Incidence of chemotherapy‐induced nausea and emesis after modern antiemetics

Abstract

BACKGROUNDThe authors determined the incidence of acute and delayed chemotherapy‐induced nausea and emesis (vomiting) (CINV) among patients receiving highly (HEC) or moderately (MEC) emetogenic chemotherapy. They also assessed whether physicians and nurses accurately recognized the incidence of acute and delayed CINV in their own practices.METHODSA prospective, observational study of adult patients receiving HEC or MEC for the first time was performed. Before patient enrollment, medical oncologists and oncology nurses estimated the incidence of acute (Day 1) and delayed (Days 2–5) CINV after first administration of HEC and MEC in their own practices. Eligible patients from their practices then completed a 6‐day diary including emetic episodes, nausea assessment, and antiemetic medication use. Observed incidence rates of acute and delayed CINV were compared with physician/nurse predictions.RESULTSTwenty‐four physicians and nurses and 298 eligible patients (67 receiving HEC and 231 receiving MEC) were recruited from 14 oncology practices in 6 countries. Greater than 35% of patients overall experienced acute nausea, whereas 13% experienced acute emesis. Delayed nausea and emesis were observed in 60% and 50% of HEC patients, respectively, and in 52% and 28% of MEC patients, respectively. Delayed symptoms appeared without acute symptoms after HEC (emesis, 38%; nausea, 33%) and MEC (emesis, 19%; nausea, 21%). Physicians and nurses accurately predicted the incidence of acute CINV but underestimated the incidence of delayed nausea and emesis after HEC by 21 and 28 percentage points, respectively, and delayed nausea after MEC by 28 percentage points. Greater than 75% of physicians and nurses underestimated the incidence of delayed CINV after both HEC and MEC.CONCLUSIONSPhysicians and nurses markedly underestimated the incidence of delayed nausea and emesis after both HEC and MEC. Delayed nausea and emesis, which may appear even in the absence of acute nausea and emesis, remain important targets for improved therapeutic intervention. Cancer 2004. © 2004 American Cancer Society.

Acute and delayed nausea and emesis control in pediatric oncology patients

“…Studies of antiemetic control rates that combine dissimilar emetogenic regimens together to report overall success rates may not be a valid means of describing actual rates of nausea and emesis control in clinical practice. 10,16,17 This heterogeneity in antiemetic response among different chemotherapy regimens indicates the need for quality improvements and may guide clinicians to focus research on chemotherapy regimens for which antiemetic therapy is inadequate. Potential future studies that can be derived from this research include targeting certain chemotherapy regimens to test newer antiemetic agents (e.g., aprepitant) in children, redefining and/or combining the acute and delayed phases for antiemetic studies in children who receive chemotherapy, and conducting studies to examine markers of chemotherapy-induced nausea and emesis that may predict the heterogeneity in response for children of different ages.…”

Chemotherapy-induced Nausea and Vomiting

“…Progress in preventing and controlling chemotherapy-induced vomiting has resulted in fewer patients experiencing vomiting during chemotherapy, whereas nausea continues to be reported by a majority of patients receiving emetogenic chemotherapy at some time during a course of treatments. 48 Compound/receptor signaling is key to initiating and controlling the emetic response. The most widely studied compound is serotonin, also known as 5-HT.…”

Prioritizing Mental Health Research in Cancer Patients and Survivors

“…With the development of national and international guidelines, the focus shifted from treatment to prevention through antiemetic prophylaxis [18]. Although CINV remains a concern, studies have shown that whereas the overall incidence of CINV was 83 percent in 1979 [19], the incidence of acute nausea was 35 percent just 25 years later [20]. The pharmaceutical industry's successful efforts had a profound impact on patients' quality of life and allowed many patients to complete chemotherapy regimens who previously would not have been able to do so [17].…”