Im 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
(http://www.nlm.nih.gov/), Cochrane (free access for UK residents),
CINAHL and ISI Web of Science, but not Embase and the other resources
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
. 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
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. Ive 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, Im 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,
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, 187198, April 2003
Chemotherapy-Induced Nausea and Vomiting: The Importance of Acute
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 regimentaking into
consideration the emetogenicity of the chemotherapy and individual
patient characteristicsmust be adhered to in order to prevent acute,
delayed, and anticipatory nausea and vomiting.
Full text pdf at http://theoncologist.alphamedpress.org/cgi/reprint/8/2/187.pdf
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 http://www.ashp.org/bestpractices/tg/Therapeutic%20Guideline%20Pharmacologic%20Management%20of%20Nausea%20and%20Vomiting%20in%20Adult%20and%20Pediatric.pdf
I have only been able to access abstracts for the following
references. Ive supplied URLs to the abstracts in cases where Ive
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.
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
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.
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.
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
. 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,
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]
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
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
Search strategy: searches on http://www.scirus.com (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.