ies, three are descriptive (including correlational and behavioral studies), eight deal with trials of interventions, and none are basic science studies.

CURRENTLY FUNDED CLINICAL TRIALS
  1. Blood Transfusions With or Without Epoietin Alfa in Treating Patients with Myelodysplastic Syndrome

  2. Phase III Study of Epoietin Alfa with or Without Filgrastim (G-CSF) vs Supportive Therapy Alone in Patients With Myelodysplastic Syndromes

  3. Exercise Plus Epoietin Alfa in Treating Cancer Patients Who Have Anemia-Related Fatigue

  4. Phase III Randomized Study of Hypericum perforatum (St. John’s Wort) for the Relief of Fatigue in Patients Undergoing Chemotherapy or Hormonal Therapy for Malignant Disease

  5. Methylphenidate in Treating Patients with Melanoma

Gastrointestinal Symptoms

Nausea, vomiting and bowel obstruction are frequent symptoms in patients with advanced cancer. More than 60 percent of patients who are treated with antineoplastic agents also experience nausea and vomiting. Both clinicians and patients identify nausea and vomiting as the most distressing side effects of chemotherapy. Nausea and vomiting are also associated with radiotherapy. Current pharmacologic treatments for nausea include prokinetic drugs, either alone or in combination with corticosteroids (Bruera and Neumann, 1998) and pure THC (which stimulates the appetite). Treatments for vomiting include: dopamine antagonists (such as ondansetron, a 5-hydroxytryptamine [HT] 3 receptor antagonist), phenothiazines, metoclopramide, corticosteroids, cannabinoids, benzodiazapines, antihistamines, and anticholinergics. Behavioral interventions can be effective against nausea and vomiting that occurs before and after treatments.

Future research should focus on the development of standard tools for the assessment of nausea and vomiting as separate symptoms. More research is needed on these symptoms in special populations of cancer patients (such as women, children, and patients of minority status). Clinical trials should be done to determine the effectiveness of the current treatments for nausea and vomiting and the effectiveness of corticosteroids for the treatment of intestinal obstruction. Well-designed clinical trials should also focus on the use of behavioral and other nonpharmacological methods for the management of nausea and vomiting, such as aerobic exercise, guided imagery, progressive relaxation, and acupressure.

The pathophysiology of nausea and vomiting may involve chemical, visceral, central nervous system, and vestibular system processes (Fessele, 1996). In vomiting associated with chemotherapy and radiotherapy, both



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement