Chemotherapy-induced nausea and vomiting in patients with breast cancer: a prospective cohort study

Abstract

Purpose: To explore the actual status of chemotherapy-induced nausea and vomiting (CINV) through a multicenter prospective cohort study.

Methods: Patients with breast cancer treated with moderately emetogenic (MEC) or highly emetogenic (HEC) chemotherapy were eligible. A 7-day diary was provided for all patients. Acute and delayed CINV were defined as nausea and vomiting that developed ≤ 24 or > 24 h after the start of chemotherapy, respectively. The severity of nausea was evaluated with a visual analog scale (VAS). We also assessed the accuracy of estimations of CINV by medical staff.

Results: In total, 426 patients were included; 352 patients (82.6%) received HEC, and 74 (17.3%) received MEC. In the acute phase, 44.9% of patients receiving HEC and 5.4% receiving MEC experienced nausea, and 12.8% receiving HEC and none receiving MEC experienced vomiting. More patients experienced nausea in both groups and vomiting in MEC during the delayed phase (nausea: 59.4% in HEC and 44.6% in MEC group; vomiting: 11.1% in HEC; and 13.5% in MEC group) than during the acute phase. Estimations of CINV by medical staff were not accurate, with a kappa coefficient of 0.10 and 0.08 for acute nausea and vomiting and 0.02 and 0.01 for delayed. The VAS scores showed that in the HEC group, the degree of nausea was worst on the first day.

Conclusions: The degree of nausea was worst in the acute phase, although delayed nausea was more in proportion in HEC. Estimation by medical staff is not accurate.

Keywords: Antiemetics; Breast cancer; Chemotherapy-induced nausea and vomiting; Guideline.

Fig. 1

Patient flow. In total, 1910 patients were included in the whole study and 429 had breast cancer. One patient treated with cisplatin and irinotecan and two male patients were excluded; therefore, 426 patients were included for the current analyses

Fig. 2

Occurrence of acute/delayed nausea and vomiting in HEC- and MEC-induced CINV. Proportion of patients with nausea and vomiting. Acute phase: ≤ 24 h from administration of emetogenic agents, delayed phase: > 24 h from administration

Fig. 3

VAS of nausea from day 1 to day 7. Visual analog scale (VAS) for the degree of nausea

Fig. 4

Multivariate analysis of prognostic factors. a Multivariate analysis of prognostic factors for acute-phase nausea. Multivariate analysis showed that pregnancy experience and treatment with HEC were significantly correlated with developing acute-phase nausea. b Multivariate analysis of prognostic factors for acute-phase vomiting. Younger age was the only factor which was significantly correlated with acute-phase vomiting. c Multivariate analysis of prognostic factors for delayed-phase nausea. Experience of motion sickness, younger age, a higher serum albumin concentration, and treatment with HEC were significantly correlated with delayed-phase nausea. d Multivariate analysis of prognostic factors for delayed-phase vomiting. Experience of hyperemesis gravidarum was the only factor which was correlated with delayed-phase vomiting. Covariates included in the analyses were as follows; history of motion sickness (yes vs no), reproductive history (yes vs no), history of pregnancy-related vomiting (yes vs no), alcohol intake history (yes vs no), age (continuous variable), hemoglobin (continuous variable), serum albumin concentration (continuous variable), number of prophylactic antiemetics (3 vs 2), use of 5HT3 antagonist (yes vs no), and HEC vs MEC