What can nurses do to advocate for the use of medications such as lorezepam (Ativan) for anticipatory nausea when the physician is reluctant to prescribe antianxiety or sleep medications. —Marva Victor, RN, BSN, OCN

An effective way to change behavior in clinicians is to provide evidence for best practices, such as National Cancer Institute (NCI) guidelines for managing the side effects of cancer and cancer treatment, including nausea and vomiting. These can be accessed through the NCI web site (www.cancer.gov). 

Anticipatory nausea and vomiting (ANV) is a conditioned response seen in 25% to 30% of patients typically in their third or fourth chemotherapy cycle, usually as a result of the patient experiencing acute or delayed nausea and vomiting in previous chemotherapy cycles.

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Benzodiazepines have no intrinsic antiemetic activity as a single agent, but are useful as adjuncts by providing anxiolytic and anterograde amnesic effects. Behavioral techniques such as systematic desensitization are also effective. However, the best approach to prevent ANV is to control nausea and vomiting in the first cycle of chemotherapy.