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Gastrointestinal symptoms are associated with trajectories of chemotherapy-induced nausea

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Abstract

Purpose

Between 19 and 58% of oncology patients experience chemotherapy-induced nausea (CIN). In a sample of outpatients with breast, gastrointestinal (GI), gynecological, and lung cancer, the study purposes were to evaluate for inter-individual differences in the severity of CIN over two cycles of chemotherapy (CTX) and to determine which demographic and clinical characteristics and GI symptoms were associated with higher initial levels as well as with the trajectories of CIN severity.

Methods

Patients completed study questionnaires at six time points over two cycles of CTX. These questionnaires provided information on demographic and clinical characteristics, as well as the occurrence of twelve GI symptoms. Hierarchical linear modeling based on full maximum likelihood estimation was performed.

Results

Of the 1251 patients, 47.2% reported CIN. Across two cycles of CTX, lower functional status scores and higher levels of comorbidity were associated with higher initial levels of CIN. Younger age and emetogenicity of the CTX regimen were associated with higher initial levels as well as worse trajectories of CIN. The occurrence of five GI symptoms (i.e., vomiting, lack of appetite, constipation, feeling bloated, and difficulty swallowing) was associated with higher initial levels of CIN. The occurrence of mouth sores was associated with higher initial levels as well as with worst trajectories of CIN.

Conclusions

This study is the first to identify distinct demographic, clinical, and GI symptom characteristics associated with CIN severity. These findings suggest that the etiology of CIN is complex and may warrant interventions beyond standard antiemetics.

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Author information

Authors and Affiliations

  1. School of Nursing, Department of Physiological Nursing, University of California, 2 Koret Way–N631Y, San Francisco, CA, 94143-0610, USA

    Komal Singh, Kord M. Kober, Steven M. Paul & Christine Miaskowski

  2. Mount Sinai Medical Center, New York, NY, USA

    Marilyn Hammer

  3. Rory Meyers College of Nursing, New York University, New York, NY, USA

    Fay Wright

  4. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

    Yvette P. Conley

  5. School of Medicine, University of California, San Francisco, CA, USA

    Jon D. Levine

Authors
  1. Komal Singh
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  4. Marilyn Hammer
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  8. Christine Miaskowski
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Corresponding author

Correspondence to Christine Miaskowski.

Ethics declarations

The study was approved by the Institutional Review Board at each of the study sites.

Conflict of interest

This study was supported by a grant from the National Cancer Institute (NCI, CA134900). Dr. Miaskowski is an American Cancer Society Clinical Research Professor and is funded by a K05 award from the NCI (CA168960). Komal Singh is supported by a T32 grant (NR016920) from the National Institute of Nursing Research. All other authors declare that they have no conflicts of interest.

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Singh, K., Kober, K.M., Paul, S.M. et al. Gastrointestinal symptoms are associated with trajectories of chemotherapy-induced nausea. Support Care Cancer 28, 2205–2215 (2020). https://doi.org/10.1007/s00520-019-05031-5

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