Entwicklung eines Behandlungspfads für die Therapie von Übelkeit und Erbrechen in der Palliativversorgung

Zusammenfassung

Ziel der Studie

Übelkeit und Erbrechen sind häufige und belastende Symptome in der Palliativversorgung. Die S3-Leitlinie Palliativmedizin empfiehlt eine ätiologiebasierte Therapie, deren Umsetzung jedoch herausfordernd bleibt; nicht-onkologische Patienten sind dabei bisher nicht berücksichtigt. Ziel dieser Arbeit war die Entwicklung eines strukturierten Behandlungspfads zur systematischen Antiemese im palliativen Setting.

Methodik

Das Projekt umfasste eine retrospektive Analyse der aktuellen Versorgung, eine explorative Literatur- und Leitlinienrecherche sowie die interdisziplinäre Entwicklung des Pfads durch ein multiprofessionelles Team.

Ergebnisse

Der entwickelte Pfad bietet strukturierte Entscheidungshilfen zur Ursachenidentifikation, Therapieauswahl inkl. Therapieeskalation und sinnvolle antiemetische Kombinationstherapien.

Schlussfolgerung

In einer Nachfolgestudie sollen klinische Anwendbarkeit und Auswirkungen auf die Therapiequalität evaluiert werden, um mit dem Behandlungspfad die Versorgung palliativ betreuter Patienten weiter zu verbessern.

Abstract

Objective

Nausea and vomiting are frequent and distressing symptoms in palliative care. The German guideline on palliative care recommends an etiology-based treatment approach, but its implementation remains challenging; non-oncological patients have not yet been considered. The aim of this study was to develop a structured pathway for the systematic treatment of nausea and vomiting.

Methods

The methodology included a retrospective analysis of current care, an exploratory literature and guideline search and the interdisciplinary development of the pathway by a multi-professional team.

Results

The developed pathway offers structured decision-making aids for identification of the underlying cause, therapy selection including therapy escalation and sensible antiemetic combination therapies.

Conclusion

In a follow-up study, clinical applicability and effects on the quality of therapy are to be evaluated in order to further improve the care of palliative care patients.

Schlüsselwörter

Palliativversorgung - Übelkeit - Erbrechen - Symptommanagement

Keywords

palliative care - nausea - vomiting - symptom management

Publication History

Received: 11 April 2025

Accepted after revision: 02 June 2025

Article published online:
17 July 2025

• Literatur

• 1 Harder S, Herrstedt J, Isaksen J. et al. The nature of nausea: prevalence, etiology, and treatment in patients with advanced cancer not receiving antineoplastic treatment. Supportive Care in Cancer 2019; 27: 3071-3080
• 2 Li B, Mah K, Swami N. et al. Symptom Assessment in Patients with Advanced Cancer: Are the Most Severe Symptoms the Most Bothersome?. J Palliat Med 2019; 22: 1252-1259
• 3 Leitlinienprogramm Onkologie. Erweiterte S3-Leitlinie Palliativmedizin für Patienten mit einer nicht-heilbaren Krebserkrankung. In: AWMF-Registernummer: 128/001OL. 2020
• 4 Glare P, Miller J, Nikolova T. et al. Treating nausea and vomiting in palliative care: a review. Clin Interv Aging 2011; 6: 243-259
• 5 Gavioli EM, Guardado N, Haniff F. et al. The Risk of QTc Prolongation with Antiemetics in the Palliative Care Setting: A Narrative Review. J Pain Palliat Care Pharmacother 2021; 35: 125-135
• 6 Hess S, Stiel S, Hofmann S. et al. Trends in specialized palliative care for non-cancer patients in Germany – Data from the National Hospice and Palliative Care Evaluation (HOPE). European Journal of Internal Medicine 2014; 25: 187-192
• 7 Berner-Sharma JM, Bausewein C, Rémi C. Management of Nausea and Vomiting in Palliative Care – Real Life Data From a Palliative Care Unit in Germany. American Journal of Hospice and Palliative Medicine® 2025; 0
• 8 Murtagh FEM, Ramsenthaler C, Firth A. et al. A brief, patient- and proxy-reported outcome measure in advanced illness: Validity, reliability and responsiveness of the Integrated Palliative care Outcome Scale (IPOS). Palliative Medicine 2019; 33: 1045-1057
• 9 Pharmaceutical Care Network Europe (PCNE). Classifcation for drug related problems. https://www.pcne.org/upload/files/334_PCNE_classification_V9-0.pdf 2020
• 10 NICE National Institute for Health and Care Excellence. Palliative Care – Nausea and Vomiting. 2021
• 11 NHS Scotland. Scottish Palliative Care Guidelines. https://www.palliativecareguidelines.scot.nhs.uk/ 2019
• 12 Dans M, Kutner JS, Agarwal R. et al. NCCN Guidelines® Insights: Palliative Care, Version 2.2021: Featured Updates to the NCCN Guidelines. Journal of the National Comprehensive Cancer Network 2021; 19: 780-788
• 13 Davis M, Hui D, Davies A. et al. MASCC antiemetics in advanced cancer updated guideline. Support Care Cancer 2021; 29: 8097-8107
• 14 Davis M, Hui D, Davies A. et al. Medical management of malignant bowel obstruction in patients with advanced cancer: 2021 MASCC guideline update. Support Care Cancer 2021; 29: 8089-8096
• 15 BC Centre for Palliative Care. Inter-Professional Palliative Symptom Management Guidelines – Nausea & Vomiting. Version 11/17. 2017
• 16 National Cancer Grid India. Palliative Care Guidelines. 2021
• 17 Hardy J, Skerman H, Glare P. et al. A randomized open-label study of guideline-driven antiemetic therapy versus single agent antiemetic therapy in patients with advanced cancer and nausea not related to anticancer treatment. BMC Cancer 2018; 18: 510-510
• 18 Hardy J, Davis MP. The Management of Nausea and Vomiting Not Related to Anticancer Therapy in Patients with Cancer. Current Treatment Options in Oncology 2021; 22: 17
• 19 Lothian Palliative Care Guidelines: Nausea/Vomiting in Palliative Care. [Anonym] 2003
• 20 Hagemann V, Bausewein C, Remi C. Off-label use in adult palliative care – more common than expected. A retrospective chart review. Eur J Hosp Pharm 2022; 29: 329-335
• 21 Eisenchlas JH, Garrigue N, Junin M. et al. Low-dose levomepromazine in refractory emesis in advanced cancer patients: an open-label study. Palliat Med 2005; 19: 71-75
• 22 Cox L, Darvill E, Dorman S. Levomepromazine for nausea and vomiting in palliative care. Cochrane Database Syst Rev 2015; 2015: Cd009420
• 23 BfArM. Wichtige Arzneimittelinformation zu Haldol® (Tabletten, Tropfen zum Einnehmen, Injektionslösung) und Haldol Decanoat Depot®. Roter Hand Brief. 2017
• 24 Digges M, Hussein A, Wilcock A. et al. Pharmacovigilance in Hospice/Palliative Care: Net Effect of Haloperidol for Nausea or Vomiting. J Palliat Med 2018; 21: 37-43
• 25 Hardy JR, Skerman H, Philip J. et al. Methotrimeprazine versus haloperidol in palliative care patients with cancer-related nausea: a randomised, double-blind controlled trial. BMJ Open 2019; 9: e029942
• 26 Braun M-S. Praxis der subkutanen Gabe von Medikamenten und Flüssigkeit bei Palliativstationen, Hospizen und onkologischen Abteilungen – eine Umfrage in Deutschland. München: lmu; 2011
• 27 Berner J, Blei J, Remi C. Subcutaneous dimenhydrinate and levomepromazine – tolerability and compatibility: observational Study. BMJ Supportive & Palliative Care 2023; spcare-2023-004613
• 28 McNeill R, Prael G, Hunt J. et al. Cyclizine pharmacovigilance in hospice/palliative care: net effects for nausea or vomiting. BMJ Support Palliat Care 2024; 13: e1191-e1197
• 29 Vayne-Bossert P, Haywood A, Good P. et al. Corticosteroids for adult patients with advanced cancer who have nausea and vomiting (not related to chemotherapy, radiotherapy, or surgery). Cochrane Database Syst Rev 2017; 7: Cd012002
• 30 Saudemont G, Prod’Homme C, Da Silva A. et al. The use of olanzapine as an antiemetic in palliative medicine: a systematic review of the literature. BMC Palliat Care 2020; 19: 56
• 31 Hindmarsh J, Lee M. The Use of Quetiapine for the Management of Nausea and Vomiting in Idiopathic Parkinson’s Disease. J Palliat Care 2022; 37: 15-17