Frequent Nausea During Chemotherapy Despite Antiemetic Prophylaxis
Current clinical research has focused on vomiting as a primary issue in the occurrence of CINV (chemotherapy-induced nausea and vomiting) and, using recommended antiemetic prophylaxis, this problem has been relatively well managed. However, the incidence and impact of nausea are underreported. We present the results of an observational study that evaluated the incidence of nausea in patients undergoing chemotherapy.
Methodology and Study Progress
A prospective observational study involved 95 patients from an oncology care center in Johannesburg, South Africa, who were treated with intravenous chemotherapy (25 patients on low emetogenic potential therapy, 24 on moderately emetogenic therapy, and 49 on highly emetogenic therapy) while also receiving antiemetic prophylaxis according to current guidelines.
The primary aim of the study was no nausea during a total of 120 hours after the administration of the first 3 cycles of chemotherapy. Secondary aims included zero nausea incidence on day 7 and day 10 after the first cycle. Data were collected using patient diaries for the period from day 1 to 5, 7, and 10 from the first cycle up to a maximum of 3 treatment cycles. Patients assessed the intensity of their nausea on a visual analogue scale (VAS) and also recorded occurrences of vomiting.
Results
The incidence of nausea was significantly higher than the occurrence of vomiting. Fourteen percent of patients vomited during cycle 1, while 58% experienced nausea. Similar results were observed during the 2nd cycle (14% vomited and 51% experienced nausea) and the 3rd cycle of therapy (18% and 46%).
Nausea was continuous throughout all 3 cycles for 25% of patients. In patients with an intermittent course, the average episode of nausea lasted 3.8 hours. The median time to the onset of the first nausea episode was 29 hours (range 1−90). Significant predictors of nausea during cycle 1 included age and a history of pregnancy-related nausea.
Conclusion
Despite the administration of recommended antiemetic prophylaxis, chemotherapy-induced nausea remains a serious issue. Further research should therefore focus on the most effective treatment for nausea and specific patient risk factors.
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Source: Smit T., Van Eeden R. I., Rapoport B. L. High incidence of nausea during initial and repeated courses of intravenous chemotherapy in patients receiving guideline consistent antiemetic prophylaxis: a prospective, observational, real-world study. Ann Oncol 2019; 30 (Suppl. 5): v723, doi: 10.1093/annonc/mdz265.015.
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