title: Predictors of response to palliative care intervention for chronic nausea in advanced cancer outpatients.
abstract: OBJECTIVE
  Nausea is a frequent and distressing symptom in advanced cancer patients. The objective of this retrospective study was to determine predictors of response to palliative care consultation for chronic nausea in advanced cancer outpatients.
  
  
  METHODS
  Eligible patients included were outpatient supportive care center seen consecutively for an initial consultation and who had one follow-up visit within 30 days of the initial consultation. We reviewed the medical records of 1,273 consecutive patients, and 444 (35 %) were found to meet the eligibility criteria. All patients were assessed using the Edmonton Symptom Assessment Scale (ESAS). Nausea response was defined as an improvement of at least 30% between the initial visit and the first follow-up. We used logistic regression models to assess the possible predictors of improvement in nausea.
  
  
  RESULTS
  Overall, 112 of 444 patients (25%) experienced moderate/severe chronic nausea (ESAS item score ≥4/10). Higher baseline nausea intensity was significantly related to constipation (r = 0.158; p = 0.046) and all the symptoms assessed by the ESAS (p < 0.001). Sixty-eight of the 112 (61%) patients with moderate/severe nausea at baseline showed a significant improvement at the follow-up visit (p < 0.001). The main predictors for nausea response were improvement of fatigue (p = 0.005) and increased appetite (p = 0.003).
  
  
  CONCLUSIONS
  Baseline nausea was associated with all the ESAS symptom and improvement of fatigue and lack of appetite predicted a lower frequency of nausea at follow-up. More research is necessary to better understand the association between nausea severity and other symptoms and to predict which interventions will yield the best outcomes depending on the mix and severity of symptoms.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, Unit 141, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: Wadih
authors.initials: W
authors.lastname: Rhondali
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.forename: Gary
authors.initials: G
authors.lastname: Chisholm
authors.forename: Jeanette
authors.initials: J
authors.lastname: Ferrer
authors.forename: Sun Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Kang
authors.forename: Marilene
authors.initials: M
authors.lastname: Filbet
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D002908:Chronic Disease; D005221:Fatigue / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D010045:Outpatients; D010166:Palliative Care / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics; D054368:Laxatives