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Supportive Care in Cancer

, Volume 23, Issue 11, pp 3341–3359 | Cite as

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

  • Catalina Hernandez Torres
  • Sasha Mazzarello
  • Terry Ng
  • George Dranitsaris
  • Brian Hutton
  • Stephanie Smith
  • Amy Munro
  • Carmel Jacobs
  • Mark Clemons
Original Article

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.

Keywords

CINV Patient Perception Breast cancer End points 

Notes

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.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Catalina Hernandez Torres
    • 1
  • Sasha Mazzarello
    • 2
  • Terry Ng
    • 1
  • George Dranitsaris
    • 3
  • Brian Hutton
    • 4
  • Stephanie Smith
    • 2
  • Amy Munro
    • 2
  • Carmel Jacobs
    • 1
  • Mark Clemons
    • 1
    • 2
    • 5
  1. 1.Division of Medical Oncology and Department of MedicineUniversity of OttawaOttawaCanada
  2. 2.Cancer Therapeutics ProgramOttawa Hospital Research InstituteOttawaCanada
  3. 3.TorontoCanada
  4. 4.Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
  5. 5.Division of Medical OncologyThe Ottawa Hospital Cancer CentreOttawaCanada

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