Evaluation of Risk Factors Predicting Chemotherapy-Related Nausea and Vomiting: Results From a European Prospective Observational Study
Abstract
Context
Demographic,
personal, clinical, and behavioral factors predicting
chemotherapy-induced nausea and vomiting (CINV) have been assessed in
the past, but inconsistencies exist in the literature, studies have
methodological shortcomings, and many risk factors have been examined in
cross-sectional studies and univariate analyses.
Objectives
To
evaluate the predictive power of personal and treatment-related
characteristics in the development of CINV, using a large and
prospectively evaluated sample of a heterogeneous group of cancer
patients receiving routine chemotherapy.
Methods
This was a
multicountry, multisite prospective study over three cycles of
chemotherapy. Adult patients from eight European countries about to
receive highly and moderately emetogenic chemotherapy were recruited.
Clinicians completed a case report form at or before the initial
chemotherapy treatment, recording patient demographic and baseline
clinical characteristics. Participants completed a daily patient diary
for six days per chemotherapy cycle describing their CINV experience.
Baseline patient data also included a history of nausea/vomiting
(yes/no), patient expectation of nausea (0–100 mm visual analogue scale
[VAS]), prechemotherapy anxiety (0–100 mm VAS), and prechemotherapy
nausea (0–100 mm VAS) measured during the 24-hour period before
chemotherapy initiation.
Results
There were 991 evaluable
patients with complete Cycle 1 data, 888 for Cycle 2 data, and 769 for
Cycle 3 data. A complex picture of predictor variables was shown, with
different contribution of variables to the acute, delayed, and overall
phases of CINV. Key predictor variables included the use of antiemetics
inconsistent with international guidelines, younger age, prechemotherapy
nausea, and no CINV complete response in an earlier cycle (all at P < 0.05).
Anxiety, history of nausea/vomiting, and expectations of nausea were
important predictors for some phases and cycles but not consistently
across the CINV pathway.
Conclusion
The results of this
study provide clarity for the relative contribution of a set of
characteristics in the development of CINV. Following evidence-based
clinical antiemetic guidelines is of paramount importance, alongside
treating patients with increased risk for CINV more aggressively, which
both could lead to more optimal CINV management. These data can assist
clinicians in making decisions about the antiemetic management of their
patients.
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