Severe Chemotherapy-induced Nausea And Vomiting Research Articles

Evaluation of chemotherapy-induced nausea and vomiting in pediatric patients with high-grade glioma treated with lomustine—a case series

PurposeAlthough lomustine has been used as a chemotherapeutic agent for decades, no recommendation on appropriate chemotherapy-induced nausea and vomiting (CINV) prophylaxis is available. As CINV is considered one of the most bothersome side effects of chemotherapy, adequate prophylaxis is of relevance to improve quality of life during cancer treatment. The aim of this retrospective case series was to report the incidence and severity of CINV in pediatric patients with high-grade glioma treated with lomustine and to formulate recommendations for appropriate CINV prophylaxis.MethodsPediatric patients treated with lomustine for high-grade glioma according to the ACNS 0423 protocol were identified retrospectively. Two researchers independently reviewed and classified complaints of CINV and administered CINV prophylaxis. Treatment details, tumor localization, and response to therapy were systematically extracted from the patients’ files.ResultsSeventeen children aged 8–18 years received a median of four cycles of lomustine. CINV complaints and administered prophylaxis were evaluable in all patients. Moderate or severe CINV was observed in 13/17 (76%) patients. Administered prophylactic CINV regimens varied from no prophylaxis to triple-agent combinations.ConclusionIn this case series, we identified lomustine as a highly emetogenic chemotherapeutic agent. According to the current guidelines, CINV prophylaxis with a 5-HT3 receptor antagonist in combination with dexamethasone and (fos)aprepitant is recommended.

Efficacy and Safety of Ginger on Chemotherapy-Induced Nausea and Vomiting: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Chemotherapy-induced nausea and vomiting (CINV) is a prevalent and distressing side effect. Historically, ginger has been explored as a potential remedy for various ailments, including its potential efficacy against CINV. The aim of this study was to determine whether taking ginger supplements can relieve CINV. A comprehensive search was conducted across PubMed, EMBASE, Cochrane Library, and the Wanfang database. Randomized controlled trials meeting our inclusion criteria were analyzed. The primary outcomes were the incidence and severity of CINV. The protocol was registered on PROSPERO, and the number is CRD4202232104. Of the 35 randomized controlled trials analyzed, 22 trials employed ginger capsules as the primary intervention, whereas 13 studies evaluated the prophylactic effects of ginger-partitioned moxibustion. The outcomes indicated that combining ginger capsules with standard antiemetic agents can significantly reduce the incidence of grade 3 acute nausea (Risk Ratio [RR], 0.19; P < .001) and the incidence of high-grade overall vomiting (RR, 0.47; P = .01). Moreover, ginger-partitioned moxibustion can significantly alleviate the incidence of both mild (RR, 0.56; P = .001) and severe (RR, 0.39; P < .00001) vomiting. Only 2.8% of patients experienced dizziness after ginger-partitioned moxibustion. Our findings indicate that ginger capsules, when used alongside antiemetic drugs, enhance the management of severe CINV, particularly in highly emetogenic chemotherapy regimens. Based on our findings, we recommend initiating ginger supplements before chemotherapy, in conjunction with standard antiemetics, to reduce the severity of CINV. The promising results warrant more rigorous clinical trials to firmly establish the role of ginger in CINV management.

Efficacy and Safety of Aprepitant in Combination with Dexamethasone, Granisetron and Metoclopramide as a Prophylaxis of Chemotherapy-Induced Nausea and Vomiting in a Acute and Delayed Emesis in Arab Cancer Patient

Background: Chemotherapy Induced Nausea and Vomiting (CINV) is one of the greatest sources of distress for patients. Severe CINV may force interruption of chemotherapy, it is important to control CINV to achieve successful chemotherapy. Objective: This study to evaluate the efficacy and safety of aprepitant in a regimen containing aprepitant in combination with dexamethasone, granisetron and metoclopramide (APRDGM) versus a regimen dexamethasone, granisetron and metoclopramide (DGM) only, as a prophylaxis in (CINV) in highly emetogenic chemotherapy(HEC) in Arabic cancer patients. Setting: This study was conducted at King Abdul-Aziz Medical city (Eastern Region, AlHasa, Saudi Arabia). Methods: 309 patients all Arab population, treated with HEC, were enrolled in a retrospective, cohort study to investigate the efficacy and safety of (APR-DGM) compared to (DGM) regimen. Main outcome measure: The primary efficacy endpoint was the complete response (CR) for acute emesis and determines the adverse drug events. Secondary endpoint was the CR for delayed emesis. Results: The APR-DGM regimen showed a significantly improved control in the management of CINV in patients treated with HEC in acute emesis compared to the DGM regimen (P=0.0021). No significant difference was observed between the two regimens regards to delayed emesis (P=0.145). Both regimens were well tolerated, and the rates of adverse events were not significantly different between the regimens. Conclusion: The addition of aprepitant to the standard regimen of dexamethasone, granisetron and metoclopramide was found to be significantly better than dexamethasone, granisetron and metoclopramide alone, but only in the control of acute emesis, with no significant change in delayed emesis in Arab population.

Fosaprepitant use in children and adolescents at Memorial Sloan Kettering Cancer Center.

10575 Background: Recent NCCN guidelines recommend the addition of a neurokinin-1(NK1) receptor antagonist (e.g. fosaprepitant) to the serotonin 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist-corticosteroid combination for controlling both acute and delayed chemotherapy induced nausea and vomiting(CINV) associated with high emetogenic chemotherapy (HEC) in adults. Fosaprepitant is bioequivalent to aprepitant and could offer benefits to patients who are unable to tolerate oral antiemetics. However, little is known about the efficacy and safety of fosaprepitant in children. Methods: This retrospective chart review included all pediatric patients less than 18 years of age who received fosaprepitant at Memorial Sloan Kettering Cancer Center from July 2011 to November 2016. Results: Thirty-one patient charts representing a total of 105 doses of fosaprepitant were reviewed. Median age was 15 (range 2-17) years. Fifty-one doses (49%) were administered for primary prophylaxis for 11 patients; 40 doses (38%) for 12 patients who had a history of severe CINV and 14 doses (13%) as rescue for CINV in 10 patients after chemotherapy. Seventy-eight of the 101 chemotherapy cycles were highly emetogenic including 39 containing cisplatin. In the first two groups, patients did not have any episodes of vomiting in 97% and 88% of chemotherapy cycles respectively after fosaprepitant therapy. Seven of 12 patients receiving fosaprepitant for &gt; 3 episodes of breakthrough vomiting within 24 hours had no vomiting episodes during the first 24 hours post fosaprepitant administration. No fosaprepitant-related side effects were reported. Conclusions: Fosaprepitant appears to be safe and tolerable in children with cancer in whom it may provide benefit as prophylaxis and treatment of CINV. However a phase III study is warranted to formally study its role in pediatrics.

Relationship between traditional Chinese medicine constitutional types with chemotherapy-induced nausea and vomiting in patients with breast cancer: an observational study.

BackgroundThe theory of traditional Chinese medicine (TCM) constitution involves genetic characteristics, psychological factors, organ functions, and many other aspects. Studies have shown that TCM constitution is associated with HLA polymorphisms and has a genetic basis. A large number of Chinese studies have suggested that the clinical evolution of breast cancer may differ among patients with different TCM constitutions. In addition, patients with breast cancer and different TCM constitutions may have different degrees of myelosuppression after chemotherapy. Some studies have revealed that some constitutions may become predictive factors for death and morbidity of some diseases. The study was to investigate the risk factors among TCM constitutions for chemotherapy-induced nausea and vomiting (CINV) in patients with primary breast cancer undergoing chemotherapy.MethodsFrom September 2008 to January 2014, 612 patients who underwent surgery and chemotherapy for breast cancer in three hospitals in Xi’an, Shanxi province, underwent TCM constitution assessment using the Nine Basic Constitutions in Chinese Medicine Questionnaire before chemotherapy. CINV was monitored during treatments. Patients were asked to complete the Functional Living Index-Emesis (FLIE) questionnaire. The most severe CINV grade during chemotherapy was recorded according to the WHO standard. The relationships between TCM constitutions, CINV, and clinical and pathological characteristics of the cancers were assessed.ResultsThere were no differences in the incidence of CINV among breast cancer patients receiving different chemotherapy regimens, and among patients with different TCM constitutions. The wetness-heat score was an independent risk factor for severe CINV (grade III-IV) (OR = 1.012, 95 % CI: 1.007–1.021, P < 0.001). In-depth analyses of the wetness-heat constitution showed that bitter taste/smelly mouth was an independent risk factor for severe CINV (OR = 1.209, 95 % CI: 1.035–1.412, P = 0.017), as well as progesterone receptor-positive cancer (OR = 1.429, 95 % CI: 1.030–1.981, P = 0.032). Vomiting history was a protective factor against CINV (OR = 0.548, 95 % CI: 0.353–0.849, P = 0.007).ConclusionRisk of grade III-IV nausea and vomiting was higher in breast cancer patients with TCM constitution of wetness-heat, especially bitter taste or smelly mouth.

An assessment of chemotherapy-induced nausea and vomiting direct costs in three EU countries.

Background:chemotherapy-induced nausea and vomiting (CINV) has been commonly reported as one of the most distressing adverse effects among treated patients with cancer. Inadequately treated, CINV can lead to increased resource utilization and severely impair patients’ daily functioning and quality of life.Direct costs include acquisition cost of antiemetic drugs and rescue medication, administration devices, add-on treatments, such as hydration, and additional patient care, that is, nursing and physician time, unscheduled office visits, emergency room admissions, and, in some cases, extended hospitalization or readmission. There are many reports on the cost-effectiveness of antiemetic drugs, but information on the total cost per patient associated with CINV is limited. The costs associated with severe CINV episodes are considered responsible for the most significant part of the expenditures.Scope:The aim of this study was to investigate the management of CINV episodes in three European health-care environments and to estimate direct costs associated with severe CINV episodes.Methods:An online survey addressed to Italian, German, and French oncologists and oncology nurses was performed. The survey included 41 questions about the management and the resource utilization for patients experiencing any CINV episode during the 6-month period preceding the survey. Furthermore, the cost associated with severe CINV episode management was estimated by adopting the National Health Service’s perspective.Findings:A large proportion of patients receiving chemotherapy experienced a CINV episode (34.4% in Italy, 50.2% in France, and 40.4% in Germany); among those, 8.8% in Italy, 11.6% in France, and 19.2% in Germany experienced a severe CINV episode. Compared with Italy, Germany and France presented a greater hospitalization rate following an unplanned visit to the oncology ward or an emergency room access due to CINV. In Italy, the mean cost per patient with a severe CINV episode resulted in approximately €389, about half of the mean cost in France (€750) and a third of the mean cost in Germany (€1,017).Conclusions:Severe CINV episodes requiring hospitalization, day hospital, or hospitalization extension involve a significant cost for the National Health Services; additional studies should be conducted in order to evaluate potential ways to offset these expenses.

Olanzapine for Preventing Nausea and Vomiting Induced by Moderately and Highly Emetogenic Chemotherapy

Nausea and vomiting are common adverse events in chemotherapy. In spite of the serious effects on the quality of life and further treatment, they remain overlooked by physicians, and no standard treatment has been developed. Neurokinin-1 (NK-1) receptor antagonists and palonosetron are the major agents in the standard regimen for treating moderately and highly emetogenic chemotherapy-induced nausea and vomiting (CINV). However, NK-1 receptor antagonists first became commercially available at the end of 2013 and palonosetron has not been extensively applied in China. Olanzapine was recommended as a therapy for moderate and severe CINV in antiemesis-clinical practice guidelines in oncology in 2014 for the first time. It is an atypical antipsychotic agent, which can block multiple receptors on neurotransmitters. During more than 10 years, olanzapine has demonstrated significant effects in preventing CINV and treating breakthrough and refractor CINV, which was observed in case reports, precise retrospective studies, and phase I, II and III clinical trials, with no grade 3 to 4 adverse events. In particular, it is superior to aprepitant and dexamethasone in delayed nausea and vomiting. Therefore, this compound is worthy of further investigation.

Chemotherapy-Induced Nausea and Vomiting in Asian Women With Breast Cancer Receiving Anthracycline-Based Adjuvant Chemotherapy

Chemotherapy-induced nausea and vomiting (CINV) remain among the most frequently reported distressing side effects associated with anthracycline-based chemotherapy despite significant advances in antiemetic management. The main risk factor for severity of CINV is the emetogenic potential of the chemotherapeutic agents. However, patient-related risk factors have been identified, including genetic makeup. Although studies have noted that ethnicity influences nausea and vomiting in other contexts, there is a paucity of research regarding the impact of ethnicity on CINV. This study was undertaken to evaluate whether Asian women receiving anthracycline-based chemotherapy experience more CINV than non-Asians. A retrospective, comparative, correlational chart review was performed to abstract the relevant variables. Data from a convenience sample of 358 women with breast cancer who received chemotherapy with doxorubicin between 2004 and 2008 at City of Hope in Duarte, California, were evaluated. The sample consisted of Caucasians (45%), Hispanics (27.7%), Asians (19.8%), and African Americans (7.5%). The results indicate that Asian women with breast cancer undergoing anthracycline-based chemotherapy experienced statistically significantly more clinically important CINV than their non-Asian counterparts. The data were collected retrospectively, with a certain population distribution at a specific time. This study provides interesting preliminary evidence that Asian ethnicity plays a role in the development of severe CINV. When managing chemotherapy toxicities in women with breast cancer, health-care providers should tailor therapy to individual risk profiles. Specifically, consideration of antiemetic therapy should accommodate patient characteristics, such as Asian descent.

Impact of 5-Hydroxytryptamine-3 Receptor Antagonist Step Therapy on Severe Chemotherapy-Induced Nausea and Vomiting Events in Patients with Lymphoma

Abstract 3137 Introduction:Older 5-hydroxytryptamine3 receptor antagonists (5-HT-3 RA), e.g., ondansetron and the more recent palonosetron are indicated for prevention of chemotherapy (CT) induced nausea and vomiting (CINV). Step therapy is a policy that encourages the use of generic 5-HT3 RAs, reserving prophylaxis with palonosetron as second-line therapy as means to containing costs. Objective:To evaluate potential impact of step therapy policy on risk of severe CINV events among patients (pts) with lymphoma who used ondansetron, granisetron, or dolasetron and later switched to palonosetron versus pts who were initiated and maintained on palonosetron throughout multiple CT cycles. Methods:Pts initially diagnosed with lymphoma during 2005–2009 were selected from PharMetrics claims dataset if enrolled for ≥6 months before first lymphoma diagnosis and received cyclophosphamide based CT and 5-HT-3 RA prophylaxis. Pts were followed (FUP) for 6 months from 1st CT date. Based on 5-HT-3 RA used at FUP, pts were grouped into those initiated and maintained on palonosetron throughout versus those initiated with an earlier 5-HT-3 RA and later switched to palonosetron. Outcomes included risk of severe CINV (using ICD-9 codes) associated with hospitalizations or ER admissions, as well as days with severe CINV. Logistic and Poisson regression models were used to compare risk and days with severe CINV, adjusting for cyclophosphamide dose received during the 6-month FUP, age, gender, Charlson Comorbidity Index (CCI), and the year of lymphoma diagnosis. Results:A total of 953 patients who used palonosetron throughout the FUP (palonosetron group) and 113 patients who switched from an older 5-HT-3 RA to palonosetron (switched group) were analyzed. The average (mean±SD) age at lymphoma diagnosis was 60.3±13.8 years, CCI was 0.47±0.97, number of cyclophosphamide treatment days was 5.6±1.93, and cyclophosphamide dose (mg/m2) per CT cycle was 930±676. Palonosetron group was significantly older (60.8 vs. 55.9 years, p=0.0006). There were no significant differences (NS) between the two groups in gender, CCI, or year of lymphoma diagnosis. Palonosetron group had significantly fewer 5-HT-3 RA prescription claims (4.81 vs. 7.72, p<0.0001). There was NS difference between the two groups in cyclophosphamide dose [palonosetron: 937 vs. switched: 871], p>0.05), although palonosetron group had significantly fewer CT treatment days (5.5 vs. 6.3, p=0.0135). Proportion of patients with ≥1 severe CINV events was significantly higher in the switched group (15.9% vs. 6.3%, p=0.0002). Switched group also had significantly more claims and days with severe CINV (2.4 vs. 0.6 in CINV claims, p=0.0001; 0.4 vs. 0.1 in CINV days, p=0.0002). Logistic regression controlling for covariates showed the palonosetron group to experience significantly lower risk of approximately 70% for hospital/ER related CINV than the switched group (Odds Ratio=0.311, p=0.0001), while older age significantly increased such an outcome. Poisson regression with number of days with severe CINV as the outcome variable found that palonosetron group had nearly 75% fewer hospital/ER related CINV days than the switched group (p=0.0024). Conclusion:Patients with lymphoma initiated and maintained on palonosetron throughout the CT cycles were at significantly lower risk and experienced fewer days with severe CINV as compared to those who were initiated on an older 5-HT-3 RA and later on switched to palonosetron. Further studies of the impact of step therapy policy with regard to first 5-HT3-RA therapy in patients with lymphoma are needed in order to assess the related economic and humanistic burden. Disclosures:Hatoum:Eisai: Consultancy, Research Funding. Lin:Eisai: Consultancy. Balu:Eisai: Employment.

Prospective validation of risk prediction models for acute and delayed chemotherapy-induced nausea and vomiting (CINV).

6103 Background: Despite the use of standardized anti-emetic guidelines, up to 20% of cancer patients (pts) suffer moderate to severe CINV (≥ grade 2). Prediction of pts at high risk for CINV, thro...

Abstract P3-13-01: Delayed Chemotherapy-Induced Nausea and Vomiting in Asian Women with Breast Cancer

Abstract Background: Chemotherapy-induced nausea and vomiting (CINV) remain among the most frequently reported distressing side effects associated with a doxorubicin-based chemotherapy regimen, and it can significantly affect patients’ quality of life and compliance with therapy. Despite the significant advances in antiemetic management in preventing and controlling CINV, as many as 50% of patients still experience some degree of nausea and vomiting. The main risk factor for the degree of CINV is the emetogenic potential of the chemotherapeutic agents. However, several patient-related risk factors have been identified, including individuals’ genetic makeup. Although several studies have noted that ethnicity influences nausea and vomiting related to motion sickness, fluorescein dye, and pregnancy, no studies have evaluated the relationship between ethnicity and CINV; specifically, if there is a higher incidence of severe CINV in patients of Asian descent. Methods: A retrospective, comparative, correlational chart review was performed to abstract all relevant variables. The association between CINV and ethnicity was examined through chi square analysis. Results: Data from a convenience sample of 300 women with breast cancer who received chemotherapy that includes doxorubicin between 2004 and 2008 at City of Hope in Duarte, CA, were evaluated. The sample consisted of Caucasians (46.3%), African Americans (3.7%), Asians (24.0%), and Hispanics (26.0%). The results of this study indicate that Asian women with breast cancer undergoing treatment with chemotherapy that includes doxorubicin experienced statistically significantly more severe CINV (grade ≥ 2) than their non-Asian counterparts (X2 = 10.601, p = .001). Conclusion: This study provides strong but preliminary evidence that Asian ethnicity plays a role in the development of severe CINV. When managing chemotherapy toxicities in women with breast cancer, healthcare providers are advised to optimize their patients’ outcomes by ensuring that therapy is tailored according to each patient's individual risk profile. Consideration of the antiemetic therapy should accommodate patient characteristics, specifically being of Asian descent. In this way, effective prevention of CINV can be maximized during a patient's initial treatment. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-13-01.

Impact on daily functioning and indirect/direct costs associated with chemotherapy-induced nausea and vomiting (CINV) in a US population

Chemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect of chemotherapy, but it may be prevented or mitigated with medications. Uncontrolled CINV can lead to reduced quality of life and can result in increased costs (due to health care utilization and missed work). We prospectively assessed the prevalence and burden of CINV in a US population. Final analysis was performed on 178 patients, beginning chemotherapy during 2007-2008 at oncology specialty settings. Patients kept a diary recording use of antiemetic medications just before the start of chemotherapy and use of antiemetic medications, health care resources, and episodes of nausea and vomiting during the 5days following. In addition, they completed a Functional Living Index-Emesis (FLIE) questionnaire and a Work Productivity and Assessment Inventory-Nausea and Vomiting assessment, to determine the impact of CINV on daily functioning and on work productivity, respectively. Physicians independently recorded prescribed medications and health care utilization. Of the patients, 61.2% reported experiencing CINV (34.3% with acute CINV and 58.4% with delayed CINV). Based on the FLIE assessment, 37.2% of all patients reported reduced daily functioning, and of those with poorly managed CINV, about 90% reported a significant impact on daily functioning. Total costs due to CINV were on average $778.58 per patient from the day of administration through the 5days following the first cycle of chemotherapy; patients with more severe CINV typically had higher costs. CINV remains a significant problem among US patients, suggesting a need for more effective prophylaxis use in clinical practice.

A prospective study on the incidence of delayed nausea and vomiting following administration of carboplatin-containing regimens for treatment of cancer without prophylactic aprepitant.

e19552 Background: Delayed nausea and vomiting following administration of carboplatin-containing chemotherapy regimen remains a clinically significant problem for patients with cancer despite administration of standard antiemetic prophylaxis (a 5-HT3 antagonist and dexamethasone). Methods: We report results of a prospective study to evaluate the incidence of delayed chemotherapy-induced nausea and vomiting (CINV) after the first cycle of treatment. Previously untreated patients with newly diagnosed cancer scheduled to receive carboplatin containing regimen (AUC 5 or above) (but no prophylactic aprepitant) were eligible to participate. Primary endpoint is the incidence of CINV after cycle 1 of chemotherapy. Secondary endpoints include the incidence of CINV after the third cycle and the gender differences in incidence of CINV. Patients completed the Functional Living Index Emesis (FLIE) questionnaires 24, 48, 72 and 96 hours after receiving chemotherapy. Telephone interviews were conducted 24-48 hours following chemotherapy to assess the severity and need for breakthrough medications for CINV. Results: The characteristics of 109 patients enrolled: 58% male, mean age 63.9 years (range 42-82 years) and 85% diagnosed with lung cancer. Twenty-two percent of patients reported moderate to severe CINV 72 hours after chemotherapy, with symptoms persisting as long as 96 hours in 23% of the patients after cycle 1. Multivariate analysis was performed to evaluate the association between gender and the incidence of CINV. There was no statistically significant difference in gender (p = 0.43) or between cycle 1 and cycle 3 (p = 0.19). Conclusions: Without prophylactic aprepitant administration, one-fifth of cancer patients receiving carboplatin containing regimen had moderate to severe delayed CINV. Percentage of patients with delayed CINV 24 hrs 48 hrs 72 hrs 96 hrs Cycle 1 9.71% 13.73% 21.78% 22.77% Cycle 3 4.00% 12.77% 14.58% 16.00% No significant financial relationships to disclose.

A prospective study on the incidence of delayed nausea and vomiting following administration of carboplatin containing regimens for treatment of cancer without prophylactic aprepitant

20626 Background: Delayed nausea and vomiting following administration of carboplatin containing chemotherapy regimen remains a clinically significant problem for patients with cancer despite administration of standard antiemetic prophylaxis (a 5-HT3 antagonist & dexamethasone). Methods: We report here preliminary results of an ongoing prospective study to evaluate the incidence of delayed chemotherapy-induced nausea and vomiting (CINV) after the first cycle of treatment. Previously untreated patients with newly diagnosed cancer scheduled to receive carboplatin containing regimen (AUC 5 or above) (but no prophylactic aprepitant) are eligible to participate. Primary endpoint is the incidence of CINV after cycle 1 of chemotherapy. Secondary endpoints include the incidence of CINV after the third cycle & the gender differences in incidence of CINV. Patients completed the Functional Living Index Emesis (FLIE) questionnaires 24, 48, 72 and 96 hours after receiving chemotherapy. Telephone interviews were conducted 24–48 hours following chemotherapy to assess the severity & need for breakthrough medications for CINV. Results: The characteristics of 50 patients enrolled thus far: 54% male, mean age 63.2 years (range 42.2 - 79.6 years) and 86% diagnosed with lung cancer. Thirty six percent of patients reported moderate to severe CINV 72 hours after chemotherapy, with symptoms persisting as long as 96 hours in 33% of the patients after cycle 1. Women had only a slightly higher incidence of CINV (38%) than men (35%) at 72 hours following cycle 1, but a significantly higher incidence of emesis was seen in women (31%) compared to men (8%) (P=0.047) at 72 hours following cycle 3. Conclusions: Without prophylactic aprepitant administration, one third of cancer patients receiving carboplatin containing regimen had moderate to severe delayed CINV. Percentage of patients with delayed CINV 24 hrs 48 hrs 72 hrs 96 hrs Cycle 1 13.51% 24.32% 36.11% 33.34% Cycle 3 3.85% 21.74% 20.00% 23.08% No significant financial relationships to disclose.

Rankings and symptom assessments of side effects from chemotherapy: insights from experienced patients with ovarian cancer

Although many patients with ovarian cancer achieve favorable responses to primary chemotherapy, the majority of women will experience recurrence of their cancer. Selection of second- or third-line chemotherapy ultimately depends on patient preferences for different side effects. To better understand this process, we evaluated preferences and symptom distress in patients with ovarian cancer. A total of 70 women with ovarian cancer who had previously received at least three cycles of platinum-based chemotherapy and currently undergoing chemotherapy for newly diagnosed or recurrent disease were interviewed in an outpatient chemotherapy clinic. The patients were asked to rank order 27 health states using a modified visual analog scale and to complete the Memorial Symptom Assessment Scale (MSAS). Most favorable health states included perfect health, clinical remission and complete control of chemotherapy-induced nausea and vomiting (CINV). Least favorable health states included more severe CINV health states and death. Patients on first-line chemotherapy had less symptom distress, and rated sexual dysfunction, fatigue and memory loss more favorably than patients on second- or third-line chemotherapy (P<0.05). Married patients generally had less symptom distress compared to patients who were not married, but married patients indicated more distress with sexual dysfunction (P=0.04). Married patients rated alopecia less favorably than unmarried patients (P=0.03), but married patients viewed certain CINV health states more favorably (P=0.02-0.04). CINV remains one of the most dreaded side effects of chemotherapy. Separate preference profiles exist for patients with newly diagnosed and recurrent disease, as well as for married versus unmarried patients. While MSAS scores and VAS rankings showed consistency across some health states, this was not true for CINV, suggesting that current symptom status may only influence patient preferences for selected side effects.