 By Dr
Ednin Hamzah, CEO/Medical Director of Hospis Malaysia
 ll of
us have, at some point in our lives, experienced the
feelings of nausea and the indignity of vomiting. It may
have been due to gastric problems, migraine, being seasick
or for some, due to more sinister reasons. However, there is
little doubt that it is a rather unpleasant symptom.
It is important to deal with nausea and vomiting in the
context of Palliative Care as both symptoms lead to further
pain and suffering. A person feeling nauseous or
experiencing vomiting will undoubtedly feel weak, tired,
have no appetite and have difficulty in taking medications.
As a consequence, the person may become dehydrated, be in
pain or perhaps not dare to venture out for fear of vomiting
or feel that he is a burden to his care-givers (usually
family members).
Nausea and vomiting in persons suffering from cancer may be
caused by the disease itself, chemotherapy, medications,
electrolyte imbalance, pressure on the stomach, an
obstruction to the digestive process as well as more general
causes mentioned earlier. It may also be due to stress and
psychological issues. In such persons therefore, these
symptoms may actually be due to many causes and a successful
treatment needs to address the various causes.
The treatment of this debilitating symptom firstly involves
an accurate assessment of the person/patient. It involves
taking a detailed history of the symptom, examining the
patient thoroughly and having the knowledge to decide on the
cause of the problem. Some investigations may be helpful
such as X rays or blood tests.
The treatment then depends on the cause or causes.
Medications such as metochlorpamide, prochlorperazine,
haloperidol and domperidome may be useful if the cause is
due to poor gastric function or a central imbalance stemming
from the vomiting centre in the brain. For chemotherapy
induced nausea and vomiting, there are specific drugs that
work very effectively. If the cause is due to gastric
obstruction, an operation may be necessary. Too much
pressure on the stomach due to the accumulation of excess
fluid in the abdomen may be improved simply by draining the
fluid.
If the symptom is caused by electrolyte imbalance, this may
be corrected fairly easily. Nausea and vomiting may also be
due to the side effects of certain medication and can be
treated in several ways. Increased fluid in the brain due to
cancer deposits may cause both headaches and vomiting. The
treatment may be to give steroids and referral to an
oncologist for possible radiotherapy.
However, many of these causes are rare. Anxiety and
unpalatable food may be a more common cause. It needs to be
remembered that patients weak from illness may already have
a poor appetite and feeding this person amounts of bland or
unappetising food is likely to cause further misery.
Lastly, the most important aspect is to accord the patient
respect and dignity. Explaining the causes and options for
treatment is more likely to enhance the quality of life of
the patient and may often allow better compliance and hence
a faster resolution of his symptoms.
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