Nausea and vomiting in end-of-life care: managing this debilitating symptom in the community

Nausea, an unpleasant sensation in the stomach, accompanied by a feeling of the need to vomit, and vomiting, the dynamic explosion of gastric contents through the mouth, are different physiologic processes, activating the same neural pathways (Wickham, 2020). Nausea and vomiting (N&V) is often multicausal for patients with advanced cancer receiving palliative care, often as a consequence of their primary disease, treatments including anti-cancer therapies, impaired gastric emptying, opioid use, or cranial causes (Leach, 2019). Collis and Mather (2015) and Glare et al (2011) highlight the importance of a comprehensive assessment in determining the cause and likely reversibility of N&V, thereby providing accurate information related to the antiemetic strategy. The antiemetic strategy is based on sound knowledge of the mechanism of N&V, the pathophysiology of this mechanism and the pharmacology of the drugs available, ensuring effective prescription and administration of medication to ameliorate the identified mechanism causing the N&V (Glare et al, 2008). There is recognition that a specific palliative care assessment tool, such as the Pepsi-Cola mnemonic (Gold Standards Framework Centre, 2014) (see Tables 1a and 1b), can complement clinical experience and assessment, directing the assessor to obtain an in-depth history and to identify the palliative care needs and support required of the person receiving care (Faull and Blankley, 2015).