title: Anticipatory Nausea, Risk Factors, and Its Impact on Chemotherapy-Induced Nausea and Vomiting: Results From the Pan European Emesis Registry Study.
abstract: Anticipatory (prechemotherapy) nausea (AN) is a classic conditioned symptom not responding well to current antiemetics. Minimal work has been done to assess its risk factors and impact on chemotherapy-induced nausea and vomiting (CINV).
  
  
  
  To evaluate risk factors for AN and assess its impact on CINV development.
  
  
  
  We analyzed data (n = 991) from a prospective observational multisite study in eight European countries over three cycles of chemotherapy. Patient/treatment characteristics were collected before chemotherapy. History of nausea/vomiting (yes/no), patient expectation of CINV (0-100 mm visual analog scale, [VAS]), and prechemotherapy anxiety (0-100 mm VAS) also were collected before chemotherapy. A patient-completed diary during each chemotherapy cycle obtained information on AN in the 24 hours before chemotherapy administration and nausea and vomiting (episodes of vomiting and severity of nausea) daily for five days after administration of chemotherapy (0-100 mm VAS).
  
  
  
  AN was reported by 8.3%-13.8% of patients, increasing in frequency and intensity over each cycle. Every 1 mm increase in AN on the VAS was significantly associated with 2%-13% of increase in the likelihood of CINV (all P-values <0.05). Key predictors of AN in Cycle 1 included metastatic disease and prechemotherapy anxiety. However, predictors of AN in subsequent cycles included prechemotherapy anxiety and AN and CINV experience in the previous cycle, the latter being the strongest predictor (odds ratio = 3.30-4.09 for CINV outcomes over the cycles).
  
  
  
  AN is a challenging symptom, and its prevention needs to consider better CINV prevention in the previous cycles as well as managing prechemotherapy anxiety.
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong. Electronic address: alex.molasiotis@polyu.edu.hk.
authors.forename: Alexander
authors.initials: A
authors.lastname: Molassiotis
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Lee
authors.affiliation: Global Health Outcomes, Merck Research Laboratories, Kenilworth, New Jersey, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Burke
authors.affiliation: Hematology-Oncology, Luxembourg Medical Center, Luxembourg City, Luxembourg.
authors.forename: Mario
authors.initials: M
authors.lastname: Dicato
authors.affiliation: August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Gascon
authors.affiliation: Santa Maria Hospital, Terni, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Roila
authors.affiliation: Breast Center, IMO Clinique de Genolier, Genolier, Switzerland.
authors.forename: Matti
authors.initials: M
authors.lastname: Aapro
mesh_terms: D059031:Anticipation, Psychological; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005060:Europe; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology / Q000209:etiology*; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D014840:Vomiting, Anticipatory / Q000453:epidemiology / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents
keywords: Anticipatory nausea; antiemetics; cancer; chemotherapy-related nausea and vomiting; prechemotherapy nausea