Supportive Care for Treatment of Hematologic Malignancies

Nausea and vomiting are the most common adverse effects of conventional chemotherapy and radiation therapy. Nausea and vomiting may occur due to treatment, emotional distress, central nervous system disorders, or gastrointestinal related issues and/or unknown etiology. Chemotherapy-induced nausea and vomiting (CINV) may lead to metabolic disturbances and significantly impact the quality of life. Therefore, prevention and management of CINV are crucial in the treatment of cancer. Depending on the emetogenic potential of either intravenous or oral chemotherapy regimen, recommended antiemetics vary. As many of the cancer treatments are administered as combination therapies, provider must offer antiemetic agents that are effective for the highest emetogenic risk level of any single agent in the regimen except for anthracycline and cyclophosphamide combinations which synergistically lead to high emetogenicity. Antiemetic prophylaxis for a given day as well as prophylaxis for delayed CINV should be considered for 2–3 days after the last dose of high to moderately emetogenic chemotherapy. Antiemetic regimen may include serotonin antagonists, substance P (NK1) antagonists, dopamine antagonists, corticosteroids, atypical antipsychotics, antihistamines, anticholinergics, cannabinoids, and anxiolytics. Generally, combination of 3–4 antiemetics are recommended; however, adverse effects such as QT prolongation and extrapyramidal symptoms should be assessed for each patient prior to administration.