Abstract
Purpose
Nausea is a troublesome and distressing symptom for patients receiving chemotherapy. While vomiting is well controlled with current antiemetics, nausea is a more difficult symptom to manage. The aim of this study was to assess the impact of nausea on nutritional status, quality of life and psychological distress.
Methods
This was a prospective observational study over two cycles of chemotherapy. Patients completed the Multinational Association of Supportive Care in Cancer Antiemesis Tool, a measure of nutritional status (Patient-Generated Subjective Global Assessment), the Functional Assessment of Cancer Therapy-General (FACT-G) quality of life scale and the Hospital Anxiety and Depression Scale at the end of each chemotherapy cycle (around day 10 post-chemotherapy).
Results
The sample consisted of 104 patients, primarily female, receiving anthracycline-based chemotherapy. While vomiting was minimal (5.2–14.6 % of the patients), high levels of nausea were observed (55.2–72.9 %), and severe nausea (>6 on a 0–10 scale) was reported by 20.5–29.2 % of the participants. Severe nausea had a borderline significant impact in relation to physical functioning (p = 0.025) and a significant impact on nutritional status (severe acute nausea, p = 0.003; severe delayed nausea, p = 0.017). Clinically meaningful changes were observed in relation to the FACT-G total score.
Conclusion
Chemotherapy-induced nausea does have an impact on nutritional status and physical functioning and can impair anxiety and quality of life. As a key symptom associated with other symptoms, it is imperative that greater attention is given to managing treatment-related nausea through innovative non-pharmacological and nutritional interventions.
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References
American Cancer Society (2000) Nutrition for the person with cancer: A guide for patients and families. American Cancer Society, Inc., Atlanta
ASHP (1999) Therapeutic guidelines on the pharmacologic management of nausea and vomiting in adult and pediatric patients receiving chemotherapy or radiation therapy or undergoing surgery. Am J Health Syst Pharm 56:729–764
Bauer J (2002) CS, and Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment. Eur J Clin Nutr 56:779–85
Bauer JD (2005) CS. Nutrition intervention improves outcomes in patients with cancer cachexia receiving chemotherapy—a pilot study. Support Care Cancer 13:270–74
Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J (2006) Delayed nausea and vomiting continue to reduce patients' quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol 24:4472–4478
Brearley SG, Clements CV, Molassiotis A (2008) A review of patient self-report tools for chemotherapy-induced nausea and vomiting. Support Care Cancer 16:1213–1229
Cella D, Tulsky D, Gray G, Sarafian B, Linn E, Bonomi A et al (1993) The Functional Assessment of Cancer Therapy Scale: development and validation of the general measure. J Clin Oncol 11:570–579
de Boer-Dennert M, de Wit R, Schmitz PI, Djontono J, v Beurden V, Stoter G, Verweij J (1997) Patient perceptions of the side-effects of chemotherapy: the influence of 5HT3 antagonists. Br J Cancer 76:1055–1061
Decker GM, DeMeyer ES, Kisko DL (2006) Measuring the maintenance of daily life activities using the functional living index-emesis (FLIE) in patients receiving moderately emetogenic chemotherapy. J Support Oncol 4:35–41
Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, Blackwell K, Rimer BK (2001) Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 19(9):2381–9
Detsky AS, Baker JP, Mendelson RA (1984) Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. JPEN J Parenter Enteral Nutr 8(2):153–9
Detsky AS, McLaughlin JR, Johnstone N, Whittaker S, Mendelson RA, Jeejeebhoy KN (1987) What is subjective global assessment of nutritional status. JPEN J Parenter Enteral Nutr 11:8–13
Eton DT, Cella D, Yost KJ et al (2004) A combination of distribution- and anchor-based approaches determined minimally important differences (MIDs) for four endpoints in a breast cancer scale. J Clin Epidemiol 57(9):898–910
Farrell C, Heaven C, Beaver K, Maguire P (2005) Identifying the concerns of women undergoing chemotherapy. Patient Educ Couns 56:72–7
Glaus A, Knipping C, Morant R, Bohme C, Lebert B, Beldermann F, Glawogger B, Ortega PF, Husler A, Deuson R (2004) Chemotherapy-induced nausea and vomiting in routine practice: a European perspective. Support Care Cancer 12:708–715
Gift AG, Jablonski A, Stommel M, Given CW (2004) Symptom clusters on elderly patients with lung cancer. Oncol Nurs Forum 31:203–212
Grunberg SM, Deuson RR, Mavros P, Geling O, Hansen M, Cruciani G, Daniele B, De Pouvourville G, Rubenstein EB, Daugaard G (2004) Incidence of chemotherapy-induced nausea and emesis after modern antiemetics. Cancer 100:2261–2268
King MT, Stockler MR, Cella DF et al (2010) Meta-analysis provides evidence-based effect sizes for a cancer-specific quality-of-life questionnaire, the FACT-G. J Clin Epidemiol 63(3):270–281
Liau CT, Chu NM, Liu HE, Deuson R, Chen JS (2005) Incidence of chemotherapy-induced nausea and vomiting in Taiwan: physicians' and nurses' estimation vs patient's reported outcomes. Supp Care Cancer 13:277–286
Lotfi-Jam K, Carey M, Jefford M, Schofield P, Charleson C, Aranda S (2008) Nonpharmacologic strategies for managing common chemotherapy adverse effects: a systematic review. J Clin Oncol 26:5618–5629
Maguire P (2000) Managing psychological morbidity in cancer patients. Eur J Cancer 36:556–58
Martin CG, Rubenstein EB, Elting LS, Kim YJ, Osoba D (2003) Measuring chemotherapy-induced nausea and emesis. Psychometric properties of a quality of life questionnaire. Cancer 98:645–655
Miller M, Kearney N (2004) Chemotherapy-related nausea and vomiting—past reflections, present practice and future management. Eur J Cancer Care 13:71–81
Molassiotis A, Yung HP, Yam BM, Chan FY, Mok TS (2002) The effectiveness of progressive muscle relaxation training in managing chemotherapy-induced nausea and vomiting in Chinese breast cancer patients: a randomised controlled trial. Support Care Cancer 10:237–246
Molassiotis A, Saunders M, Valle J, Wilson G, Lorigan P, Wardley A, Levine E, Cowan R, Loncaster J, Rittenberg C (2008) A prospective observational study of chemotherapy-induced nausea and vomiting in routine practice in a UK cancer centre. Support Care Cancer 16:201–208
Molassiotis A, Coventry PA, Stricker CT, Clements C, Eaby B, Velders L, Rittenberg C, Gralla RJ (2007) Validation and psychometric assessment of a short clinical scale to measure chemotherapy-induced nausea and vomiting: the MASCC Antiemesis Tool (MAT). J Pain Symptom Manage 34:148–159
Molassiotis A, Wengström Y, Kearney N (2010) Symptom cluster patterns during the first year after diagnosis with cancer. J Pain Symptom Manage 39:847–858
Nissen MJ, Shapiro A, Swenson KK (2011) Changes in weight and body composition in women receiving chemotherapy for breast cancer. Clin Breast Cancer 11(1):52–60
Olver I, Molassiotis A, Aapro M, Herrstedt J, Grunberg S, Morrow G (2011) Antiemetic research: future directions. Support Care Cancer 19(Suppl 1):S49–55
Osoba D, Zee B, Warr D, Latreille J, Kaizer L, Pater J (1997) Effect of postchemotherapy nausea and vomiting on health-related quality of life. The Quality of Life and Symptom Control Committees of the National Cancer Institute of Canada Clinical Trials Group. Support Care Cancer 5:307–313
Ottery F (2000) Patient-generated subjective global assessment. In: Polisena C (ed) The clinical guide to oncology nutrition. American Dietetic Association, Chicago, pp 1–23
Read JA, Crockett N, Volker DH, MacLennan P, Choy STB, Beale P et al (2005) Nutritional assessment in cancer: comparing the Mini-Nutritional Assessment (MNA) With the Scored Patient-Generated Subjective Global Assessment (PGSGA). Nutr Cancer 53(1):51–56
Richardson J, Smith JE, McCall G, Richardson A, Pilkington K, Kirsch I (2007) Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence. Eur J Cancer Care 16:402–412
Roscoe JA, Morrow GR, Hickok JT, Bushunow P, Pierce HI, Flynn PJ, Kirshner JJ, Moore DF, Atkins JN (2003) The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting. A University of Rochester Cancer Center Community Clinical Oncology Program multicenter study. J Pain Symptom Manage 26:731–742
Roila F, Herrstedt J, Aapro M, Gralla RJ, Einhorn LH, Ballatori E, Bria E, Clark-Snow RA, Espersen BT, Feyer P, Grunberg SM, Hesketh PJ, Jordan K, Kris MG, Maranzano E, Molassiotis A, Morrow G, Olver I, Rapoport BL, Rittenberg C, Saito M, Tonato M, Warr D, ESMO/MASCC Guidelines Working Group (2010) Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 21(Suppl 5):v232–43
Rusthoven JJ, Osoba D, Butts CA, Yelle L, Findlay H, Grenville A (1998) The impact of postchemotherapy nausea and vomiting on quality of life after moderately emetogenic chemotherapy. Support Care Cancer 6:389–395
Shaw C (2011) Nutrition and cancer. Blackwell, Oxford
Smith HS (2005) A receptor-based paradigm of nausea and vomiting. J Cancer Pain Symptom Pall 1:11–23
Trédan O, Bajard A, Meunier A, Roux P, Fiorletta I, Gargi T, Bachelot T, Guastalla JP, Lallemand Y, Faure C, Pérol D, Bachmann P (2010) Body weight change in women receiving adjuvant chemotherapy for breast cancer: a French prospective study. Clin Nutr 29(2):187–91
Tong H, Isenring E, Yates P (2009) The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients. Support Care Cancer 17:83–90
Wood JM, Chapman K, Eilers J (2011) Tools for assessing nausea, vomiting, and retching. Cancer Nurs 34:E14–24
Zigmund AS, Snaith RP (1983) Hospital Anxiety and Depression Scale. Acta Psych Scand 67:361–370
Acknowledgments
This study was funded by the European Oncology Nursing Society through its Major Grant Award.
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Farrell, C., Brearley, S.G., Pilling, M. et al. The impact of chemotherapy-related nausea on patients' nutritional status, psychological distress and quality of life. Support Care Cancer 21, 59–66 (2013). https://doi.org/10.1007/s00520-012-1493-9
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DOI: https://doi.org/10.1007/s00520-012-1493-9