Predictors of response to palliative care intervention for chronic nausea in advanced cancer outpatients

Abstract

Purpose: 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.

Fig. 1

Nausea intensity at first follow-up according to baseline nausea intensity

Fig. 2

Most frequent pharmacological intervention interventions by nature of the intervention s (n=444). NSAID: non-steroidal anti-inflammatory drug.