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Hospitality Meets Healthcare In Oncology At Cancer Treatment Centers Of America®
Published in Frederick J. DeMicco, Ali A. Poorani, Medical Travel Brand Management, 2023
Peter C. Yesawich, Ananth Mohan, Carolyn Lammersfeld, Kelly Murray
Most of these guidelines recommend the use of mind-body therapies such as yoga, meditation, and relaxation training to help manage symptoms such as anxiety, depression, and insomnia. Guidelines also support acupressure and acupuncture as considerations for the management of chronic pain and chemotherapy-induced nausea and vomiting that is not completely relieved by anti-emetics.
Substrates of Human CYP2D6
Published in Shufeng Zhou, Cytochrome P450 2D6, 2018
CYP2D6 is involved in the metabolism of several antiemetics including tropisetron (Firkusny et al. 1995; Fischer et al. 1994; Sanwald et al. 1996a,b), ondansetron (Fischer et al. 1994; Sanwald et al. 1996a), dolasetron (Sanwald et al. 1996a), ezlopitant (Obach 2001), and metoclopramide (Desta et al. 2002). Tropisetron, ondansetron, and dolasetron are 5-HT3 antagonists used in the control of chemotherapy-induced nausea and vomiting (Aapro 2005; Aapro and Blower 2005; Hesketh 2008; Schwartzberg 2007); ezlopitant and aprepitant are both nonpeptidic antagonists of the neurokinin-1 (NK1) receptor (Rojas et al. 2014); and metoclopramide is mainly used as a gastroprokinetic and antiemetic agent. Tropisetron hydroxylation is primarily by CYP2D6, whereas that of ondansetron is CYP2D6 and 2E1 dependent (Sanwald et al. 1996a). Ezlopitant is metabolized by both CYP2D6 and 3A4 (Obach 2000), whereas aprepitant is mainly metabolized by CYP3A4 (Sanchez et al. 2004). The three-drug combination of a 5-HT3 receptor antagonist, dexamethasone, and aprepitant is highly recommended before chemotherapy of high emetic risk (Kris et al. 2006).
Identifying Pharmaceutical-Grade Essential Oils and Using Them Safely and Effectively in Integrative Medicine
Published in Aruna Bakhru, Nutrition and Integrative Medicine, 2018
Nausea and vomiting is experienced by approximately 70%–80% of all cancer patients receiving chemotherapy, and it is ranked first on the list of troublesome symptoms experienced by chemotherapy patients despite drug interventions.63,64 Oral administration of essential oils has been used to ameliorate chemotherapy-induced nausea and vomiting (CINV). Cancer patients preparing to receive chemotherapy (cancer naïve prior to study) were chosen to participate in a randomized, double-blind clinical study investigating the oral administration of peppermint and spearmint essential oils for CINV. Patients received a capsule filled with 2 drops of peppermint or spearmint essential oil (the rest of the capsule was filled with sugar) 30 minutes prior to chemotherapy (concomitant with normal antiemetic regimen) and again 4 hours after the first capsule, and finally 4 hours later at home. A significant reduction in CINV (intensity and number of emetic events) was observed during the first 24 hours for both the peppermint and spearmint groups when compared to placebo.65 The study authors also reported that the essential oil intervention reduced the cost of treatment.
The Association between Dietary Patterns and Chemotherapy Side Effects in Patients with Breast Cancer (BrCa)
Published in Nutrition and Cancer, 2023
Vahid Sanati, Mohammad Hassan Sohouli, Homa Dareini, Ahmad Esmailzadeh, Akram-Sadat Sajadian, Mahsa Raji Lahiji, Cain C. T. Clark, Mitra Zarrati
Chemotherapy-induced nausea and vomiting (CINV) is often the most common complaint among these patients. When these symptoms worsen, they can lead to further side effects, such as loss of appetite, dehydration, electrolyte imbalance, and quality of life reduction (9). Constipation and Chemotherapy-induced diarrhea (CID) represent additional side effects of chemotherapy injections that affect approximately 75% of patients during treatment (10–12). Interestingly, some studies posit a potential link between these side effects and the intake of some nutrients and food (13). For example, Consumption of oils, milk, dairy products, eggs, consumption of fruit juices, bananas, beans and oranges, deficiency of vitamin A and zinc, as well as increased intake of vitamin C, increase gastrointestinal complications caused by chemotherapy (13,14).
Cost-effectiveness of palonosetron and dexamethasone-based triple and quadruple regimens in preventing highly emetogenic chemotherapy-induced nausea and vomiting
Published in Current Medical Research and Opinion, 2022
Shiraz Halloush, Abdullah A. Alhifany, Nimer S. Alkhatib, Abdel Qader Al Bawab, Batool AL-Qawasmeh, Esra’a Al Shawakri, Jim Koeller
One of the greatest challenges that physicians encounter when they order chemotherapies for cancer patients is the extreme discomfort accompanied by the acute phase (0–24 h) and delayed phase (24–120 h) of chemotherapy-induced nausea and vomiting (CINV), which affect quality of life, increase the length of hospital stay, and interrupt treatment1. In 2016, The National Comprehensive Cancer Network (NCCN) and the Multinational Association of Supportive Care in Cancer (MASCC)/European Society for Medical Oncology (ESMO) guidelines2,3 had recommended three different drug regimens for controlling highly emetogenic CINV: a “backbone” of dexamethasone (DEX) and a serotonin-receptor antagonist (5-HT3 RA), and a third agent, either olanzapine (OLA) or a neurokinin-1 receptor antagonist (NK-1 RA)2,3. Recently, these guidelines were updated to consider the combination of four regimens PAL + NK-1-RA + DEX + OLA as an option for highly emetogenic CINV patients4.
Safety considerations for the management of cholestatic itch
Published in Expert Opinion on Drug Safety, 2021
Substance P is a neuropeptide released by primary afferent neurons in response to itch that has been found in high concentrations in patients with cholestatic disorders. This peptide seems to exert its effect through activation of neurokinin-1 (NK-1) receptors in the spinal cord, facilitating the transmission of evoked stimuli [76,77] and by promoting the release of pro-inflammatory mediators by mast cells and keratinocytes [78]. Aprepitant is the first commercially available NK-1 receptor antagonist that has been approved for the management of acute and delayed chemotherapy-induced nausea and vomiting (CINV). In a small open-label trial, this medication was effective in the management of patients with pruritus from multiple etiologies with 80% of the participants experiencing a significant reduction of itch intensity by VAS [79]. Unfortunately, only one patient in this trial had chronic liver disease and its efficacy in this particular population remains largely unknown. Aprepitant is a substrate for the cytochrome P450 and CYP2C9 and therefore, its interaction with other drugs metabolized via these isoenzymes represents a major safety concern in clinical practice. Additional minor side effects have also been described that include anorexia, constipation, diarrhea and hiccups [80]. There are currently no trials evaluating the role of Aprepitant in the management of cholestatic itch.