Imagine you're an
oncologist. You spot one of your patients at the mall. You stroll
over to say hello.
He throws up at the
sight of you.
This actually happens,
says Rudy Navari, M.D., '66, associate dean of the College of
Science, director of the Walther Cancer Research Center at Notre
Dame and a practicing oncologist himself.
Along with hair loss
and fatigue, nausea and vomiting are among the most common and
miserable side effects of chemotherapy. The reaction is thought
to result from the damage many anti-cancer drugs inflict on cells
in the small intestine.
But psychology also
appears to play a role. Some patients come to associate stomach
distress so strongly with their chemotherapy, Navari says, that
they will vomit in the car on the way to the doctor's office or
even at the sight of their oncologist outside of the office setting.
For the past 10 years
Navari has been involved in clinical trials of drugs to combat
nausea and vomiting in patients undergoing chemotherapy. In further
evidence of a psychological component, studies show that if a
patient suffers nausea and vomiting following the initial chemotherapy
treatment, the patient will do so from then on, no matter what
anti-nausea drugs are tried. Apparently, if you expect nausea,
you experience it.
Fortunately, in the
mid-1990s a new group of drugs was introduced that for most patients
eliminated the distress normally experienced within the first
24 hours of chemotherapy, Navari says. Unfortunately, the remedy
wasn't as effective against a secondary wave that commonly strikes
two to four days after treatment.
Researchers now believe
that the two bouts result from two different neurotransmitters.
Early last year a pharmaceuticals manufacturer introduced a set
of drugs that blocks the second transmitter. A drawback is the
cost -- $250 a pill -- which Medicare won't pay because it doesn't
currently include a prescription drug benefit. The earlier-onset
blocker is covered because it's administered intravenously, Navari
says.
The combination of
the two drugs has been a huge benefit for cancer patients, the
oncologist says. With the earliest forms of chemotherapy, the
side effects were so severe that some patients opted to discontinue
treatment, even with curable conditions.
"We've gone from
people incapacitated by chemotherapy to many being able to go
to work the next day," he says.
Some newer anti-cancer
drugs don't cause nausea and vomiting, and in the future there
may be more, Navari says. But for now many of the most effective
forms of chemotherapy irritate the gastrointestinal tract and
require additional drugs to block the effects.
* * *
(April 2004)
