title: Likelihood of a subsequent chemotherapy-induced nausea and vomiting (CINV) event in patients receiving low, moderately or highly emetogenic chemotherapy (LEC/MEC/HEC).
abstract: OBJECTIVE
  To assess the likelihood of subsequent chemotherapy-induced nausea and vomiting (CINV) events following a first chemotherapy administration CINV event in patients receiving single-day low, moderately, or highly emetogenic chemotherapy (LEC, MEC, or HEC).
  
  
  METHODS
  A retrospective analysis was conducted utilizing Georgia Cancer Specialists, Florida Cancer Specialists, and ACORN electronic medical records databases (April 2006 through July 2009). Patients were included who received more than one single-day LEC, MEC, or HEC administration (oral or intravenous) with no chemotherapy 3 months prior to the first LEC, MEC, or HEC administration. Two cohorts, patients with a first administration CINV and no first administration CINV, were created and followed for 6 months. A multivariate logistic regression assessed the likelihood of subsequent CINV, controlling for age, gender, Charlson comorbidity index, cancer type, number of chemotherapy administrations, gap between LEC, MEC, or HEC administrations, and number of different LEC, MEC, or HEC agents administered.
  
  
  RESULTS
  A total of 10,586 patients met the inclusion criteria (LEC = 3099; MEC = 5172; HEC = 2315). Of those patients, 4.4% (n = 136), 7.8% (n = 402), and 13.8% (n = 320) experienced a CINV event with their initial single-day LEC, MEC, or HEC administration, respectively. The unadjusted subsequent CINV rate was higher in the cohorts with first LEC, MEC, or HEC administration CINV for all groups receiving LEC (33.1% vs. 16.0%; p < 0.0001), MEC (46.5% vs. 18.9%; p < 0.0001), or HEC (59.1% vs. 26.9%; p < 0.0001). After controlling for covariates, patients with first LEC, MEC, or HEC administration CINV were 3.1, 3.8, and 3.7 times more likely to have a subsequent CINV compared to patients without a first LEC, MEC, or HEC administration CINV (Odds Ratio: 3.05 [95% CI: 2.08-4.48, p < 0.0001]; 3.77 [95% CI: 3.04-4.68, p < 0.0001]; and 3.70 [95% CI: 2.88-4.74, p < 0.0001], respectively).
  
  
  CONCLUSIONS
  In this retrospective analysis, patients receiving single-day LEC, MEC, or HEC who had a prior CINV were at increased risk of subsequent CINV. Further studies assessing increased risk of a subsequent CINV events are warranted given this study represents an assessment of electronic medical record data within select community-based populations under usual care.
authors.affiliation: Accelerated Community Oncology Research Network, Memphis, TN, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Schwartzberg
authors.forename: Stephen
authors.initials: S
authors.lastname: Szabo
authors.forename: James
authors.initials: J
authors.lastname: Gilmore
authors.forename: Sally
authors.initials: S
authors.lastname: Haislip
authors.forename: James
authors.initials: J
authors.lastname: Jackson
authors.forename: Gagan
authors.initials: G
authors.lastname: Jain
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Balu
authors.forename: Deborah
authors.initials: D
authors.lastname: Buchner
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000145:classification*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced* / Q000453:epidemiology*; D009369:Neoplasms / Q000188:drug therapy*; D011336:Probability; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014839:Vomiting / Q000139:chemically induced* / Q000453:epidemiology*