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Defining optimal control of chemotherapy-induced nausea and vomiting—based on patients’ experience

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Abstract

Purpose

A considerable challenge when comparing antiemetic trials for chemotherapy-induced nausea and vomiting (CINV) is the large number of outcome measures for nausea and vomiting. The objective of this study is to determine the optimal definition of CINV control from the patients’ perspective.

Methods

Patients with early-stage breast cancer who had received anthracycline-cyclophosphamide-based chemotherapy were surveyed. They were asked about their experiences of CINV and perceptions of different CINV assessment tools.

Results

Of 201 patients approached, 168 (83 %) completed the survey. Patients consistently ranked nausea over vomiting as the “worst side effect from chemotherapy.” Despite the use of multi-agent antiemetic regimens, 71 % of patients experienced nausea and 26 % vomiting. Only 57 % of patients with any nausea or vomiting took rescue medications and only then when the symptom was severe. Most (76 %) patients believed that the primary end point of antiemetic trials should include the absence of both nausea and vomiting. Patients felt that CINV should be evaluated for the overall period post chemotherapy (i.e., days 1–5) and not simply the acute (the first 24 h) or delayed (days 2–5) periods.

Conclusions

Patients strongly favored a CINV end point that includes the absence of both nausea and vomiting. Patients’ experience with CINV is underestimated when nausea is not included in composite end points. “Use of rescue medication,” a commonly used surrogate for emesis control, is inappropriate as it underestimates nausea. A standardized primary end point that includes nausea is essential if CINV control is to be improved.

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Acknowledgments

The EPIC study was funded by the Canadian Breast Cancer Foundation—Ontario Chapter. The authors would like to thank all patients from the EPIC study who agree to participate in the current survey.

Conflict of interest

Brian Hutton received Honoraria for attendances at advisory boards from Amgen Canada. Catalina Hernandez-Torres, Sasha Mazzarello, Terry Ng, George Dranitsaris, Stephanie Smith, Amy Munro, Carmel Jacobs, and Mark Clemons have no conflicts to declare.

Author information

Authors and Affiliations

  1. Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada

    Catalina Hernandez Torres, Terry Ng, Carmel Jacobs & Mark Clemons

  2. Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada

    Sasha Mazzarello, Stephanie Smith, Amy Munro & Mark Clemons

  3. Toronto, Canada

    George Dranitsaris

  4. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada

    Brian Hutton

  5. Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Box 912, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

    Mark Clemons

Authors
  1. Catalina Hernandez Torres
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  2. Sasha Mazzarello
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  3. Terry Ng
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  4. George Dranitsaris
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  5. Brian Hutton
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  6. Stephanie Smith
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  7. Amy Munro
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  8. Carmel Jacobs
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  9. Mark Clemons
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Corresponding author

Correspondence to Mark Clemons.

Appendices

Appendix 1 EPIC ER 11-02 sub study survey

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Appendix 2

Fig. 4
figure 4

Worst cycle for nausea and vomiting control from patients’ experience

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Appendix 3

Fig. 5
figure 5

Day after AC chemotherapy cycle, when nausea and vomiting was worse

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Hernandez Torres, C., Mazzarello, S., Ng, T. et al. Defining optimal control of chemotherapy-induced nausea and vomiting—based on patients’ experience. Support Care Cancer 23, 3341–3359 (2015). https://doi.org/10.1007/s00520-015-2801-y

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  • DOI: https://doi.org/10.1007/s00520-015-2801-y

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