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Case Study Essay Assignment on Colorectal Cancer

Case Study Essay Assignment on Colorectal Cancer


A study conducted by Wolfgram, & Geiger 2013) indicated that chemotherapy-induced nausea and vomiting are two of the worst side effects of cancer treatment. One research study that examined distress within patients having cancer indicated that chemotherapy-induced nausea and vomiting can considerably affect the patient’s quality of life as well as result to chemotherapy delays and thus it should be managed and controlled effectively. Moreover, evidence indicates that cancer patients experience nausea and vomiting in anticipation of chemotherapy (Wolfgram, & Geiger, 2013). This essay seeks to analyze a case study of a patient experiencing breakthrough and anticipatory vomiting due to chemotherapy treatment he has been receiving as a result of his colorectal cancer condition. The causes of the patient’s breakthrough and anticipatory vomiting will be discussed, as well as the appropriate nausea assessment tools to assess the patient’s nausea. The essay will further discuss two priority interventions that will best manage the patient’s nausea condition and thus the focus will be on two interventions that are most appropriate for the patient.

Breakthrough and Anticipatory Vomiting

According to Wickham (2012) there are several causes of breakthrough and anticipatory vomiting in cancer patients undergoing chemotherapy and they include: the kinds of chemotherapy drugs used, the doses of drugs, the frequency of drug administration, drug administration route, individual differences and personal risk factors such as being younger than 50years, history of motion sickness, anxiety/nervousness, among others (Wickham, 2012).

In this case study, the causes of John’s of breakthrough and anticipatory vomiting include the fact that he is prone to motion sickness, he has had a chemotherapy in the past since this is third chemotherapy cycle, he is anxious and nervous is this is demonstrated by the fact that he doesn’t look forward to chemotherapy cycles and thinks about his family and does not want to be sick again (Wickham, 2012).

The types of drugs John is being administered with are also cause of breakthrough and anticipatory vomiting. Holmes (2011) found out that 10% to 30% of patients using fluorouracil as a chemotherapeutic agent experience vomiting, and thus this drug could be contributing to breakthrough and anticipatory vomiting. The chemotherapy drug dosage that the patient is receiving is relatively high and thus this could be another cause too since high doses of chemotherapy drugs have a higher likelihood of causing breakthrough and anticipatory vomiting. Patients who experience vomiting immediately after chemotherapy have a higher likelihood of experiencing of breakthrough and anticipatory vomiting and thus this is another cause because during the initial cycle of chemotherapy John vomited numerous times.

Grunberg (2012) explains that chemotherapy treatment triggers vomiting by destroying cells lining the intestines resulting to releasing of serotonin that triggers vomiting and through releasing substances that induce vomiting in the blood. Therefore, John’s breakthrough and anticipatory vomiting could have resulted from the chemotherapy cycles he had been undergoing. The patient is also on dexamethasone drug, whose side effects include nausea and vomiting.

Nausea Assessment

MASCC (Multinational Association for Supportive Care in Cancer) Anti-emesis Tool

This is a tool that helps cancer patients and oncologists to communicate accurately regarding the prevention and control of nausea and vomiting occurring with chemotherapy. The rationale of using this tool is that it provides an easy-to-use and easy-to-assess tool in helping to provide the most effective individual care for the patient and also the tool is important in better understanding the efficacy and the anti-emetic strategies for John (Grunberg, 2012).

Additionally, since John is nervous and anxious about his condition, this assessment tool will pay a vital role in emphasizing to John that his healthcare team is concerned about his cancer condition as well as his quality of life and thus will help him relax (Ruggeri et al, 2007). Moreover, since the anti-emetics that John has been using have not been fully effective, this tool will be effective in resulting to improved guideline adherence as well as prescribing practices (Kearney et al., 2008).

Morrow Assessment of Nausea and Emesis Follow-up (MANE-FU)

This is a self-report that assesses post-treatment and anticipatory aspects of nausea and vomiting independently. The tool will provide information onset, intensity as well as time duration of nausea and vomiting for the patients. The tool provides data regarding the efficacy of drugs to control nausea and vomiting (Olsen, & Frank-Stromborg, 2004). According to Kearney et al. (2008) this tool is appropriate for John because it will not only provide required information regarding the intensity of his breakthrough and anticipatory vomiting condition but will also provide the effectiveness of drugs of controlling nausea and vomiting for John and thus if the drugs are found not be effective, an alternative drug will be used to control the breakthrough and anticipatory vomiting (Olsen, & Frank-Stromborg, 2004).


Intervention 1: Acupuncture

According to Paul (2013) acupuncture is a treatment that comes from a conventional Chinese medicine and normally needles or heat are applied to pressure points on the body, whose purpose is to stimulate the “vital energy” of the body. According to studies carried out by Roila et al. (2010), acupuncture functions through having an effect on the response of the central nervous system and the study found out that acupuncture can assist in treating anticipatory nausea (Roila et al., 2010).

Basically, acupuncture stimulates the pericardium 6 or neiguan site; sites that are very important in managing chemotherapy-induced nausea and vomiting. The technique that can be used in John’s case and it will involve stimulating the insertion of fine needles manually. Acupuncture will also cause physical responses on John’s body within nerve cells, the pituitary gland as well as some parts of the brain and also will relieve pain (Lee, & Fan, 2009). Consequently, the responses stimulate the body to discharge proteins, hormones, in addition to brain chemicals responsible for controlling several functions of the body. In this manner the acupuncture simultaneously will impact the blood pressure of John; his body temperature and also boost his immune activity and more importantly reduce John’s vomiting and nausea. For John, acupuncture will be administered using needles. Stainless steel needles that are disposable should be inserted in John’s skin at acu-points. The needles that will be inserted can be twisted, moved in different directions, speeds and depths, heated or a weak electric current can be used to charge them. Normally, a human body has more than 360 acu-points. The acupuncture practitioner will establish the appropriate acu-points for John (Cohen, 2005).

Clinical trials provide the strongest evidence regarding the usage of acupuncture in relieving nausea and vomiting. A number of clinical trials utilizing varying acupuncture procedures indicate that acupuncture decreased nausea and vomiting resulting from chemotherapy. However, studies indicate that acupuncture is more effective in prevention of vomiting than in decreasing nausea. A study carried out to find the efficacy of acupuncture for nausea as well as vomiting in patients who had undergone and were about to undergo chemotherapy for ovarian cancer established that acupuncture was very effective in relieving vomiting before and after chemotherapy (Ezzo et al., 2006).

Similarly, a study conducted to find out if acupuncture was effective in relieving nausea and vomiting in women going through chemotherapy found out that acupuncture applied to the appropriate acupuncture point greatly reduced nausea and vomiting and also decreased the quantity of medication the women had been using to treat nausea and vomiting (Molassiotis, 2008). In addition, another study on acupuncture in relieving nausea and vomiting was carried out in patients who were going through chemotherapy. A comparison of patients who had acupuncture during the chemotherapy and those who did not receive acupuncture during their chemotherapy sessions was done and the study found out that the patients who received acupuncture
developed less nausea and vomiting during their chemotherapy sessions as compared to the patients who did not receive acupuncture (Deng et al., 2009).

Intervention 2: Olanzapine

Olanzapine is an antipsychotic drug that is important in treating breakthrough nausea and vomiting allied to chemotherapy. Olanzapine has antiemetic aspects that enable it to act on various receptor sites that control nausea and vomiting as well. Basically, olanzapine is effective in treating refractory and breakthrough nausea and vomiting and thus John can be administered with the drug to control his breakthrough nausea. John should be administered with a dosage of 2.5-5 mg olanzapine to control his breakthrough nausea and the drug should be combined with the antiemetic medications he is taking (Manuel, 2008).

Olanzapine works through blocking receptors responsible for inducing nausea and vomiting. It blocks these receptors through binding to 5-HT3 receptors in the peripheral as well as within the central nervous and therefore prevents the activation of breakthrough chemotherapy-induced nausea and vomiting (Hawkins & Grunberg, 2009). Olanzapine can be administered orally or through r intramuscular injection. Equally important, olanzapine prevents nausea and vomiting that result from using other medications and thus the drug will be appropriate for John in preventing nausea and vomiting that could be resulting from the other drugs he is taking for his therapy. A study carried out by Navari, et al (2012), found that among forty two patients receiving olanzapine, thirty of them did not experience any vomiting and also 28 of the patients never had any case of nausea during their chemotherapy treatment (Navari et al, 2012).

In John’s case, olanzapine should be combined with the other medications he is taking to control breakthrough nausea and vomiting such as dexamethasone. Basically, combining olanzapine with dexamethasone and palonosetron has been shown to be very effective in preventing and controlling both acute and delayed chemotherapy induced nausea and vomiting. Because of high efficacy of olanzapine in controlling acute and delayed chemotherapy induced nausea and vomiting, the medication is recommended in the MASCC as well as NCCN guideline in treating breakthrough emesis (Karin, et al., 2007).

Results of a study conducted by Gray et al (2013) on randomized phase III trial about treatment of breakthrough CINV in patients undergoing an extremely emetogenic chemotherapy indicated that 70 percent of patients receiving chemotherapy sessions when administered with olanzapine did not have emesis in comparison to 31% patients who did not receive olanzapine. This shows that olanzapine is effective in controlling breakthrough emesis and nausea for patients having very emetogenic chemotherapy just like in John’s case (Gray et al., 2013). Additionally, results of a study conducted by Johnson, et al (2007) to establish the control of chemotherapy induced nausea and vomiting in patients receiving chemotherapy showed that olanzapine when combined with a single dosage of Palonosetron along with a single dosage of dexamethasone was extremely effective in control of chemotherapy induced nausea and vomiting in patients receiving chemotherapy. Therefore, since John is already receiving palonosetron as well as dexamethasone, these drugs can be combined with olanzapine to control John’s breakthrough nausea (Johnson et al, 2007).


Effective management of chemotherapy-induced nausea and vomiting remains a challenge and thus it is important to have management interventions for managing side effects of chemotherapy treatment that include vomiting and nausea. The patient in the above case study had breakthrough and anticipatory vomiting which was caused by the types and dosage of chemotherapy drugs the patient has been receiving, the patient is a bit nervous and anxious because he doesn’t look forward to his chemotherapy sessions and is prone to motion sickness. The nausea assessment tools that are appropriate in assessing the patient’s nausea included MASCC and MANE-FU. These assessment tools provide the required data about the intensity of the patient’s breakthrough and anticipatory vomiting condition as well as show the efficacy of the medications used to control the nausea and vomiting. Finally, the interventions for managing John’s nausea condition include acupuncture and olanzapine. Acupuncture intervention will prevent nausea for the patient by affecting the response of the central nervous system to nausea and vomiting and thus effective in treating anticipatory nausea. On the other hand, olanzapine is effective in treating breakthrough nausea and vomiting allied to chemotherapy and thus will be helpful in John’s case.


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