{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T01:46:31Z","timestamp":1775612791409,"version":"3.50.1"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":38,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008967","name":"Philipps-Universit\u00e4t Marburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008967","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These cases illustrate the concept of \u201ctotal nausea,\u201d which is analogous to the well-known model of \u201ctotal pain.\u201d Raising awareness of \u201ctotal nausea\u201d could help make future guidelines and decision-making processes for refractory symptoms at the end of life more nuanced.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13256-026-05933-z","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T10:14:56Z","timestamp":1772273696000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cTotal nausea\u201d as a manifestation of \u201ctotal pain\u201d and an expression of suffering: a case report"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2008-0197","authenticated-orcid":false,"given":"Christian","family":"Volberg","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Janke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moritz","family":"Erk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Riera-Knorrenschild","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Toussaint","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"issue":"2","key":"5933_CR1","first-page":"103","volume":"1","author":"HS Smith","year":"2012","unstructured":"Smith HS, Smith JM, Smith AR. An overview of nausea\/vomiting in palliative medicine. Ann Palliat Med Juli. 2012;1(2):103\u201314.","journal-title":"Ann Palliat Med Juli"},{"issue":"1","key":"5933_CR2","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.jpainsymman.2006.10.015","volume":"34","author":"SCCM Teunissen","year":"2007","unstructured":"Teunissen SCCM, Wesker W, Kruitwagen C, de Haes HCJM, Voest EE, de Graeff A. Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage Juli. 2007;34(1):94\u2013104.","journal-title":"J Pain Symptom Manage Juli"},{"key":"5933_CR3","doi-asserted-by":"publisher","first-page":"243","DOI":"10.2147\/CIA.S13109","volume":"6","author":"P Glare","year":"2011","unstructured":"Glare P, Miller J, Nikolova T, Tickoo R. Treating nausea and vomiting in palliative care: a review. Clin Interv Aging. 2011;6:243\u201359.","journal-title":"Clin Interv Aging"},{"issue":"1","key":"5933_CR4","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s12904-017-0264-2","volume":"17","author":"BL Prado","year":"2018","unstructured":"Prado BL, Gomes DBD, Us\u00f3n J\u00fanior PLS, Taranto P, Fran\u00e7a MS, Eiger D, u. a. Continuous palliative sedation for patients with advanced cancer at a tertiary care cancer center. BMC Palliat Care. 2018;17(1):13.","journal-title":"BMC Palliat Care"},{"key":"5933_CR5","unstructured":"Saunders DC, Saunders C, Herausgeber. The management of terminal malignant disease. 2 ed. London: Arnold; 1984. 252 S. (The management of malignant disease series)."},{"key":"5933_CR6","doi-asserted-by":"publisher","DOI":"10.3389\/fsoc.2023.1286208","volume":"8","author":"M Rattner","year":"2023","unstructured":"Rattner M. \u201cTotal pain\u201d: reverence and reconsideration. Front Sociol. 2023;8: 1286208.","journal-title":"Front Sociol"},{"issue":"1","key":"5933_CR7","doi-asserted-by":"publisher","first-page":"e3","DOI":"10.1016\/j.jpainsymman.2017.10.011","volume":"55","author":"NJ Darrah","year":"2018","unstructured":"Darrah NJ, Goldberg JH. A case of \u201ctotal nausea:\u201d an interprofessional approach to the management of chemotherapy-induced nausea\/vomiting complicated by anxiety and existential distress. J Pain Symptom Manage Januar. 2018;55(1):e3-5.","journal-title":"J Pain Symptom Manage Januar"},{"issue":"10","key":"5933_CR8","first-page":"1533","volume":"19","author":"JA Roscoe","year":"2011","unstructured":"Roscoe JA, Morrow GR, Aapro MS, Molassiotis A, Olver I. Anticipatory nausea and vomiting. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2011;19(10):1533\u20138.","journal-title":"Support Care Cancer Off J Multinatl Assoc Support Care Cancer"},{"issue":"9","key":"5933_CR9","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1200\/JCO.19.00470","volume":"38","author":"LA Henson","year":"2020","unstructured":"Henson LA, Maddocks M, Evans C, Davidson M, Hicks S, Higginson IJ. Palliative care and the management of common distressing symptoms in advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. J Clin Oncol Off J Am Soc Clin Oncol. 2020;38(9):905\u201314.","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol."},{"issue":"4","key":"5933_CR10","first-page":"232","volume":"51","author":"VA Rhodes","year":"2001","unstructured":"Rhodes VA, McDaniel RW. Nausea, vomiting, and retching: complex problems in palliative care. CA Cancer J Clin. 2001;51(4):232\u201348.","journal-title":"CA Cancer J Clin."},{"issue":"3","key":"5933_CR11","first-page":"435","volume":"11","author":"EJ Cassell","year":"2010","unstructured":"Cassell EJ, Rich BA. Intractable end-of-life suffering and the ethics of palliative sedation. Pain Med Malden Mass M\u00e4rz. 2010;11(3):435\u20138.","journal-title":"Pain Med Malden Mass M\u00e4rz"},{"key":"5933_CR12","unstructured":"Leitlinienprogramm Onkologie, Herausgeber. Erweiterte S3-Leitlinie Palliativmedizin f\u00fcr Patienten mit einer nicht-heilbaren Krebserkrankung: Langversion 2.0 \u2013 August 2019, AWMF-Registernummer: 128\/001-OL: Leitlinie (Langversion). Stuttgart: Kohlhammer; 2019. 566 S. (Leitlinienprogramm Onkologie)."},{"issue":"7","key":"5933_CR13","doi-asserted-by":"publisher","first-page":"780","DOI":"10.6004\/jnccn.2021.0033","volume":"19","author":"M Dans","year":"2021","unstructured":"Dans M, Kutner JS, Agarwal R, Baker JN, Bauman JR, Beck AC, u. a. NCCN Guidelines\u00ae insights: palliative care, 2021. J Natl Compr Cancer Netw JNCCN. 2021;19(7):780\u20138.","journal-title":"J Natl Compr Cancer Netw JNCCN."}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-026-05933-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-05933-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-05933-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T01:01:55Z","timestamp":1775610115000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13256-026-05933-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,28]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5933"],"URL":"https:\/\/doi.org\/10.1186\/s13256-026-05933-z","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,28]]},"assertion":[{"value":"17 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"An application to publish the two case reports was submitted to the Ethics Committee of Philipps University Marburg\u2019s Medical Faculty and approved on 4 February 2025 (file no. 25-32RS). As both patients had died, it was not possible to obtain their consent to participate. The relatives were informed about the publication of the anonymized cases and consented to it.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient\u2019s next-of-kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there are no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"164"}}