Running head: EVIDENCED BASED PAPER
Pharmacologic vs. Non-Pharmacologic Evidenced-Based Paper
Shannon Demboski
NURS 315
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EVIDENCED BASED PAPER
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Abstract
Pharmacologic and non-pharmacologic treatments in patients who are experiencing nausea and
vomiting with advanced cancer while receiving chemotherapy treatments is explored. Popular
pharmacological treatments include the use of anti-emetic and anti-nausea medications. Guided
imagery, progressive muscle relaxation, self-hypnosis, and music therapy are popular nonpharmacological methods used. One or more of these techniques may be used at the same time
in order to provide the patient with the best possible experience while reducing the unpleasant
symptoms of chemotherapy treatment.
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Pharmacologic vs. Non-pharmacologic Treatments for
Symptomatic Control of Advanced Disease
Nausea, vomiting, and retching are among the most common and distressing symptoms
that patients encounter when dealing with advanced disease. “Nausea and vomiting are one of
the most frequently reported adverse effects that significantly affect patients’ daily functioning,
quality of life, and compliance with therapy” (Rhodes & McDaniel, 2001, p. 232). Management
of these symptoms both with pharmacologic and non-pharmacologic treatments vary depending
on the state of advanced disease and the individual patient. People may will experience similar
symptoms but the cause of the symptoms and each person’s response to the symptoms and
treatments have a wide variety of outcomes. An “accurate assessment of the individual’s
symptoms provides the basis for custom-designed management and patient education that
promotes and enhances coping and self-care behaviors” (Rhodes & McDaniel, 2001, p. 233).
Nausea, vomiting and retching have different meanings but are often referred to as the same
thing. A thorough assessment should be conducted with the patient to determine the meaning to
the individual patient. Nausea and vomiting may have different meanings to patients from
different cultural and ethnic backgrounds. In order to effectively treat and manage the
symptoms, an accurate assessment of understanding is necessary.
This paper will discuss pharmacologic and non-pharmacologic treatments for nausea and
vomiting related to advanced disease in patients who have cancer and are receiving
chemotherapy. Pharmacologic treatments include medications while non-pharmacologic
treatments include guided imagery, progressive muscle relaxation, music therapy and selfhypnosis.
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Descriptive Summary of Evidence
Nausea
Nausea and vomiting is often referred to as one in the same, but in actuality nausea
usually precedes vomiting. “Nausea is considered to be the most debilitating effect of
chemotherapy for many patients, impairing quality of life and physical well-being” (Casey,
2012, para 7). Patients who have nausea usually have decreased level of functioning, poor
appetite and nutrition. As a result patients will experience weight loss, dehydration and the loss
of income due to the inability to work. It can be difficult to assess nausea in patients since it is
subjective. Nurses should ask the patient questions regarding the severity, frequency duration of
the nausea, along with the level of discomfort and distress it is causing.
The management of nausea in chemotherapy patients can be challenging. The use of
anti-emetic drugs have multiple levels of success and often do not work well in patients who are
experiencing severe nausea (Casey, 2012).
Vomiting
Retching and vomiting occurs as a result of a stimulus and a chain of anatomical events.
Retching and vomiting involves “autonomic stimulation that induces hyper-salivation (a reflex
designed to protect teeth from stomach acid), vasoconstriction and pallor, cold sweat and the
release of antidiuretic hormone” (Casey, 2012, para 13). Nausea usually occurs before vomiting
but it does not determine the severity of the vomiting. If vomiting is prolonged it may lead to
malnutrition and may impact a patients’ health.
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Treatments for Nausea and Vomiting
Anti-nausea medications are usually given before chemotherapy treatment begins and is
given on a scheduled basis for several hours or days after treatment. A person may receive
additional medications if nausea and vomiting after chemotherapy (Mayo Clinic, 2011). Antiemetic medications have been more successful in treating vomiting than nausea (Casey, 2012).
There are many anti-emetics medications but the drug of choice for chemotherapy patients are
Dolasetron mesylate (Anzemet), Granisetron HCI (Kytril), and Ondansetron HCI (Zofran). All
three of these medications work on a specific type of nerve cell receptor and have been proven
effective in preventing nausea and vomiting in chemotherapy patients (Eremita, 2001). While
the use of these medications has shown to reduce nausea and vomiting, the do come with side
effects of their own such as headaches, constipation, diarrhea and hypersensitivity.
Non-pharmacological techniques can be useful in treating nausea and vomiting associated
with chemotherapy treatment. Guided imagery, progressive muscle relaxation, hypnosis, and
music therapy are some of the techniques that can be used to help prevent the unpleasant side
effects from chemotherapy (Eremita, 2001). All of these non-pharmacological methods can be
used to help reduce nausea and vomiting by relaxation, distraction and allows a person to feel a
sense of control.
Guided imagery is a technique used to help reduce nausea and vomiting in cancer patients
by allowing the mind to imagine it is in a different place. “Guided imagery allows people
mentally remove themselves from the cancer treatment and imagine that they are in a place that
they enjoy and that is relaxing” (American Cancer Society, 2012, para 5). The place can be any
spot a person feels relaxed and enjoys spending time, such as favorite vacation destination, their
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home, or another pleasant place. The use of guided imagery allows patients’ to close their eyes
and use their senses to visualize a pleasant place while the brain blocks the sensations that cause
nausea and vomiting (American Cancer Society, 2012). Researchers have been studying how
images can trigger physiological changes in mind and body. “The brain cannot tell the
difference between an image that is actually seen and the one that you are simply imagining
inside the head, so it responds just as strongly to an image that is real” (Michaud, 2003).
Progressive muscle relaxation is a “technique used to help a person relax by teaching how
to progressively tense and release different muscle groups. It has been used in patients to help
decrease nausea and vomiting in chemotherapy patients” (American Cancer Society, 2012, para
5). Patients who learn how to use this method use it as a way to help them deal with stress,
anger, pain and depression (American Cancer Society, 2012).
Music therapy is a technique that is used to reduce the effects of chemotherapy endued
nausea and vomiting. Music therapy may be used to help reduce blood pressure, anxiety, stress
and heat rate by allowing a person to relax calmly (American Cancer Society, 2012). A variety
of music selections are available based upon the likes of the patient. “There is some evidence
that, when used with standard treatment, music therapy can help to reduce nausea and vomiting
due to chemotherapy” (American Cancer Society, 2012, para 12).
Self-hypnosis was “the first technique used to make behavior changes to control nausea
and vomiting. It creates a state of intense attention, willingness, and readiness to accept an idea.
It has been shown to work very well with children and teens. ” (American Cancer Society, 2012,
para 5). Self-hypnosis is not something everyone will be willing to try but it has been a popular
way to help with nausea and vomiting in chemotherapy treatments.
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Analysis of Evidence
Nausea and Vomiting in advanced cancer patient who receiving chemotherapy can be
treated with pharmacological and non-pharmacological treatments. Approximately 60 % of
advanced cancer patients will experience nausea and 30% will have vomiting (Gupta, 2013).
Non-pharmacological treatments may be used without the use of medications in patients with a
mild case of nausea or vomiting (American Cancer Society, 2012). Pharmacological treatments
may be used prior to chemotherapy treatment and in some cases used post treatment depending
on the severity of the nausea and vomiting. Often these treatments are used together to reduce
the unpleasant side effects of nausea and vomiting in relation to cancer treatments.
The use of anti-emetic and anti-nausea medications can drastically help reduce nausea and
vomiting in patients who are receiving chemotherapy. The medications do have side effects such
as headaches, constipation, diarrhea and hypersensitivity. These side effects are taken into
consideration when a patient choses to try the medications. Many patients would rather deal
with these side effects over nausea and vomiting. Nurses can help educate patients what to
expect during treatment, discuss the medications that are available to them and what side effects
they may experience. A detailed history and assessment of the patient need to be determined in
order to properly treat the nausea and vomiting (Gupta, 2013). The use of these medications are
very effective in treating nausea and vomiting in patients and they are likely to control these
distressing symptoms (Eremita, 2001).
Nurses can help promote the use of non-pharmacologic techniques of self-relaxation to
patients. The use of guided imagery can help a patient focus on a place they would like to be
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where they feel calm and relaxed. The mind is powerful, when a person focuses and imagines
they are in a particular place the mind does not know the difference. Progressive muscle
relaxation is another way nurses can help patients learn to help relieve stress and help them relax.
It is a technique that is used in chemotherapy patients to help combat the side effects of the
treatment. The use of music therapy has been known to help reduce the anxiety, blood pressure,
heart rate and nausea and vomiting. Music therapy is very popular and is used often as a form of
non-pharmacological treatments. Nurses can assist patient in music selection and can promote
an environment where relaxation and guided imagery can occur. The use of guided imagery and
music have been shown to work well together to promote relaxation and distraction. Selfhypnosis is a technique that has weak evidence on the success related to nausea and vomiting
treatment. Self-hypnosis is an interesting concept but the needs further research to determine the
effectiveness it has on nausea and vomiting.
The American Cancer Society (2012) provided very useful information regarding the
possible treatments used in patients who are undergoing chemotherapy treatment. Research
suggests the use of pharmacological medications have been used successfully. Nonpharmacological techniques have positive outcomes but there is limited research available to
review on some of the techniques discussed. The positive side about using non-pharmacologic
techniques is they come without side effects and anyone can learn to use them. Multiple
techniques and treatments may be used at the same time in order to treat nausea and vomiting
more effectively.
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Recommendations
Treatment
Multiple treatment options have been reviewed regarding the treatment of nausea and
vomiting in chemotherapy patients. Nurses should do an in depth assessment in order to provide
the best possible treatment option available to the patient. Pharmacologic medications used to
treat nausea and vomiting are welcomed and provide relief for patient and should be used. Nonpharmacologic treatments and techniques such as guided imagery, progressive muscle relaxation
and music therapy can be used in conjunction with the medications to enhance the well-being of
the patient. Nurses can use guided imagery to help the patient think they are in a place they
enjoy which takes the patients mind off of being in a hospital and the reality of what is
happening around them. Music therapy is another way to relax the mind and body. Music
therapy can ease the patient, allowing them to forget about reality for a while. Nurses can
encourage and promote the use of these techniques to the patient (American Cancer Society,
2012). Patient who have a positive experience will be more likely to continue with treatment and
are more likely to have a positive outcome.
Conclusion
Nausea and vomiting are one of the most unpleasant side effects that patients with
advanced cancer receiving chemotherapy treatment will experience. Nurses can help patients
combat these unpleasant side effects by properly assessing what nausea and vomiting means to
them and assessing their level of tolerance. A wide variety of treatments are available to
patients, including pharmacological and non-pharmacological. Pharmacological treatments such
as anti-emetic and anti-nausea medications are a good choice to help combat nausea and
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vomiting. Non-pharmacologic treatments such as the use of guided imagery, progressive muscle
relaxation, and self-hypnosis and music therapy can be used alone or in conjunction with the
medications to promote a more positive experience for the patient. The overall goal is to reduce
the unpleasant side effects the patient is experiencing from chemotherapy treatments. Nurses can
assist patients in helping control these distressing symptoms.
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References
American Cancer Society. (2012). Nausea and vomiting. Other treatments for nausea and
vomiting. Retrieved from http://www.cancer.org/treatment/treatmentsandsideeffects
Casey, G. (2012). Treating nausea and vomiting. Kai Tiaki: Nursing New Zealand, 18 (11), 20.
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Eremita, D. (2001). Dolasetron for chemo nausea. Rn, 64(3), 38-40. Retrieved from http://0web.ebscohost.com.libcat.ferris.edu
Gupta, M., Davis, M., LeGrand, S., Walsh, D. & Lagman, R. (2013). Nausea and vomiting in
advanced cancer: The cleveland clinic protocol. The Journal of Supportive Oncology, 11,
8-13. Retrieved fromhttp://www.oncologypractice.com/fileadmin/content_images
Rhodes, V. A. and McDaniel, R. W. (2001), Nausea, Vomiting, and Retching: Complex
Problems in Palliative Care. CA: A Cancer Journal for Clinicians, 51: 232–248. doi:
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Mayo Clinic. (2011). Chemotherapy. Chemotherapy nausea and vomiting: Prevention is best
defense. Retrieved from http:www.mayoclinic.com/health/cancer
Michaud, E. (2003). Healing with your sixth sense. Prevention, Emmaus: PA, 55(5), 154-161.
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