"Total nausea" as a manifestation of "total pain" and an expression of suffering: a case report.

BACKGROUND

Nausea and vomiting are common symptoms of advanced tumor diseases, which can usually be effectively managed with medication. However, in rare cases, refractory courses occur for which no structural cause can be identified, leading to severe multidimensional suffering.

CASE PRESENTATION: We present two cases involving white male patients, aged 64 and 61 years, with incurable metastatic gastrointestinal tumors who developed severe, therapy-resistant nausea accompanied by continuous regurgitation of saliva. In both cases, gastrointestinal transit was intact. The symptoms caused significant physical, psychological, and existential distress. An attempt was made to treat the persistent nausea and vomiting with medication. Despite using potent drugs, there was no improvement. Psycho-oncological therapy also failed to produce satisfactory results. Symptom control was achieved under sedation, and both patients died peacefully a few days later.

CONCLUSION

These cases illustrate the concept of "total nausea," which is analogous to the well-known model of "total pain." Raising awareness of "total nausea" could help make future guidelines and decision-making processes for refractory symptoms at the end of life more nuanced.