. Eur J Cancer
Care Engl 4(4):173-7

Madeya ML (1996) Oral complications from cancer therapy: Part 2 -
Nursing implications for assessment and treatment. Oncology Nursing
Forum 23(5):808-19.

NHS Centre for Reviews and Dissemination (1996) Undertaking systematic
reviews of research on effectiveness: CRD guidelines for those
carrying out or commissioning reviews. York Publishing Services,
University of York.

Oxman A (ed) (1994) The Cochrane Collaboration handbook. The Cochrane
Collaboration, Oxford.

Sonis ST and Haley JD (1996) Pharmacological attenuation of
chemotherapy-induced oral mucositis. Expert Opinion on Investigational
Drugs 5/9:1152-62.    Last revised: 13 Aug 2003  

IntroductionCollaborating Centres MapHistoryList of current
membersBoard of ManagementResearch AssociatesStaff Contact DetailsAims
and ObjectivesMembershipHomeAbout Collaborating
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KongNew South WalesNew ZealandNorthern TerritoryThailandWestern
OptionsBest Practice Information SheetsChanging Practice Information
SheetsClinical Information ServiceSystematic Reviews
InformationNon-JBI Systematic ReviewsApproach to Systematic
ReviewsExecutive SummariesAnnual ReportsSUMARIRAPIDResearch RoomNotice
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MembersEducational InstitutionsMembership
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I haven't followed this site/articles up so I would be grateful if you
could. You will note the other sites that should be helpful.

Clarification of Question by tropical-ga on 20 Aug 2003 18:59 PDT
Good night Tehuti [morning] 
Sleep tight. I actually posted that last bit before I saw you had
already made a comment - can't complain about the service.
Subject: Re: Nursing problem, vomiting following chemo with 6 [1999-2003] research articl
Answered By: tehuti-ga on 21 Aug 2003 04:58 PDT
Rated:4 out of 5 stars
Hello tropical,

I’m afraid that, unlike in most civilized countries, the decrepit
public library system in the UK does not allow us access to electronic
databases as part of our membership rights, thinking all we really
want is physical access to dog-eared romance novels and similar!

However, I do have access by various routes to Medline
(, Cochrane (free access for UK residents),
CINAHL and ISI Web of Science, but not Embase and the other resources
you list.

The item you mention is a protocol for a systematic review carried out
for Cochrane.  Cochrane does not appear to have a systematic review of
direct relevance to your question. The nearest I could find are some
structured abstracts.  I cannot provide links, because I am using the
UK residents’ access

1. Structured abstract produced in 1998 of a 1994 paper (outside your
time scale, but perhaps still relevant since covered by Cochrane)
Smith M C, Holcombe J K, Stullenbarger E. A meta-analysis of
intervention effectiveness for symptom management in oncology nursing
research. Oncology Nursing Forum. 1994. 21(7). 1201-10.
“The interventions considered for the following symptoms were:  for
nausea and vomiting - medication, self-hypnosis, aerobics, relaxation
and ginger;
…. for chemotherapy side-effects - teaching;
….. for anorexia - teaching;
….. Authors’ conclusions: There is currently insufficient evidence to
recommend particular research-based nursing interventions for the
relief of symptoms in cancer patients, because of the wide variety of
instruments used, the lack of nursing theory foundations, missing
patients' characteristics, and the need for replications.
The Cochrane reviewers agree with this conclusion. 

2. Structured abstract produced in 2002 of a meta-analysis
Redd W H, Montgomery G H, DuHamel K N. Behavioral intervention for
cancer treatment side effects. Journal of the National Cancer
Institute. 2001. 93(11). 810-823.
Objective: To evaluate the clinical impact of behavioural
interventions in patients undergoing cancer treatment.
“The actual interventions included the following behavioural
components, either alone or in combination: relaxation; cognitive or
attentional distraction; hypnosis; desensitisation; rehearsal
modelling; contingency management; emotive imagery; and cognitive
restructuring. The interventions were carried out on an individual,
group, or family basis.
…. Studies supported the effectiveness of behavioural interventions in
controlling anticipatory nausea and vomiting. Twelve of the 13 RCTs
reported a statistically-significant benefit from behavioural
interventions when compared with a no treatment or attention control
interventions. Modest results were found in the 4 studies that
assessed behavioural interventions in post-chemotherapy side-effects.”
The Cochrane reviewers are fairly critical of the methodology used in
this meta-analysis.
They conclude: “The authors state that behavioural interventions can
effectively control anticipatory nausea and vomiting in adult and
paediatric patients undergoing chemotherapy. However, the evidence for
the efficacy of behavioural interventions in controlling post-
chemotherapy nausea and vomiting is less clear. Hypnotic-like methods,
involving relaxation, suggestion, and distracting imagery hold the
greatest promise for pain management.”

3. Structured abstract produced in 1999 of:
Klein S, Koretz R L. Nutrition support in patients with cancer: what
do the data really show?. Nutrition in Clinical Practice. 1994. 9(3).
This is a meta-analysis of the efficacy of parenteral and enteral
The authors conclude: “Many of the trials had serious shortcomings in
study design which made it difficult to draw definitive conclusions
from the data. In general, the data failed to demonstrate the clinical
efficacy of providing nutrition support to most patients with cancer.
Therefore, the indications for using nutrition therapy should be the
same as those for patients with benign disease.”
The Cochrane reviewers agree with this conclusion although they are
critical of the methodology used.

Here is the other material I have been able to find.  I’ve kept to
your time frame and not listed any papers dated prior to 1999. I did
try to broaden out the search, but most of the literature seems to
focus on nausea and vomiting. I have not been able to find pertinent
references from Australian sources, I’m afraid.

4. Chemotherapy-Induced Nausea and Vomiting
Catherine M. Bender, PhD, RN, Roxanne W. McDaniel, PhD, RN, Kathleen
Murphy-Ende, RN, PhD, AOCNŽ, Mary Pickett, PhD, RN, Cynthia N.
Rittenberg, RN, MN, AOCNŽ, Miriam P. Rogers, EdD, RN, AOCNŽ, CNS,
Susan M. Schneider, PhD, RN, CS, AOCNŽ, and Rowena N. Schwartz,
PharmD, BCOP
Clinical Journal of Oncology Nursing
March/April 2002 - Volume 6, Number 2

The article discusses the pathophysiology of nausea or vomiting;
physiological consequences: impaired nutritional intake, electrolyte
imbalances and dehydration, pulmonary and gastrointestinal
complications and behavioral consequences. It looks at methods of
patient assessment and discusses pharmaceutical and non-pharmaceutical
management of the problem. It has a good bibliography.
Full text at ONS Online (Oncology Nursing Society):
NB, despite the fact the URL implies this is a members only area of
the website, I reached it by following a link from my search results
on the Scirus scientific search engine.

5. The Oncologist, Vol. 8, No. 2, 187–198, April 2003
Chemotherapy-Induced Nausea and Vomiting: The Importance of Acute
Antiemetic Control
Frederick M. Schnell
“Evidence suggests that good control of nausea and vomiting during the
acute period correlates with the control of delayed emesis.
Conversely, protection failure during the first 24 hours has a high
predictive value for delayed emesis in the same cycle.The
5-HT3-receptor antagonists, regarded as the ‘gold standard’ in
antiemetic therapy, are the first-line treatment….
…..  Antiemetic therapeutic guidelines stress that the goal of therapy
is to prevent cytostatic-induced nausea and vomiting. Therefore, the
prophylactic use of the most effective antiemetic regimen—taking into
consideration the emetogenicity of the chemotherapy and individual
patient characteristics—must be adhered to in order to prevent acute,
delayed, and anticipatory nausea and vomiting.”
Full text pdf at

6. ASHP therapeutic guidelines on the pharmacologic management of
nausea and vomiting in adult and pediatric patients receiving
chemotherapy or radiation therapy or undergoing surgery
Full text pdf at

I have only been able to access abstracts for the following
references. I’ve supplied URLs to the abstracts in cases where I’ve
either found the article directly on Medline, or been able to find it
there subsequent to identifying it elsewhere.

7. Oncol Nurs Forum. 2003 Mar-Apr;30(2):259-71. 
Antiemetic therapy in patients receiving cancer chemotherapy.
Marek C.
“PURPOSE/OBJECTIVES: To examine the currently available antiemetic
medications and review their uses in the treatment of
chemotherapy-induced nausea and vomiting
…. CONCLUSIONS: Nurses are in a position to identify patients who are
at risk for NV and to manage their care using accepted practice
guidelines. IMPLICATIONS FOR NURSING: Although practice guidelines
have been established, the nurse's role in assessment and
implementation of care is critical in the prevention and management of
chemotherapy-induced NV.”

8. Eur J Cancer Care (Engl). 2000 Dec;9(4):230-4. 
A pilot study of the use of progressive muscle relaxation training in
the management of post-chemotherapy nausea and vomiting.
Molassiotis A.
“The aim of this pilot study was to assess the effectiveness of using
progressive muscle relaxation training (PMRT) in the management of
chemotherapy-related nausea and vomiting in Chinese breast cancer
patients receiving doxorubicin and cyclophosphamide as well as
feasibility issues for a larger study.
…. Despite the small sample size, the study showed that PMRT is an
effective adjuvant method to decrease nausea and vomiting in
chemotherapy patients. This has implications for nursing practice, as
it is a low-cost and easy-to-leam technique that can be incorporated
in the care planning of patients receiving chemotherapy.”

9. Oncol Nurs Forum. 1999 Oct;26(9):1453-8. 
The efficacy and cost effectiveness of new antiemetic guidelines.
Engstrom C, Hernandez I, Haywood J, Lilenbaum R..
“PURPOSE/OBJECTIVES: To develop antiemetic guidelines to improve
efficacy, optimize nursing and pharmacy time, increase compliance, and
enhance cost savings.
… CONCLUSIONS: The new oral antiemetic regimen compared favorably with
published data, was well-tolerated, and resulted in lower pharmacy and
nursing costs, with a cost saving potential of $20,000 per year.
IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses must be able to
implement state-of-the-art knowledge of chemotherapy, antiemetics, and
nonpharmacologic interventions to effectively manage the care of
patients receiving chemotherapy. This must be performed to achieve
cost effectiveness as well as useful clinical outcomes.”

10. AACN Clin Issues. 2000 Nov;11(4):590-603. 
    Management of cancer cachexia.
    Finley JP.
This is a review of the literature: “Control of symptoms, such as
anorexia, nausea and vomiting, and mucositis is imperative in the
management of cancer cachexia. Current pharmacologic therapies, as
well as complementary and alternative methods, are presented. The
nurse plays a key role in ensuring that the nutritional needs of
oncology patients are met.”

11. J Pain Symptom Manage. 2002 Sep;24(3):345-58. 
Treatment of nausea and emesis during cancer chemotherapy.
Discrepancies between antiemetic effect and well-being.
Borjeson S, Hursti TJ, Tishelman C, Peterson C, Steineck G.
“In study I, a combined antiemetic strategy including a nursing
intervention program (increased access to support and increased
information) and antiemetics based on high-dose metoclopramide and
dexamethasone was compared with the standard antiemetic treatment
during the 1980s. In study II, ondansetron plus dexamethasone/placebo
was evaluated.
…. The mean intensity of acute nausea during the first cycle was
higher in the groups in study I, as compared to the groups in study
II. The group receiving a nursing intervention reported better
well-being than the other groups. Duration of nausea was an important
predictor of well-being, even when nausea intensity was controlled.”

12  Garrett K, Tsuruta K, Walker S, Jackson S, Sweat M. 
Managing nausea and vomiting. Current strategies.
Crit Care Nurse. 2003 Feb;23(1):31-50
“The authors present the physiological mechanisms of nausea and
vomiting and compare therapeutic agents recommended for treating and
preventing nausea and vomiting. Because most episodes of nausea and
vomiting are preventable, implications for critical care nursing will
focus on prevention rather than control.”

13. Support Care Cancer. 2002 Oct;10(7):519-22. 
Antiemetic guidelines: creating a more practical treatment approach.
Koeller JM, Aapro MS, Gralla RJ, Grunberg SM, Hesketh PJ, Kris MG,
Clark-Snow RA.
“Antiemetic guidelines from a variety of professional organizations
have been available for several years. It is unclear just how often
these guidelines have been used, however; data indicate that some
practitioners still do not treat their patients according to the
recommendations. Some of those involved in the creation of the
original guidelines convened to try to create a simpler, more
practical approach to the use of antiemetics in preventing
chemotherapy-induced nausea and vomiting.
…. Patients' management should be considered over a 4- to 5-day
period, rather than primarily dealing with the day of treatment only.
The group created three tables: emetic risk of chemotherapy; treatment
options based on emetic category; and antiemetic dosing
recommendations. Use of these tables should make appropriate
antiemetic selection more straightforward and easier for the
practitioner in an everyday setting”

14 Int J Palliat Nurs. 2002 Jul;8(7):331-5. 
  An overview of chemotherapy-induced emesis highlighting the role of
lorazepam as adjuvant therapy.
Cooper R, Gent P.
” This article reviews improvements made in antiemetic therapy and
considers how the addition of lorazepam may further optimize the
prevention and management of emesis at various stages of

15  Gan To Kagaku Ryoho. 2003 Jun;30(6):765-71.
[Chemotherapy-induced diarrhea]  [Article in Japanese]
Kobayashi K.
“Chemotherapy-induced diarrhea is a well-documented side effect of
many cancer treatments and is associated with increased morbidity and
The author reviews the topic with reference to irinotecan (CPT-11).
The following part of the abstract might be useful, because it
supplies other references for potential follow up:
“To prevent CPT-11-induced delayed diarrhea, oral alkalization (OA)
and control of defecation (CD) [Int J Cancer 92: 269-275, 2001] were
developed based on fundamental studies [Int J Cancer 83: 491-496,
1999; Cancer Res 62: 179-187, 2002]. Oral administration of
antibiotics [Cancer Res 56: 3752-3757, 1996; Clin Cancer Res 7:
1136-1141, 2001] or kampo medicine [Jpn J Cancer Res 86: 978-984,
1995; Jpn J Cancer Res 86: 985-989, 1995] to decrease
beta-glucuronidase activity derived from bacteria in the large
intestine was also reported to be successful in preventing delayed
diarrhea. When CPT-11-induced delayed diarrhea occurs, the
conventional treatment is loperamide [J Natl Cancer Inst 86: 446-449,
1994], and the early recognition and treatment of diarrhea with this
opioid has reduced, although not entirely eliminated, patient
morbidity. Other therapies are needed to treat patients with
loperamide-refractory CPT-11 induced diarrhea, and the successful use
of the somatostatin analogue octreotide has been reported [Support
Care Cancer 9: 258-260, 2001; Ann Oncol 12: 227-229, 2001; Proc Am Soc
Clin Oncol 21: 387a, 2002].”

Incidentally, the Medline search “cancer chemotherapy diarrhea”
retrieved mostly Japanese papers!

16. Support Care Cancer. 2003 Mar;11(3):156-61. 
Is delayed chemotherapy-induced emesis well managed in oncological
clinical practice? An observational study.
 Fabi A, Barduagni M, Lauro S, Portalone L, Mauri M, Marinis F,
Narduzzi C, Tonini G, Giampaolo M, Pacetti U, Paoloni F, Cognetti F.
“……  The Consensus Conference held in 1997 outlined the therapeutic
procedure to prevent delayed emesis that might otherwise be induced by
chemotherapy. So far, no study has evaluated the correct management of
delayed emesis in clinical practice.
….. analysis of the data took account of whether the chemotherapy had
a high (HEC), moderate (MEC) or low (LEC) emetogenic potential.
…. We deduce from the study that antiemetic treatment for delayed
emesis in clinical practice needs more attention. Correct prophylaxis
is necessary when HEC is given, and antiemetic protection for patients
receiving MEC must be improved; among patients treated with LEC those
at high risk must be identified so that overtreatment can be avoided.”

17. Patients needlessly suffering from chemotherapy induced nausea and
New survey identifies need for new nurse awareness and training
Venice, Saturday 13 April, 2002. 
”Nearly two decades after the introduction of highly effective
antiemetic (anti-nausea) therapies, almost a third of patients are
still suffering from chemotherapy induced nausea and vomiting (CINV).
Unmet needs in nurse training may be contributing to this sub-optimal
patient care.
Delegates attending the third biannual convention of the European
Oncology Nursing Society (EONS) heard for the first time results of a
pan-European nurse survey, the aim of which was to identify unmet
training and treatment needs in the management of CINV.
…. Commenting on the results of the survey, Giel Vaessen, President,
EONS, said," The survey has clearly demonstrated an unmet need in
patient management and nurse training."
"The high incidence of CINV uncovered by this survey is clearly
unacceptable. While inappropriate utilization of anti-emetics
significantly contributes to poor CINV control, another key issue is a
lack of relevant nurse training. In addition, a low level of awareness
of the issue and cultural influences may also be a contributory
factor" he concluded.
Trained oncology nurses have a significant influence over treatment
strategies with 39% of respondents having a high, and 28% having a
moderate involvement in the decision regarding which anti-emetic
treatment is used.” 

18. Information on nausea and vomiting from the US National Cancer
Institute, which includes a bibliography:
General Risk Factors And Etiologies
Anticipatory Nausea And Vomiting
Acute / Delayed Emesis
Treatment Of Acute / Delayed Emesis
Nausea, Vomiting, Constipation, And Bowel Obstruction In Advanced
Alternative Management Of Nausea And Vomiting
Radiation Therapy 

Search strategy: searches on (a scientific
search engine) and on the databases listed above.  Search terms: 1.
vomiting, chemotherapy, nursing  2. vomiting, chemotherapy, management
 3.  cancer, chemotherapy, nutritional   4. cancer, chemotherapy,
anorexia 5. cancer chemotherapy diarrhea

I hope this to some extent meets your needs.  If not, please use the
request clarification feature, and I will try to dig around some more.
tropical-ga rated this answer:4 out of 5 stars
Thanks Tehuti, I apologise for the delay in 'rating'.

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