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Incidence and predictors of anticipatory nausea and vomiting in Asia Pacific clinical practice—a longitudinal analysis

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Some patients experience nausea and/or vomiting (NV) before receipt of chemotherapy. Our objective was to evaluate the impact of prior chemotherapy-induced NV (CINV) on the incidence of anticipatory NV in later cycles.


This multicenter, prospective non-interventional study enrolled chemotherapy-naïve adults scheduled to receive highly or moderately emetogenic chemotherapy (HEC/MEC) for cancer in six Asia Pacific countries, excluding those with emesis within 24 h before cycle 1 chemotherapy. On day 1 before chemotherapy, patients answered four questions regarding emesis in the past 24 h, nausea, expectation of post-chemotherapy nausea, and anxiety in the past 24 h, the latter three scored from 0–10 (none–maximum). Multivariate logistic regression was used to assess the impact of prior CINV on anticipatory NV in cycles 2 and 3.


Five hundred ninety-eight patients (59 % female) were evaluable in cycle 2 (49 % HEC, 51 % MEC). The incidence of anticipatory emesis was low before cycles 2 and 3 (1.5–2.3 %). The incidence of clinically significant anticipatory nausea (score of ≥3) was 4.8, 7.9, and 8.3 % before cycles 1, 2, and 3, respectively, with adjusted odds ratio (OR), 3.95 (95 % confidence interval (CI), 2.23–7.00; p < 0.001) for patients with clinically significant nausea in prior cycles, compared with none. The adjusted ORs for other anticipatory NV endpoints ranged from 4.54–4.74 for patients with prior CINV. The occurrence of clinically significant anxiety in the prior cycle also resulted in a significantly increased likelihood of anticipatory nausea.


These findings highlight the importance of preventing CINV in cycle 1 to reduce anticipatory NV in subsequent cycles.

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We thank all the investigators who participated in this study. This study was sponsored by Merck & Co., Inc. Medical writing and editorial assistance was provided by Elizabeth V. Hillyer, DVM. This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ.


AC has received remuneration, served as a consultant/advisor, and received funding from Merck Sharp & Dohme (MSD). GL has received remuneration and funding from MSD. AB is an employee of OptumInsight Inc., the contract research organization that conducted the study. SB is an employee of MSD. TAB is an employee of Merck and may own stock or stock options. DMKK has served as a consultant/advisor for Merck, Pfizer, Soligenix, Entera, and Helsinn and has received funding from Entera and Helsinn. All remaining authors have declared no conflict of interest. The authors state that they have full control of all primary data and that they agree to allow the journal to review their data if requested.

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Correspondence to Alexandre Chan.

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Chan, A., Kim, HK., Hsieh, R.K. et al. Incidence and predictors of anticipatory nausea and vomiting in Asia Pacific clinical practice—a longitudinal analysis. Support Care Cancer 23, 283–291 (2015).

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