title: An assessment of aetiology-based guidelines for the management of nausea and vomiting in patients with advanced cancer.
abstract: OBJECTIVE
  The aim of this study was to assess the effectiveness of aetiology-based guidelines for the management of nausea and vomiting (N&V) in patients with advanced cancer.
  
  
  METHODS
  This was a prospective study of 121 patients admitted to a hospice. Patients with N&V underwent assessments at presentation, 48 h and 1 week, to determine the aetiology of N&V and the response to treatment. Antiemetics were prescribed according to aetiology-based guidelines.
  
  
  RESULTS
  Sixty-one patients (50%) had N&V during their admission: 21 (17%) had isolated nausea, 2 (2%) had isolated vomiting and 38 (31%) had combined N&V. During the assessment period, physicians altered their opinion about the primary cause of N&V in 26% of cases and finally expressed confidence about the aetiology in 75% of patients. The most common cause of N&V was impaired gastric emptying (contributing in 44% of patients), followed by chemical causes (33%) and bowel obstruction (19%). At 1 week, nausea was controlled in 56% of patients, and vomiting in 89% of patients, and residual symptoms were generally mild.
  
  
  CONCLUSIONS
  An approach using aetiology-based guidelines in the management of N&V is moderately effective, although there are some patients with N&V refractory to standard antiemetic regimens.
authors.affiliation: St. Luke's Hospice, Stamford Road, Turnchapel, Plymouth, PL9 9XA, UK. jeff.stephenson@stlukes-hospice.org.uk
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Stephenson
authors.forename: Andrew
authors.initials: A
authors.lastname: Davies
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000627:therapeutic use; D000077608:Aprepitant; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy*; D009369:Neoplasms / Q000145:classification*; D010166:Palliative Care; D011446:Prospective Studies; D006113:United Kingdom; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D000932:Antiemetics; D009025:Morpholines; D000077608:Aprepitant