Chemotherapy-induced nausea and vomiting in daily clinical practice: a community hospital-based study

Abstract

BackgroundChemotherapy-induced nausea and vomiting (CINV) are major adverse effects of cancer chemotherapy. This study investigated: (1) the impact of CINV on patients' health-related quality of life (HRQL) in daily clinical practice; (2) the association between patient characteristics and type of antiemetics and CINV; and (3) the role of CINV in physicians' decisions to modify antiemetic treatment.Patients and methodsThis prospective, multicenter study was conducted in nine general hospitals in the Netherlands. During three consecutive chemotherapy cycles, patients used a diary to record episodes of nausea, vomiting and antiemetic use. For each cycle, these ratings were made 1 day prior to and 7 days after having received chemotherapy. The influence of CINV on patients' HRQL was evaluated with the Functional Living Index-Emesis (FLIE) questionnaire at day 6 of each treatment cycle. (Changes in) antiemetic use were recorded by the treating nurse. Patient inclusion took place between May 2005 and May 2007.ResultsTwo hundred seventy-seven patients were enrolled in the study. Acute and delayed nausea during the first treatment cycle was reported by 39% and 68% of the patients, respectively. The comparable figures for acute and delayed vomiting were 12% and 23%. During the first and subsequent treatment cycle, approximately one-third of the patients indicated that CINV had a substantial impact on their daily lives. Female patients and younger patients reported significantly more CINV than male and older patients. At all treatment cycles, patients receiving treatment with moderately emetogenic chemotherapy, containing anthracycline, reported more acute nausea than patients receiving highly emetogenic chemotherapy. Acute vomiting was associated significantly with change in (i.e., additional) antiemetic treatment. Delayed CINV did not influence antiemetic treatment.ConclusionCINV continues to be a problem that adversely affects the daily lives of patients. CINV is worse in women and in younger patients. In daily clinical practice, acute CINV, but not delayed CINV, results in changes in antiemetic treatment. In view of the effects of not only acute, but also delayed CINV on daily life, more attention should be paid to adjustment of antiemetic treatment to cover CINV complaints, later during the chemotherapy cycle.

Control of Nausea Based on Risk Analysis in Patients with Esophageal and Gastric Cancer Who Received Cisplatin-based Chemotherapy

“…The present data were consistent with our previous data in 779 patients receiving the first cycle of different emetic risk categories of chemotherapy for various cancer types showing that female gender (odds ratio: 1.615, 95% confidence interval: 1.022-2.552; p=0.04) was a significant risk for nausea (22). A number of studies have also demonstrated that being female is a risk factor for CINV associated with cisplatin (23)(24)(25).…”

Control of Nausea and Vomiting in Patients with Colorectal Cancer Receiving Chemotherapy with Moderate Emetic Risk

“…Sekine et al reported in 1,549 patients receiving high emetic risk of MEC that females were more likely to experience failure in CR than males (26). Hilarius et al also showed in 225 patients receiving high emetic risk or MEC that the incidence rates of acute and delayed nausea and vomiting were significantly higher in females than males (18). On the other hand, it has been reported that younger age is one of the risks for the loss of emetic control (15-16, 18, 26-27).…”

“…On the other hand, it has been reported that younger age is one of the risks for the loss of emetic control (15-16, 18, 26-27). However, the cut-off value of age that influences the control of CINV remains unclear: poor control of CINV was reportedly associated with age under 55 years (19,26), age under 65 years (17,18), and age under 40 years (15). We reported very recently that in 608 patients receiving the first cycle of chemotherapy with any emetic risk, age under 50 years was significantly associated with high risk of CINV (OR=5.803, 95% CI=2.667-12.63; p<0.001) (21).…”

NCCN Guidelines Insights: Antiemesis, Version 2.2017

“…9,11,12 Although vomiting can often be prevented or substantially decreased by using prophylactic antiemetic regimens, nausea is much harder to control. [13][14][15][16][17][18] The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Antiemesis are intended to provide an overview of the treatment principles for preventing chemotherapy-induced (or RT-induced) N/V, and to provide recommendations for antiemetic prophylaxis according to the emetogenic potential of antitumor therapies. These NCCN Guidelines are updated at least once a year by a multidisciplinary panel of experts; the first guidelines were published in 1997.…”