Impact of tumour burden on chemotherapy-induced nausea and vomiting

Abstract

Summary We investigated how residual tumour burden after cytoreductive surgery was related to the occurrence of acute and delayed nausea and vomiting in 101 ovarian cancer patients receiving their first chemotherapy course. The anti-emetic treatment included ondansetron combined with dexamethasone or placebo. After chemotherapy all patients received ondansetron only for 5 days. Two categories of tumour burden (TB) were formed according to the diameter of the greatest residual tumour (<2 cm = minimal TB and > 2 cm= large TB). Self-reports of nausea and vomiting were obtained for 15 days. Other potential predictor variables were assessed and included in multivariate analyses. Patients with large compared with minimal TB had more delayed emesis, especially on days 2-7. They also had more acute nausea. The aggravating effect associated with large residual TB was more evident in patients >55 years. During the second week after the chemotherapy the occurrence of nausea was higher in patients >55 years than in those <55 years. This was seen primarily in patients with large residual TB. Predictors for no delayed emesis at all were anti-emetic treatment with dexamethasone, minimal tumour burden, low neuroticism and no history of motion sickness. The increased risk of 'persistent' delayed nausea and vomiting seen in older patients with large tumour burden may have important clinical implications and warrants further attention.

Occurrence of fatigue and associated factors in disease-free breast cancer patients without depression

“…Ranchor et al reported that high neuroticism was associated with higher levels of distress in both short-and long-term adaptation to cancer [26]. Hursti et al reported low neuroticism to be a predictor of no delayed emesis [15]. As for fatigue, only one study of mixed cancer patients has explored the association between fatigue and neuroticism [31].…”

Nausea as a sentinel symptom for cytotoxic chemotherapy effects on the gut-brain axis among women receiving treatment for recurrent ovarian cancer: an exploratory analysis

“…Another explanation for the high rates of nausea in our study could be that the recurrent cancer itself contributes to the nausea. In women with recurrent ovarian cancer, chemotherapy-induced nausea may be further complicated by the presence of peritoneal or liver involvement that may cause additional nausea via direct mechanical effects on the gut, or via stimulation of biological responses (e.g., cytokines, prostaglandins) that may systemically activate the GBA [63]. This study cannot distinguish between these possible mechanistic pathways, however, it is important to note that the presence of cancer per se does not explain the variability in nausea in our sample; 42% of women with active disease were not experiencing nausea.…”

Control of nausea and vomiting after chemotherapy: what is the evidence?

“…These factors have been confirmed by multivariate analysis in large, well‐controlled trials, although they have not been assessed prospectively (level of evidence II) 1,9 , 10 . Other factors that are less consistently found in trials but that may be predictive are: (i) younger age, (ii) tumour burden, (iii) low social functioning and (iv) high fatigue scores (level of evidence III) 13 . The clinical application of patient‐related risk factors is somewhat limited.…”