Abstract
Background
The major objective of the study was to determine the incidence and prevalence of acute and delayed chemotherapy-induced nausea and vomiting (CINV) among patients receiving chemotherapy and assess the accuracy with which medical providers perceive the incidence of CINV in their practice.
Methods
Specialists, residents and nurses (medical providers) from two cancer centers in Taiwan estimated the incidence of acute and delayed CINV. Chemotherapy-naïve patients from the same centers then completed a 5-day nausea and vomiting diary following highly and moderately emetogenic chemotherapy (HEC and MEC) to determine the actual incidence of acute and delayed CINV. Daily nausea ratings were recorded on a 100-mm visual analogue scale (VAS). No nausea was defined as a nausea VAS score <5 mm. Vomiting episodes were also recorded. Nausea and vomiting were defined as acute and delayed based on whether they occurred during the first 24 h after chemotherapy, or during days 2–5 after chemotherapy, respectively.
Results
In the two oncology centers, 37 medical providers (13 specialists, 4 residents, 20 nurses) and 107 patients were enrolled. The mean patient age was 49.2 years with 76% female and 74% having breast cancer. Of the 107 patients, 39% received HEC and 61% received MEC, and 77% received a 5-HT3 receptor antagonist and 94% received dexamethasone. There were no significant differences between patients with acute CINV and delayed CINV in terms of demographics, chemotherapy treatment or antiemetic treatment. The proportion of patients without alcohol use was significantly higher among patients with delayed CINV than among those with non-delayed CINV. Good control of CINV during the acute period correlated with the control of delayed emesis. There were no significant differences between specialists’, residents’, and nurses’ estimations of the incidence rates of CINV. For HEC given to chemotherapy-naïve patients, the medical providers estimated acute CINV to be 44/41% and delayed CINV to be 61/53%, respectively. However, patient diaries revealed acute CINV to be 43/21% and delayed CINV to be 64/60%, respectively. For MEC given to chemotherapy-naïve patients, medical providers estimated acute CINV to be 39/36% and delayed CINV to be 44/39%, respectively. However, patient diaries revealed acute CINV to be 55/18% and delayed CINV to be 74/55%, respectively.
Conclusions
Medical providers significantly overestimated the incidence of acute vomiting by 20% and 18% in HEC and MEC patients, respectively. While they correctly estimated the rate of delayed vomiting in HEC patients, they underestimated it by 16% in MEC patients. With respect to nausea, medical providers correctly estimated rates of both acute and delayed nausea in HEC patients, but significantly underestimated rates of acute and delayed nausea by 16% and 30%, respectively, in MEC patients.
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References
Berger AM, Clark-Snow RA (1997) Adverse effects of treatment, nausea and vomiting. In: DeVita VT, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology. Lippincott-Raven, Philadelphia, pp 2705–2714
Hesketh PJ (2000) Comparative review of 5-HT3 receptor antagonists in the treatment of acute chemotherapy-induced nausea and vomiting. Cancer Invest 18:163–173
Rhodes VA, Watson PM, Johnson MH, Madsen RW, Beck NC (1987) Patterns of nausea, vomiting, and distress in patients receiving antineoplastic drug protocols. Oncol Nurs Forum 14:35–44
Rhodes VA, McDaniel RW (2001) Nausea, vomiting, and retching: complex problems in palliative care. CA Cancer J Clin 51:232–248; quiz 249–252
Morrow GR (1989) Chemotherapy-related nausea and vomiting: etiology and management. CA Cancer J Clin 39:89–104
Tonato M, Roila F, Del Favero A (1991) Methodology of antiemetic trials: a review. Ann Oncol 2:107–114
Pollera CF, Giannarelli D (1989) Prognostic factors influencing cisplatin-induced emesis. Cancer 64:1117–1122
Pater J, Slamet L, Zee B, Osoba D, Warr D, Rusthoven J (1994) Inconsistency of prognostic factors for post-chemotherapy nausea and vomiting. Support Care Cancer 2:161–166
Hesketh PJ, Kris MG, Grunberg SM, Beck T, Hainsworth JD, Harker G, et al (1997) Proposal for classifying the acute emetogenicity of cancer chemotherapy. J Clin Oncol 15:103–109
Yalcin S, Tekuzman G, Baltali E, Ozisik Y, Barista I (1999) Serotonin receptor antagonists in prophylaxis of acute and delayed emesis induced by moderately emetogenic, single-day chemotherapy: a randomized study. Am J Clin Oncol 22:94–96
Roila F, Boschetti E, Tonato M, Basurto C, Bracarda S, Picciafuoco M, et al (1991) Predictive factors of delayed emesis in cisplatin-treated patients and antiemetic activity and tolerability of metoclopramide or dexamethasone: a randomized single-blind study. Am J Clin Oncol 14:238–242
Italian Group For Antiemetic Research (1992) Ondansetron+dexamethasone vs metoclopramide+dexamethasone+diphenhydramine in prevention of cisplatin-induced emesis. Lancet 340:96–99
Roila F (1993) Ondansetron plus dexamethasone compared to the ‘standard’ metoclopramide combination. Oncology 50:163–167
Hesketh PJ, Gandara DR (1991) Serotonin antagonists: a new class of antiemetic agents. J Natl Cancer Inst 83:613–620
Kris MG, Gralla RJ, Clark RA, Tyson LB (1989) Phase II trials of the serotonin antagonist GR38032F for the control of vomiting caused by cisplatin. J Natl Cancer Inst 81:42–46
Grunberg SM, Hansen M, Deuson R, Mavros P (2002) Incidence and impact of nausea/vomiting with modern antiemetics: perception vs. reality. Proc Am Soc Clin Oncol 21:250a
Gralla RJ, Osoba D, Kris MG, et al (1999) Recommendations for guidelines for the use of antiemetics: evidence-based clinical practice guidelines. J Clin Oncol 17:2971–2994
Borjeson S, Hursti TJ, Peterson C, et al (1997) Similarities and differences in assessing nausea and vomiting on a verbal category scale and a visual analogue scale. Cancer Nurs 20:260–266
Martin AR, Cai B, Pearson J, et al (2001) Patient-assessed impact of chemotherapy-induced nausea on daily life: how much is too much? Oncol Nurs Forum 28:338
Fetting JH, Grochow LB, Folstein MF, Ettinger DS, Colvin M (1982) The course of nausea and vomiting after high-dose cyclophosphamide. Cancer Treat Rep 66:1487–1493
Morrow GR (1992) A patient report measure for the quantification of chemotherapy induced nausea and emesis: psychometric properties of the Morrow Assessment of Nausea and Emesis (MANE). Br J Cancer [Suppl] 19:S72–S74
Willan A, Warr D, Pater J, et al (1991) Methodological issues and antiemetic studies. In: Osoba D (ed) Effect of cancer on quality of life. CRC Press, Boca Raton, pp 229–249
Koo WH, Ang PT (1996) Role of maintenance oral dexamethasone in prophylaxis of delayed emesis caused by moderately emetogenic chemotherapy. Ann Oncol 7:71–74
Ossi M, Anderson E, Freeman A (1996) 5-HT3 receptor antagonists in the control of cisplatin-induced delayed emesis. Oncology 53 [Suppl 1]:78–85
Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hesketh PJ, Chinnery LW, et al (1999) Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. American Society of Clinical Oncology. J Clin Oncol 17:2971–2994
Gralla RJ (1994) Antiemetic treatment for cancer chemotherapy: problems and progress. Support Care Cancer 2:275–276
Heron JF (1995) Single-agent oral granisetron for the prevention of acute cisplatin-induced emesis: a double-blind, randomized comparison with granisetron plus dexamethasone and high-dose metoclopramide plus dexamethasone. Semin Oncol 22 [4 Suppl 10]:24–30
Poli-Bigelli S, Rodrigues-Pereira J, Carides AD, Julie MG, Eldridge K, Hipple A, et al (2003) Addition of the neurokinin 1 receptor antagonist aprepitant to standard antiemetic therapy improves control of chemotherapy-induced nausea and vomiting: results from a randomized, double-blind, placebo-controlled trial in Latin America. Cancer 97:3090–3098
Goedhals L, Heron JF, Kleisbauer JP, Pagani O, Sessa C (1998) Control of delayed nausea and vomiting with granisetron plus dexamethasone or dexamethasone alone in patients receiving highly emetogenic chemotherapy: a double-blind, placebo-controlled, comparative study. Ann Oncol 9:661–666
Schnell FM (2003) Chemotherapy-induced nausea and vomiting: the importance of acute antiemetic control. Oncologist 8:187–198
Acknowledgement
We thank Dr. Steven Grunberg, Fletcher Allen Health Care, University of Vermont, USA, for his critical review of the manuscript.
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Liau, CT., Chu, NM., Liu, HE. et al. Incidence of chemotherapy-induced nausea and vomiting in Taiwan: physicians’ and nurses’ estimation vs. patients’ reported outcomes. Support Care Cancer 13, 277–286 (2005). https://doi.org/10.1007/s00520-005-0788-5
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DOI: https://doi.org/10.1007/s00520-005-0788-5