化疗引起的恶心呕吐的预防与管理

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1、Evidence,Challenges andSolutions:PreventingandManagingChemotherapy-InducedNauseaandVomitingScottEdwards,PharmDClinicalOncologyPharmacistEasternHealth,St.John’s,NLNOPS2008PatientPerceptionsoftheMostSevereSideEffectsofCancerChemotherapyRank198311993219953199941

2、.VomitingNauseaNauseaNausea2.NauseaConstantlytiredLossofhairLossofhair3.LossofhairLossofhairVomitingConstantlytired4.ThoughtofcomingfortreatmentEffectonfamilyConstantlytiredVomiting5.LengthoftimetreatmenttakesVomitingHavingtohaveaninjectionChangesinthewaythin

3、gstasteAdaptedfrom:1CoatesAetal.EurJCancerClinOncol.1983;19:203-8.2GriffinAMetal.AnnOncol.1996;7:189-95.3DeBoer-DennertMetal.BrJCancer.1997;76:1055-61.4LindleyCetal.CancerPract1999;7:59-65.CINV-DefinitionsAcute–withinafewminutestoseveralhoursafterdrugadminist

4、rationandcommonlyresolveswithin24hours.Delayed–developsinpatientsmorethan24hoursafterchemotherapyadministration.Maylastupto6daysItcommonlyoccurswithcisplatin,carboplatin,cyclophosphamideand/oranthracyclines.Anticipatory–nauseaand/orvomitingbeforepatientsrecei

5、vetheirchemotherapy,afterapriornegativeexperiencewithchemotherapyBreakthrough–occursdespiteprophylactictreatmentand/orrequiresrescue.Refractory–nauseaandemesisduringsubsequentcycleswhenantiemeticprophylaxisand/orrescuehavefailedinearliercyclesAdaptedfrom:ASHP

6、AmJHealthSystPharm1999;56:729-764NCCNPracticeGuidelinesinOncology–Version3.2008.AntiemesisRatesofCINVAdaptedfrom:1.HickokJT,etal.Cancer.2003;97:2880-6.2.http://www.ashpadvantage.com/previous_meetings/mcm_2005/cemornings2005/CEM_CINV_handout.pdfChemotherapy-In

7、ducedEmesisRiskFactorsPatient-relatedriskfactorsinclude:YoungerageFemalegenderNo/minimalpriorhistoryofalcoholusePriorCINVAnxietyHighpretreatmentexpectationofseverenauseaAdaptedfrom:GregoryREetal.Drugs.1998.;2.HeskethPJetal.JClinOncol.1997.RoscoeJA,BushunnowP,

8、MorrowGR,etal.Patientexperienceisastrongpredictorofseverenauseaafterchemotherapy:aUniversityofRochesterCommunityClinicalOncologyProgramstudyofpatientswithbreastcarcinoma.Cancer2004;101:27