Nausea - Multiple Myeloma Center for Nurses

Nausea

Nausea

Gastrointestinal (GI) issues in patients with multiple myeloma, including nausea, are largely treatment-related, although hypercalcemia can also cause nausea in some patients.1,2

GI symptoms can have a negative physical and psychological effect on patients; appropriate management can help maintain or improve adherence to treatment and patient quality of life.

Nausea typically is graded in terms of its impact on a patient’s appetite (see below) and, in extreme cases, nausea can cause patients to lose the ability to eat or drink, potentially requiring hospitalization.1,3

Signs and Symptoms1

  • Nausea related to antimyeloma therapy usually occurs within a few minutes to several hours after treatment administration, and often resolves in ≤24 hours
  • Delayed nausea occurs >24 hours after treatment administration, peaks at 48 to 72 hours, and can last 6 to 7 days
  • Patients may also experience anticipatory nausea before receiving treatment

Grading3

Grade 1
Loss of appetite without alteration in eating habits

Grade 2
Oral intake decreased without significant weight loss, dehydration, or malnutrition

Grade 3
Inadequate oral caloric or fluid intake; tube feeding, total parenteral nutrition, or hospitalization indicated

Assessment1

  • Conduct physical exam, as appropriate
  • Probe about the circumstances surrounding episodes of nausea, presence of upper abdominal pain, pain when swallowing, dizziness, hiccups, or heartburn
  • Monitor unintended weight loss
  • Review medication history

Management1

  • Consider dose adjusting aggravating medications if patient loses appetite
  • Consider discontinuing or switching aggravating medications if patient has difficulty eating or drinking
  • Consider antinausea medications in appropriate patients (eg, lorazepam, prochlorperazine, promethazine, metoclopramide, famotidine, and dexamethasone)

For Your Patients1

Encourage dietary and lifestyle changes, for example:

  • Eat small/infrequent meals
  • Avoid fried or fatty foods and strong odors
  • Avoid exercising after eating

Remind patients to report symptoms to their healthcare team as soon as possible.

References:

  1. Faiman B, Doss D, Colson K, et al; for the International Myeloma Foundation Nurse Leadership Board. Renal, GI, and peripheral nerves: evidence-based recommendations for the management of symptoms and care for patients with multiple myeloma. Clin J Oncol Nurs. 2017;21(5 suppl):19-36.
  2. Durie BGM. Patient handbook. 2018 ed. International Myeloma Foundation website. Accessed May 13, 2021. https://imf-d8-prod.s3.us-west-1.wasabisys.com/2020-06/patient-handbook.pdf
  3. Common Terminology Criteria for Adverse Events v5.0. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2017. Accessed February 18, 2021. https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf.
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