title: 2016 Updated MASCC/ESMO consensus recommendations: Management of nausea and vomiting in advanced cancer.
abstract: The aim of this paper is to review the existing literature related to the management of nausea and vomiting (N & V) in advanced cancer and derive clinical evidence-based recommendations for its management.
  
  
  
  Available systematic reviews on antiemetic drug effectiveness were used. One generic systematic review of antiemetics in advanced cancer (to 2009) was updated to February 2016. Agreement on recommendations was reached between panel members, and these were voted in favor unanimously by the larger antiemetic committee membership (n = 37).
  
  
  
  The evidence base in this field is minimal with largely poor quality trials or uncontrolled trials and case studies. The level of evidence in most studies is low. The drug of choice for managing N & V in advanced cancer is metoclopramide titrated to effect. Alternative options include haloperidol, levomepromazine, or olanzapine. For bowel obstruction, the recommendation is to use octreotide given alongside an antiemetic (haloperidol) and where octreotide is not an option to use an anticholinergic antisecretory agent. For opioid-induced N & V, no recommendation could be made.
  
  
  
  These new guidelines, based on the existing (but poor) evidence, could help clinicians manage more effectively the complex and challenging symptoms of N & V in advanced cancer.
authors.affiliation: Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland. walshtd@tcd.ie.|Faculty of Health Sciences, Trinity College Dublin, Dublin 2, Ireland. walshtd@tcd.ie.|School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. walshtd@tcd.ie.
authors.forename: Declan
authors.initials: D
authors.lastname: Walsh
authors.affiliation: Section of Palliative Medicine and Supportive Oncology, Department of Hematology- Oncology, The Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Mellar
authors.initials: M
authors.lastname: Davis
authors.affiliation: Supportive Care in Cancer Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Ripamonti
authors.affiliation: Department of Palliative, Rehabilitation, & Integrative Medicine UT MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.affiliation: Supportive & Palliative Care Department, St. Luke's Cancer Centre, Royal Surrey County Hospital / St. Luke's Cancer Centre, Guildford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davies
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China, SAR.
authors.forename: Alex
authors.initials: A
authors.lastname: Molassiotis
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000628:therapy*; D009369:Neoplasms / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D014839:Vomiting / Q000139:chemically induced / Q000628:therapy*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents
keywords: Antiemetics; Cancer; Nausea; Palliative care; Symptoms; Vomiting