CHRONIC NAUSEA IN ADVANCED CANCER-PATIENTS - A RETROSPECTIVE ASSESSMENT OF A METOCLOPRAMIDE-BASED ANTIEMETIC REGIMEN

The purpose of this retrospective study is to assess the frequency and intensity of chronic nausea in patients admitted to the Palliative Ca re Unit and the results of a metoclopramide-based treatment regimen. W e reviewed the medical records of 100 consecutive patients admitted to the Palliative Care Unit at the Edmonton General Hospital until death during 1992-1993. All patients had terminal cancer and normal cogniti ve function. All patients completed the Functional Analogue Scale from appetite, nausea, pain, activity: shortness of breath, and sensation of well-being at 1000 and 1600 hours every day. Patients who complaine d of nausea initially received metoclopramide 10 mg every 4 hr orally or subcutaneously (Step 1). If nausea persisted, dexamethasone 10 mg t wice daily was added (Step 2). Step 3 consisted of a continuous subcut aneous infusion of metoclopramide of 60-120 mg/day plus dexamethasone. If no response was observed, other antiemetics were administered (Ste p 4). Upon admission to the unit, 32 patients (32%) presented with nau sea. During the average admisssion of 25 +/- 13 days, 98 patients (98% ) developed nausea. Twenty-five patients (25%) required other antiemet ics because of bowel obstruction (18), extrapyramidal side effects (3) , or other reasons (4). Most patients without bowel obstruction achiev ed excellent control of nausea using the metoclopramide-based regimen. During the first 5 days and last 5 days of admission, nausea had sign ificantly lower intensity than the rest of the symptoms that were moni tored. Our results suggest that, although nausea is very frequent, it can be well controlled in the majority of patients using safe and simp le antiemetic regimens.