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Pioneer in Supportive Care Research Discusses History of Emesis Management


Dr. Ricahrd J Gralla discusses the history of the early medical oncology space and how things have changed when it comes to treating side effects related to chemotherapy.

Emesis, the medical term for vomiting, is one of the most common side effects associated with cancer treatment, especially chemotherapy. But now the field has a host of antiemetic drugs to help prevent vomiting, a reality that wasn’t the case in the early days of medical oncology.

Dr. Richard J. Gralla was one of the leaders in the early medical oncology field looking at making supportive care an integral part of cancer care. Part of his work involved having patients with lung cancer take antiemetics to help prevent vomiting and avoid treatment discontinuation due to side effect fears.

In an interview with CURE® Gralla, director of oncology research for the North Bronx Healthcare Network, spoke about what the early days of research into cancer treatment-related emesis looked like and where supportive care stands now in the lung cancer space.


In those early days, when we were thinking what we should do, we needed to look at something a little different. Basically, over two or three days, or even less, I read the world's literature on clinical studies in emesis. It didn't take very long. However, these two pioneers, Boris and McCarthy, and several others had really worked out the physiology of emesis. And most of us really have not been well educated in reading their views and understanding the clinical problem.

We were able to look at some different areas, and then, because we've done work in phase one, said, hey, are we giving the right doses of these drugs? And then when we found ways that were working, the question came up: how are these working? And then it was through collaboration with some neuro pharmacologists, who were so bright and said, we think that these must be working in this pathway, not the original pathway, and the drugs that work in that pathway might be safer and more effective. And so that was kind of a fun way of putting that together. But then seeing the clinical aspect of it, as that nurse expressed to me, yeah, that’s true.

Then, one of my other interests has been in day hospitals, and doing (treatment) without overnight admissions in many, many aspects, and having proper antiemetics is kind of important for that. And then measuring, from a quality of life standpoint, do patients agree with us, and well let's hear the patient's voice. So, hearing those things together, has been very interesting and rewarding at the same time.

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