Optimal management of nausea and vomiting in clinical oncology.

The exact mechanisms involved in chemotherapy-induced nausea and vomiting are not known. Therapies are largely empiric. There is no completely effective single agent or even combination-agent regimen. This paper identifies important factors in selecting antiemetic therapy, particularly the emetogenic potential of the chemotherapy and the fact that antiemetic drugs have differing sites of action. Regarding acute emesis, great strides have been made in the 1980s. Anticipatory and delayed symptoms remain a challenge and are a focus of this article. A key in the timing of pharmacologic intervention is pinpointed in each of these situations.