Dr. Hesketh

One of the most common fears before beginning chemotherapy is whether you will experience nausea and vomiting (N&V). Thankfully, over the last 20 years, drugs that prevent nausea and vomiting, called antiemetics, have significantly improved our ability to control this most unwanted side effect. Given orally or intravenously, these antiemetics may be administered before or after chemo, and most patients welcome them.  

Paul J. Hesketh, MD, director of thoracic oncology at Lahey and one of the world’s leading researchers on this topic, has published extensively in scientific literature on chemotherapy-induced N&V, most recently in a New England Journal of Medicine article. He answers some of your questions about this topic.

Before we had effective antiemetics, how did patients handle N&V?

We would often have to admit patients to the hospital, instead of giving them chemo on an outpatient basis, as we do now. Sometimes we would have to use sedating medications to put patients to sleep because they could not tolerate the chemotherapy. Few were able to eat normally, and so many lost weight. We didn’t see much improvement until the early 1990s when a new class of antiemetic agents became available.

How effective are they?

They are very effective, and they’re improving further. Despite the progress, about 25 percent of chemo patients today will still experience N&V. One of our challenges is trying to figure out who these patients will be, and figuring out what therapies will help them.

Who is more likely to experience chemo-induced N&V?

Women are more likely than men to experience chemo-induced N&V. We don’t really know why more women are affected. Age, too, is a consideration. We know that younger patients have more N&V. Alcohol use plays a role, but it’s not the glass-of-wine-with-dinner patients. It seems that prior or current heavy alcohol use may protect against N&V, even if the patient is recovering from the addiction. (No one is suggesting cancer patients drink heavily to avert N&V.) The kind of chemo is also a critical factor.

Are some chemotherapy drugs more likely to cause N&V?

Yes, my colleagues and I studied more than three dozen chemotherapy drugs and ranked them by the probability the patient taking them would experience N&V. A high probability for N&V might be a drug like Cisplatin, which will produce N&V in about 90 percent of patients if appropriate antiemetics are not used. The lowest probability, perhaps less than 10 percent, would be for patients on a drug like Bleomycin.

Why is this something you wanted to study?

When I began practicing oncology, we knew very little about this side effect.  Chemotherapy drugs I most commonly used for my lung cancer patients had significant potential to induce N&V. N&V weakens quality of life, impairs functional activities and can compromise adherence to treatment. It has been gratifying to both witness and contribute to the progress we have made in this area over the last 25 years.