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Prevalence and predictors of long-delayed (> 120 h) chemotherapy-induced nausea and vomiting (CINV)—a systematic review and individual patient data meta-analysis

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Abstract

Introduction

Although there have been reports of chemotherapy-induced nausea and vomiting (CINV) beyond 120 h, its overall prevalence has not been systematically examined. The aim of this review and meta-analysis was to report on the prevalence of this long-delayed CINV.

Methods

This review was registered on PROSPERO (CRD42022346963). PubMed (Medline), Embase, and Cochrane Central were searched from inception until August 2022. Articles were included if they reported on CINV > 120 h after initiation of the chemotherapy regimen and patients received a single-agent highly emetogenic (HEC) or moderately emetogenic (MEC) antineoplastic agent for 1 day alone or in combination with low/minimal emetogenic chemotherapy. For all eligible articles, individual study authors were contacted and requested to provide individual patient-level data of demographics, emetogenicity of chemotherapy regimens, and daily incidence of nausea and vomiting. Forward stepwise logistic regression identified predictors for the incident day’s CINV based on prior day’s CINV episodes, controlling for patient demographics, and stratified by regimen emetogenicity.

Results

A total of 2048 patients from 2 studies were included in this individual patient data meta-analysis: 1333 patients (65%) received HEC and 715 (35%) received MEC. Among those receiving HEC, 325 (24%) experienced acute, 652 (49%) delayed, and 393 (31%) long-delayed nausea; 107 (8%) experienced acute, 179 (14%) delayed, and 79 (6%) long-delayed vomiting. Among those receiving MEC, 48 (7%) experienced acute, 272 (38%) delayed, and 167 (24%) long-delayed nausea; 12 (2%) experienced acute, 97 (14%) delayed, and 42 (6%) long-delayed vomiting. Nausea in the long-delayed phase was as severe as in the delayed phase. Patients experiencing nausea and vomiting on days 4 and 5 were at significant risk of experiencing long-delayed CINV.

Conclusion

While not as prevalent as delayed nausea and vomiting, long-delayed CINV affects a significant proportion of patients and severity is similar. Patients with delayed CINV, specifically on days 4–5, are at risk of experiencing long-delayed CINV.

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Conceptualization: RC.

Data curation: RC and GB.

Formal analysis: RC.

Investigation: RC, BY, WB, RH, GB, and JH.

Methodology: RC and JH.

Project administration: RC and CZ.

Resources: RC, GB, and CZ.

Supervision: CZ and JH.

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Writing—review and editing: all authors.

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Appendix. Search strategy

Appendix. Search strategy

PubMed/ Medline (2286 Results)

(neoplasms [mh] OR cancer*[tw])

AND

(anti-eme*[tw] OR antieme*[tw] OR induced nausea*[tw] OR associated nausea*[tw] OR cinv[tw] OR vomit*[tw] OR vomiting[mh] OR nausea*[tw] OR Nausea[mh] OR emesis[tw] OR Emetics[mh] OR emetic*[tw] OR retch*[tw])

AND

(chemotherapy [tw] OR drug therapy [mh] OR Antineoplastic Combined Chemotherapy Protocols[mh])

AND

(time to treatment [mh] OR time factors [mh] OR patient care [tw] OR delay*[tw])

Filters: Humans

EMBASE (1352) & Cochrane (39)

(exp neoplasm/ or cancer*.mp.)

and

(anti-eme*.mp. or chemotherapy induced emesis/ or exp antiemetic agent/ or antieme*.mp. or vomiting/ or nausea/ or induced nausea*.mp. or associated nausea*.mp. or exp "chemotherapy induced nausea and vomiting"/ or cinv.mp. or vomit*.mp. or nause*.mp. or emesis.mp. or Emetics.mp. or exp emetic agent/ or exp retching/ or retch*.mp.)

and

(exp cancer chemotherapy/ or chemotherapy.mp. or exp chemotherapy/ or exp cancer combination chemotherapy/ or exp drug therapy/)

and

(exp time to treatment/ or exp time factor/ or exp patient care/ or exp therapy delay/ or delay*.mp.)

Limit to human and exclude Medline journals

Limit to human and Cochrane Library

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Chow, R., Yin, L.B., Baqri, W. et al. Prevalence and predictors of long-delayed (> 120 h) chemotherapy-induced nausea and vomiting (CINV)—a systematic review and individual patient data meta-analysis. Support Care Cancer 31, 505 (2023). https://doi.org/10.1007/s00520-023-07978-y

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