Evaluation of risk factors predicting chemotherapy-related nausea and vomiting: results from a European prospective observational study.
BACKGROUND
Demographic, personal, clinical, and behavioral factors predicting chemotherapy-induced nausea and vomiting (CINV) have been assessed in the past, but inconsistencies exist in the literature, studies have methodological shortcomings, and many risk factors have been examined in cross-sectional studies and univariate analyses.


OBJECTIVE
To evaluate the predictive power of personal and treatment-related characteristics in the development of CINV, using a large and prospectively evaluated sample of a heterogeneous group of cancer patients receiving routine chemotherapy.


METHODS
This was a multicountry, multisite prospective study over three cycles of chemotherapy. Adult patients from eight European countries about to receive highly and moderately emetogenic chemotherapy were recruited. Clinicians completed a case report form at or before the initial chemotherapy treatment, recording patient demographic and baseline clinical characteristics. Participants completed a daily patient diary for six days per chemotherapy cycle describing their CINV experience. Baseline patient data also included a history of nausea/vomiting (yes/no), patient expectation of nausea (0-100 mm visual analogue scale [VAS]), prechemotherapy anxiety (0-100 mm VAS), and prechemotherapy nausea (0-100 mm VAS) measured during the 24-hour period before chemotherapy initiation.


RESULTS
There were 991 evaluable patients with complete Cycle 1 data, 888 for Cycle 2 data, and 769 for Cycle 3 data. A complex picture of predictor variables was shown, with different contribution of variables to the acute, delayed, and overall phases of CINV. Key predictor variables included the use of antiemetics inconsistent with international guidelines, younger age, prechemotherapy nausea, and no CINV complete response in an earlier cycle (all at P < 0.05). Anxiety, history of nausea/vomiting, and expectations of nausea were important predictors for some phases and cycles but not consistently across the CINV pathway.


CONCLUSIONS
The results of this study provide clarity for the relative contribution of a set of characteristics in the development of CINV. Following evidence-based clinical antiemetic guidelines is of paramount importance, alongside treating patients with increased risk for CINV more aggressively, which both could lead to more optimal CINV management. These data can assist clinicians in making decisions about the antiemetic management of their patients.
School of Nursing, The Hong Kong Polytechnic University, Hong Kong. Electronic address: alex.molasiotis@polyu.edu.hk.
Alexander
A
Molassiotis
Medical Oncology and Radiation, IMO Clinique de Genolier, Genolier, Switzerland.
Matti
M
Aapro
Hematology-Oncology, Luxembourg Medical Center, Luxembourg, Luxembourg.
Mario
M
Dicato
Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
Pere
P
Gascon
Hospital Teresa Herrera-Complejo Hospitalario Universitario A Coruña-CHUAC, A Coruña, Spain.
Sylvia A
SA
Novoa
Centre G-F Leclerc, Dijon, France.
Nicolas
N
Isambert
Global Health Outcomes, Merck Sharp & Dohme Corp., Whitehouse Station, New Jersey, USA.
Thomas A
TA
Burke
St. John's University, New York, New York, USA.
Anna
A
Gu
Medical Oncology, Santa Maria Hospital, Terni, Italy.
Fausto
F
Roila
D000367:Age Factors; D000368:Aged; D059031:Anticipation, Psychological; D000932:Antiemetics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D014839:Vomiting / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology
D000932:Antiemetics; D000970:Antineoplastic Agents
Chemotherapy; emesis; nausea; prediction; risk factor; vomiting