Nausea, vomiting, diarrhoea and mucositis from cancer therapy
Antiemetic prophylaxis by emetic risk, breakthrough and anticipatory nausea, grading and treating chemotherapy and immunotherapy diarrhoea, and preventing and managing oral mucositis.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Prevention beats rescue. Antiemetic prophylaxis is chosen by the emetic risk of the most emetogenic drug in the regimen, before the first cycle. Poor control in cycle 1 creates anticipatory nausea.
- Highly emetogenic chemotherapy (cisplatin, AC) gets four drugs: NK1 antagonist, 5-HT3 antagonist, dexamethasone and olanzapine.
- Diarrhoea is graded, and grade 3 or 4, fever, neutropenia or dehydration make it "complicated" and need admission.
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Sources
- eviQ Cancer Treatments Online (antiemetic prophylaxis, treatment-induced diarrhoea and oral mucositis protocols)AU/NZCancer Institute NSW
- Therapeutic Guidelines: Oncology and Palliative Care (chemotherapy-induced nausea and vomiting)AU/NZTherapeutic Guidelines Ltd
- Herrstedt J et al. 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting. ESMO Open 2024;9:102195MASCC and ESMO, 2023 (current at November 2026)
- Hesketh PJ et al. Antiemetics: ASCO guideline update. J Clin Oncol 2020;38:2782-97American Society of Clinical Oncology, 2020
- Elad S et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2020;126:4423-31MASCC and ISOO, 2020
- Haanen J et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline. Ann Oncol 2022;33:1217-38European Society for Medical Oncology, 2022
- Navari RM et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting. N Engl J Med 2016;375:134-42New England Journal of Medicine, 2016
- Navari RM, Nagy CK, Gray SE. The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer 2013;21:1655-63Supportive Care in Cancer, 2013
- MBS item 73322: DPYD genotyping before, during or after fluoropyrimidine therapyAU/NZAustralian Government Department of Health, Disability and Ageing (MBS Online), From 1 November 2025
- Hashimoto H et al. Olanzapine 5 mg plus standard antiemetic therapy for the prevention of chemotherapy-induced nausea and vomiting (J-FORCE). Lancet Oncol 2020;21:242-49Lancet Oncology, 2020
- Rugo HS et al. Prevention of everolimus-related stomatitis with dexamethasone mouthwash (SWISH). Lancet Oncol 2017;18:654-62Lancet Oncology, 2017
- Last updated
- 14 November 2026
What changed
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