Initial Control of Chemotherapy-Induced Nausea and Vomiting in Patient Quality of Life

ABSTRACT: The side effects commonly experienced by patients receiving chemotherapy for the treatment of cancer can challenge many aspects of daily life. Nausea and vomiting, the most common side effects reported by patients, affect the ability to continue with usual life activities and, thus have a pronounced impact on quality of life. This paper reviews studies of the impact of nausea and emesis on quality of life, and highlights the importance of prevention of these side effects by presenting new data on how persistent uncontrolled nausea and vomiting can be. The Morrow Assessment of Nausea and Emesis (MANE) was used to collect information on symptoms experienced by consecutive patients starting chemotherapy between September 1987 and December 1995 at any of 18 geographically diverse member sites of the University of Rochester Cancer Center Community Clinical Oncology Program. Data from 1,413 patients were collected after each of four successive chemotherapy treatments. Reported incidences of posttreatment nausea and posttreatment vomiting after the first treatment were 59.4% and 28.6%, respectively. Occurrence of nausea/vomiting at the first treatment was a strong predictor of nausea/vomiting at later treatments. Of the 839 patients reporting initial nausea, 763 (90.9%) reported nausea at at least one subsequent treatment, and approximately 59% reported nausea after all three subsequent treatments. Fewer than half (45.6%) of the patients who had no nausea at the first treatment developed it later. The majority (72.0%) of patients reporting vomiting at the first treatment also reported subsequent vomiting, 30.7% of whom experienced emesis at all remaining treatments. Conversely, 76.2% of patients who were emesis-free at the first treatment remained so for all later treatments. These findings show a continuing need for further progress in controlling nausea and vomiting, and demonstrate the importance of aggressive nausea/vomiting control at the first treatment. In addition, more emphasis on controlling chemotherapy-induced nausea after its initial occurrence is necessary. [ONCOLOGY(Suppl 4):32-37, 1998]

Patients invariably rank nausea and vomiting as among the most distressing adverse effects of chemotherapy.[1-3] Furthermore, in a recent survey of 621 oncology nurses, nausea and vomiting, along with tiredness, were judged to be the chemotherapy side effects with the greatest negative impact on quality of life (QOL).[4] In another study, nausea and vomiting were each found to be important predictors of patient distress from chemotherapy, difficulty with chemotherapy, disruption of social life, and disruption of work.[5] Chemotherapy-related nausea and vomiting are highly prevalent. Despite the advances brought about by widespread use of the new 5-HT3 antiemetic agents ondansetron (Zofran), granisetron (Kytril), and tropisetron (Navoban), more than 75% of patients develop nausea following chemotherapy and approximately 40% report emesis.[6]

Aside from being distressing in and of themselves, chemotherapy-related nausea and vomiting (NV) are often associated with physiologic complications such as fatigue, muscle strain, esophageal tears, and metabolic imbalance.[7] They can also contribute to inadequate caloric and fluid intake, which, in turn, can aggravate the cachexia, lethargy, fatigue, and weakness often caused by cancer itself.[8] Increased anxiety and depression have also been associated with NV,[9-11] as has lowered cognitive functioning (which may be due to the use of prochlorperazine).[8] In addition, as a result of frequent or severe postchemotherapy NV, many patients develop what are believed to be conditioned responses to the treatment, including not only the well documented anticipatory NV, which occurs prior to treatment, but also food aversions and aversions to other oncology treatment-related stimuli, such as needles, nurses, and clinic waiting rooms. Finally, poorly controlled NV can lead to dosage reduction or even termination of potentially curative chemotherapy treatment regimens.[2,12,13]

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