Cutaneous Treatment of Nausea: You Can’t Get There From Here

At the annual assembly of the American Academy of Hospice and Palliative Medicine, Boston

Courtesy flickr user rjcox (CC)

Nausea and vomiting are a common reason for palliative care consultation and admission and are a frequent reason for “hospice failure” admissions, Dr. Thomas Smith of Virginia Commonwealth University said to no surprise to his palliative care colleagues at this meeting. He expressed the keen needs for guidelines for the cutaneous treatment of nausea and vomiting in palliative/hospice care, and bemoaned the fact that the lack of evidence-based therapies all but precludes the writing of such guidelines.

While topical compounds, including lorazepam, diphenhydramine, and haloperidol (ABH gel) with or without metoclopramide (ABHM gel), are routinely used and have anecdotally yielded promising results, “we have no data to show that any of the drugs are absorbed through the skin in therapeutic amounts,” Dr. Smith said.

He shared with the attendees his own failed attempt at getting an efficacy study of ABH gel approved. “I wrote a clinical trial, and since I am an oncologist, I sent it to the [review committee] at the NCI.” Among the comments he received from the review panel were:

  • “Poorly structured preliminary data,” despite the fact that the preliminary data were not his and, in fact, were precisely the data that proposed study aimed to improve;
  • “Reporting nausea and vomiting by subjective assessment isn’t good enough. There has to be some sort of objective assessment.” Huh?
  • “The study is needed, but frankly it’s not going to change clinical practice because people are so wedded to [ABH gel] already.”

Although the study didn’t get approved, Dr. Smith later received notice of a grant to conduct a small pilot study on the absorption of ABH gel, “so in 3-6 months, we will have some actual data about whether the drug is absorbed through the skin,” he said. “That’s a start.”

—Diana Mahoney (@DMPM1 on Twitter)

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Filed under Hospice and Palliative Care, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Oncology

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