Severity Of Chemotherapy-induced Nausea And Vomiting Research Articles

Impact of oncology pharmacy services on the management of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To evaluate the effect of oncology services rendered by clinical pharmacists on reducing chemotherapy-induced nausea and vomiting (CINV) and improving overall treatment experiences. A systematic review and meta-analysis were conducted using studies retrieved from PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Information Sharing Service (RISS). The incidence and severity of CINV were evaluated as primary outcomes. Secondary outcomes were patient adherence, patient satisfaction, quality of life (QoL), emergency department (ED) visits, hospitalizations, and costs. A total of 12 studies were selected for systematic review, with 8 studies eligible for meta-analysis. We found that clinical pharmacy services contributed to preventing and alleviating CINV as well as improving patient's medication adherence, treatment satisfaction, and QoL, reducing hospital visits, and achieving cost savings. In the meta-analysis, pharmacists' interventions were notably effective in reducing the incidence of nausea (odds ratio [OR], 1.917; 95% CI, 1.243-2.955; P = 0.003) and vomiting (OR, 2.491; 95% CI, 1.199-5.177; P = 0.014) during overall treatments periods relative to results in control groups. In addition, the impact of clinical pharmacy services on CINV control was greater during the delayed phase compared to the acute phase. This study demonstrated the important role of clinical pharmacy services in controlling CINV and enhancing the overall treatment experience for patients with cancer. Further studies with standardized pharmacists' services and outcome measures are needed to validate our findings.

A nurse-led multidomain intervention to improve the management of chemotherapy-induced nausea and vomiting in patients with head and neck cancers: A randomized controlled trial

PurposeThis study aimed to investigate the effect of a nurse-led multidomain intervention on chemotherapy induced nausea and vomiting (CINV) in patients with head and neck squamous cell carcinomas (HNSCC). MethodsNinety-two HNSCC patients who received cisplatin-based chemotherapy were divided into intervention group (n = 45) and control group (n = 47). The control group received usual care of CINV, which consisted of administration of antiemetics according to physicians' preference, education about CINV control and dietary recommendations provided by primary nurses. The intervention group received nurse-led, evidence-based multidomain management, including nurse-led CINV risk factors assessment, education on prevention and control of CINV, antiemetics following guidelines, dietary strategies, and relaxation therapy. The number of patients who experienced CINV was collected. The severity of CINV was graded according to the Common Terminology Criteria for Adverse Events v3.0. The influence of CINV on patient's quality of life was assessed by the Functional Living Index-Emesis (FLIE). ResultsThe incidence and the severity of nausea and vomiting in the intervention group were significantly lower than those in the control group within 5 days after chemotherapy, and the scores of the dimension of nausea and vomiting in the intervention group were significantly higher than those in the control group [63.00 (50.00–63.00) vs 40.00(28.00–63.00), 63.00(63.00–63.00) vs 63.00 (43.00–63.00)], the differences were statistically significant (P < 0.05). ConclusionsNurse-led multidomain intervention can reduce the incidence and the severity of CINV in patients with HNSCC who were treated with cisplatin-based chemotherapy, and thus reduced the influence of CINV on patients' quality of life. The clinical trial registration numberNCT05792228.

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.

Abstract PD8-01: PantoCIN: Pantoprazole’s effectiveness as prophylaxis against delayed Chemotherapy-Induced Nausea and Vomiting (CINV) in patients receiving adjuvant or neoadjuvant breast cancer chemotherapy

Abstract Background: Rates of delayed CINV remain high at over 50% following adjuvant chemotherapy for breast cancer, despite the use of multiple antiemetics. Delayed CINV is complex, distressing to patients and it’s incidence is underestimated by physicians. Anti-emetics used with early breast cancer chemotherapy are often directed against acute rather than delayed CINV. Chemotherapy is virtually eliminated from the circulation prior to the delayed phase (24-120 hours post-chemotherapy), suggesting the etiologies for acute and delayed CINV may differ. Chemotherapy and steroids can alter the gastric environment and acid secretion, while chemotherapy can cause gastroesophageal mucositis. We hypothesized that the altered gastric environment, combined with disrupted gastroesophageal mucosa, could contribute to delayed nausea in a proportion of patients. Anecdotal experience suggested proton pump inhibitors, such as Pantoprazole, reduced symptoms in this setting. Methods: This study incorporated a double-blinded crossover design to determine whether Pantoprazole would reduce the incidence of delayed CINV in patients receiving adjuvant, or neoadjuvant breast cancer chemotherapy. Patients were randomized to either pantoprazole or placebo from Day 1-5 after cycle 1, changing to the other intervention for cycle 2. CINV symptoms during the delayed phase were assessed using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool and recorded in real time by patients using the PantoCIN ePRO application. With 160 patients, this approach had an 80% power to detect a statistically significant effect (one-sided α (type 1) error of 0.025) of Pantoprazole, if the true effect of Pantoprazole is a 10% reduction in the rates of any delayed CINV compared to placebo. The primary endpoint was the proportion of patients with complete absence of both nausea and vomiting during days 2-5, with severity of CINV and patient preference for intervention described as secondary endpoints. Results: 160 patients were recruited between June 2019 and October 2021, from 10 different cancer centers in New Zealand. Primary statistical analysis has shown a significant reduction in absolute CINV with pantoprazole as the primary end point, with incidence of any CINV symptoms reducing from 61.0% to 49.6% (OR=1.8, 95% confidence interval (1.0 to 3.3); p-value=0.04), in patients with full data. There was also a clear preference for patients to prefer the blinded pantoprazole arm of the 2 cycles of treatment under study, with the proportion of participants who preferred pantoprazole to placebo being 49% and the proportion who preferred placebo to pantoprazole was 25.2%, (difference in proportions 23.8% and 95% confidence interval 12.4 to 35.2; p=0.0017). Conclusion: CINV is a common and distressing complication of early breast cancer chemotherapy, which persists despite the use of a range of current antiemetics. Pantoprazole is a cheap, well-tolerated agent without significant drug interactions, which clearly ameliorates this symptom in a significant proportion of patients and should be considered as a standard prophylactic intervention. Citation Format: Navin Wewala, Katrina Sharples, Yujin Kim, Sarah Benge, Robert Cartwright, Louise Clement, Ying Huang, Richard Isaacs. PantoCIN: Pantoprazole’s effectiveness as prophylaxis against delayed Chemotherapy-Induced Nausea and Vomiting (CINV) in patients receiving adjuvant or neoadjuvant breast cancer chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-01.

Dietary strategies for chemotherapy-induced nausea and vomiting: A systematic review

Chemotherapy-induced nausea and vomiting (CINV) is one of the most distressing cancer treatment side effects, affecting 20-70% of patients despite routine antiemetic prescription. Although dietary modifications are routinely recommended in clinical practice, there is lack of data synthesis to determine which dietary strategies for managing CINV are supported by quality evidence. This systematic review was conducted to examine the effect of dietary strategies on incidence and severity of CINV in adults compared with no intervention, usual care, or alternative strategies. Five electronic databases were searched from inception to 15th July 2021 for original research studies of interventional or observational design assessing dietary strategies for CINV. The quality of evidence was appraised, data were synthesized narratively, and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment of the certainty of the evidence was applied. Twenty-one studies were included, 10 (48%) interventional studies and 11 (52%) observational studies. Most interventional and observational studies had a high or neutral risk of bias (70% and 72%, respectively). Of the interventions studied, strongest evidence with highest certainty was found for the very large positive effect of CINV-specific education and support with a personalized meal plan from a dietician, implemented in person or in writing, for reducing the severity of nausea and overall CINV (effect size: very large; GRADE: high). A statistically significant very large positive effect of ginger tea consumption was also found on overall CINV severity; however, certainty in this effect was very low. Although confidence in the findings from observational studies was very low to low, a statistically significant positive association was also found between a moderate intake of alcohol and incidence of nausea, vomiting, or overall CINV as well as nausea severity; the Mediterranean diet and nausea incidence and severity; and adequate intake of energy, protein, fat, or carbohydrate and nausea or vomiting incidence. Improved CINV was associated with CINV-specific nutrition education and support from health professionals. Non-restrictive dietary patterns that include adequate energy and macronutrient intakes, particularly protein, and include ginger, and Mediterranean diet concepts may benefit CINV; however, the confidence in the body of evidence to inform these conclusions is mostly very low to moderate. Future rigorous trials with adequate sample sizes, clearly defined dietary strategies, and valid outcome measures are warranted prior to dietary strategies being routinely prescribed alongside antiemetic regimens.

The Effect of Foot Reflexology on Chemotherapy-Induced Nausea and Vomiting in Patients With Digestive or Lung Cancer: Randomized Controlled Trial.

BackgroundCancer is a chronic disease with an incidence of 24.5 million and 9.6 million deaths worldwide in 2017. Lung and colorectal cancer are the most common cancers for both sexes and, according to national and international recommendations, platinum-based chemotherapy is the reference adjuvant treatment. This chemotherapy can be moderately to highly emetogenic. Despite antiemetic therapy, chemotherapy-induced nausea and vomiting (CINV) may persist. Moreover, cancer patients are increasingly interested in alternative and complementary medicines and have expressed the desire that nonpharmacological treatments be used in hospitals. Among alternative and complementary medicines, foot reflexology significantly decreases the severity of CINV in patients with breast cancer.ObjectiveThe primary aim of this study was to assess the benefits of foot reflexology as a complement therapy to conventional treatments regarding the severity of acute CINV in patients with digestive or lung cancer. The secondary objectives assessed were the frequency and severity of delayed CINV, quality of life, anxiety, and self-esteem.MethodsThis study was conducted between April 2018 and April 2020 in the Hospices Civils de Lyon, France. This was an open-label randomized controlled trial. Participants were randomized into two groups: the intervention group (ie, conventional care with foot reflexology; n=40) and the control group (ie, conventional care without foot reflexology; n=40). Foot reflexology sessions (30 minutes each) were performed on outpatients or inpatients. Eligible participants were patients with lung or digestive cancer with an indication for platinum-based chemotherapy.ResultsThe severity of acute nausea and vomiting was assessed with a visual analog scale during the second cycle of chemotherapy. A significant increase of at least 2 points was observed for the control group (7/34, 21%; P=.001). Across all cycles, the foot reflexology group showed a trend toward less frequent delayed nausea (P=.28), a significantly less frequent consumption of antiemetic drugs (P=.04), and no significant difference for vomiting (P=.99); there was a trend toward a perception of stronger severity for delayed nausea in the control group (P=.39). Regarding quality of life and anxiety, there was no significant difference between the intervention group and the control group (P=.32 and P=.53, respectively).ConclusionsThis study’s results indicate that foot reflexology provides significantly better management of acute nausea severity and decreased consumption of antiemetic drugs in patients with lung or digestive cancer. In order to fulfill patients’ desires to use nonpharmacological treatments and complementary and alternative medicines in hospitals, foot reflexology could be provided as a complementary intervention to conventional antiemetic drugs. Foot reflexology did not result in adverse effects. To assess the benefits of foot reflexology in routine practice, a larger study with several health care centers would be needed with a cluster randomized controlled trial.Trial RegistrationClinicalTrials.gov NCT03508180; https://clinicaltrials.gov/ct2/show/NCT03508180International Registered Report Identifier (IRRID)RR2-10.2196/17232

Efficacy of Granisetron in the Prevention of Nausea and Vomiting among Paediatric Oncology Patients Receiving Moderate to Highly Emetogenic Chemotherapy: A Single-Blinded, Non-Inferiority Trial

This single-blinded, non-inferiority trial was conducted over an 8-month period to examine the efficacy of intravenous granisetron at two differing doses in preventing acute and delayed chemotherapy-induced nausea and vomiting (CINV)among paediatric patients receiving moderate to highly emetogenic chemotherapy. Seventeen patients (9 males and 8 females) were recruited and randomly assigned to receive alternating granisetron dosages of 0.01 mg/kg and 0.04 mg/kg during each chemotherapy cycle. The severity of CINV during and three days post-completion of chemotherapy, as well as common side effects of granisetron were recorded. A total of 78 cycles of chemotherapy (38 cycles of 0.01 mg/kg and 40 cycles of 0.04 mg/kg) were evaluated. The median age of the study population was 5.2 years (interquartile range 25th, 3.8; 75th, 8.7). Patients’ diagnoses comprised of haematological malignancy, bone tumour and cerebral neoplasm. From this study, we demonstrated that intravenous (IV) granisetron 0.01 mg/kg was non-inferior to 0.04 mg/kg in terms of achieving a complete response for acute CINV. However, a similar observation was not seen in the post-treatment period analysis (delayed CINV). In conclusion, IV granisetron at 0.04 mg/kg/dose provides effective protection and prophylaxis of both acute and delayed CINV. Further study with a larger sample size may be required before a definite conclusion can be made with regards to efficacy of 0.01 mg/kg dose.

Acupuncture treatment for chemotherapy-induced nausea and vomiting: A protocol for systematic review and meta-analysis.

Background:Chemotherapy-induced nausea and vomiting (CINV) make many patients have negative adherence of treatment. Acupuncture has been widely applied in treatment of CINV, but its efficacy has not been evaluated scientifically and systematically in recent years. Hence, evaluating the safety and effectiveness of acupuncture treatment in patients with CINV is the main purpose of this review.Methods and analysis:We will search the following electronic databases from inception to Mar 2020: the Cochrane Central Register of Controlled Trials, EMBASE, PubMed, the Web of Science, China National Knowledge Infrastructure (CNKI), Traditional Chinese Medicine, Chinese Biomedical Literature Database (CBM), Wan-Fang Database and Chinese Scientific Journal Database (VIP database). All published academic data about clinical randomized controlled trials in English or Chinese related to acupuncture for treating CINV will be obtained. The primary outcomes are defined as frequency and severity of CINV during chemotherapy. The secondary outcomes are defined as any adverse events and quality of life of CINV during chemotherapy. The study selection, data extraction, and assessment of study quality will be conducted by 2 researchers independently. Review Manager Software (RevMan) V.5.3 will be performed for meta-analysis.Results:The results of this review will provide a high-quality synthesis of current available evidence to evaluate acupuncture is an effective and safe treatment for CINV.Conclusion:The conclusion of this review will provide the highest level of evidence to judge whether acupuncture is an effective and safe treatment for patients suffered from CINV.PROSPERO registration number:CRD42020153993.

Nausea in Numbers: Electronic Medical Record Nausea and Vomiting Assessment for Children With Cancer.

Purpose: Chemotherapy-induced nausea and vomiting (CINV) is a distressing, underrecognized effect of treatment that can occur in up to 80% of patients. The purpose of this quality improvement project was to evaluate the impact of implementation of a standardized nausea assessment tool, the Baxter Animated Retching Faces (BARF) scale, on nursing compliance with nausea assessment and the frequency and severity of patient-reported CINV for children with cancer. Method: The Plan-Do-Study-Act cycle was used to implement this practice change. With stakeholder support and hospital governance council approval, the BARF scale was introduced into the electronic medical record. Nurses were provided education about the assessment tool and were given badge buddy cards to prompt use of the tool, and workstation reminders were created. A root cause analysis was conducted to provide feedback for continuous quality improvement. Results: Retrospective, aggregate electronic medical record data from May 2018 to April 2019 were analyzed for assessment compliance, total number of admissions with vomiting episodes, and average BARF score. Over the 12-month implementation period, run charts demonstrated a shift in nursing practice with increased compliance in documented nausea assessments during the second 6-month period. There was not a significant decrease in patient-reported CINV. Conclusion: The use of standardized nausea assessments based on patient self-reporting can provide useful and consistent feedback for nurses and health care providers. This quality improvement project demonstrated increased compliance with nausea assessment documentation. Further studies are needed to demonstrate that improvements in nausea assessment may reduce the frequency and severity of CINV.

A review of the literature on the relationships between genetic polymorphisms and chemotherapy-induced nausea and vomiting

Despite current advances in antiemetic treatments, between 30% to and 60% of oncology patients experience chemotherapy-induced nausea (CIN) and 13% to 33% report chemotherapy-induced vomiting (CIV). Inter-individual differences are observed in the occurrence and severity of chemotherapy-induced nausea and vomiting (CINV). This review summarizes and critiques studies on associations between occurrence and severity of CINV and polymorphisms in serotonin receptor, drug metabolism, and drug transport pathway genes. Sixteen studies evaluated the associations between the occurrence and/or severity of CINV and single nucleotide polymorphisms (SNPs). Across these studies, three SNPs in 5-hydroxytryptamine receptor (5-HT3R) genes, two alleles of the cytochrome P450 family 2 subfamily D member 6 (CYP2D6) gene, and three SNPs in ATP binding cassette subfamily B member 1 (ABCB1) gene were associated with the occurrence and severity of CINV. Given the limited number of polymorphisms evaluated, additional research is warranted to identify new mechanisms to develop more targeted therapies.

The influence of chemotherapy induced nausea and vomiting (CINV) on survival: An individual participant data meta-analysis of the North-Eastern German Society of Gynecological Oncology (NOGGO) of 1213 recurrent ovarian cancer patients.

e17062 Background: Nausea and vomiting are frequent side effects of chemotherapy and are the most feared toxicities of our patients. Aim of this study is to evaluate the potential influence of chemotherapy induced nausea and vomiting (CINV) on survival. Methods: Synthesized raw data of three phase II/III studies (“Tower”, “Topotecan phase III” and “Hector”) of the North-Eastern German Society of Gynecological Oncology (NOGGO) including 1213 patients were analyzed using logistic regression and cox regression analyses. Results: In this analysis 661 patients (54.5%) developed grade I/II and 44 patients (3.6%) grade III/IV nausea. 343 patients (28.3%) had grade I/II vomiting and 33 patients (2.7%) grade III/IV. There were no differences between severity of CINV regarding FIGO, grading, histology and amount of recurrences. Patients &lt;65 years developed more frequently grade III/IV nausea than patients ≥ 65 years (p&lt;0.001, OR 1.29, 95% CI 0.68-2.46). Polypharmacy was also associated with grade III/IV CINV (p&lt;0.001 and p=0.002 respectively). Progression free survival was worse in patients with grade III/IV nausea (p=0.023, HR 1.58, 95% CI 1.14-2.20). Median overall survival (OAS) in patients without nausea was 19.0 months compared to patients with grade III/IV nausea with 11.0 months (p&lt;0.001, HR for grade III/IV 2.35, 95% CI 1.64-3.37). Grade III/IV vomiting was also highly associated with worse OAS (median of 22.0 months in patients without vs. 5.9 months in patients with grade III/IV vomiting, p&lt;0.001, HR for grade III/IV vomiting 3.4, 95% CI 2.32-5.00). However, dose reductions and prior discontinuation of chemotherapy were not more frequent in patients with nausea and vomiting. Conclusions: Patients with nausea and vomiting had a decreased progression and overall survival. This study underlines once again the importance of early best supportive care on survival.

Efficacy of ginger for chemotherapy-induced nausea and vomiting (CINV) prophylaxis in breast cancer patients receiving adriamycin – cyclophosphamide (AC) regimen: Randomized double-blind placebo-control crossover study.

e21621Background: Data on efficacy of ginger for CINV prophylaxis are conflicting. Several studies observed a reduction in incidence and severity of CINV when ginger was given along with highly eme...

Chemotherapy-Induced Nausea and Vomiting in Women With Gynecological Cancer: A Preliminary Single-Center Study Investigating Medical and Psychosocial Risk Factors.

Chemotherapy is the treatment of choice for many gynecological tumors, but cytotoxic drugs lead to a wide range of stressful side effects; nausea and vomiting are 2 of the most common and distressing consequences of many chemotherapy regimens. The aim of this study is to investigate various risk factors that could influence the experience of nausea and vomiting after the first chemotherapeutic infusion. Women treated for various gynecological cancers (n = 94) took part in the study. Pharmacological and personal risk factors in the development of chemotherapy-induced nausea and vomiting (CINV) were assessed with the use of the State-Trait Anxiety Inventory and a self-report questionnaire. Regression analyses (both univariate and multiple) were performed to establish risk factors associated with CINV. The study highlights the importance of working status (being involved in a working activity during treatment) as a protective factor for developing chemotherapy-induced nausea. Furthermore, younger age, levels of state anxiety, chemotherapy-induced nausea in previous treatments, and alcohol intake were found to have an effect on CINV, increasing its risk. Emetogenic potential was associated only with the presence of delayed vomiting. Although this is a preliminary study into the risk factors of CINV in gynecological tumors, these findings offer support that personal risk factors contribute to individual differences in the frequency and severity of CINV. Personal factors should be taken into consideration by the multidisciplinary treating team in gynecology.

Patterns and severity of chemotherapy-induced nausea (CIN) in patients with gastrointestinal cancers associated with highly to moderately emetogenic chemotherapy (HEC and MEC).

24 Background: Chemotherapy-induced nausea and vomiting (CINV) is well controlled recently thanks to novel antiemetic therapy, but the incidence of nausea remained high in patients receiving either HEC or MEC. The aim of the study is to investigate patterns and severity of CIN in cancer patients who are to receive chemotherapy for the first time. Methods: A nationwide survey on CINV was conducted by the CINV study group of Japan. A 7-day diary for CINV was provided to the patient prior to chemotherapy to record daily occurrence and severity of CINV. CIN was measured using visual analog scales(VAS) of 10cm length scales. Acute and delayed CINV were defined as nausea and vomiting which developed within or after 24 hours after the start of chemotherapy, respectively. Results: A total of 2,068 patients were registered and 1,910 patients were analyzed. A mean age was 62 (range:19-87) and there were 873 males and 1,037 females. MEC was given to 715 as was HEC to 1,195 patients. Underlying diseases were esophageal (192 patients), gastric (152), colorectal (90), hepato-biliary-pancreatic (100), lung (426) and breast cancer (429), and gynecological (214) and hematological malignancy (197). Comparing patients with various cancers treated with similar emetogenic agents or regimens, we easily could find that there are several patterns of CIN severity. Firstly, temporal profiles of CIN severity of esophageal, gastric and lung cancers were similar, having daily increased delayed nausea up to Day 7. The reason of this phenomenon seems due to a single high dose of CDDP. Colorectal and hepato-biliary-pancreatic cancer had a similar mild CIN pattern over 7days, probably due to mild emetogenic nature of oxaliplatin and moderate dose of CDDP. Conclusions: Temporal profile and severity of CIN patterns seem to be divided into several groups and delayed CIN remained to be high and needs further investigation.

Prospective observational study on chemotherapy-induced nausea and vomiting (CINV) for hepatobiliary and pancreatic cancer patients who were to receive chemotherapy including cisplatin by the CINV study group of Japan.

341 Background: There has been no nationwide survey on CINV or validation of the guideline in Japan. The aim of the study is to investigate occurrence of CINV in hepatobiliary and pancreatic (HBP) cancer patients who are to receive chemotherapy including high and moderate emetic risk for the first time. In addition, primary care medical staffs' perception on CINV for their patients is also studied. Methods: A nationwide survey on CINV was conducted by the CINV study group of Japan. 21 institutions participated in the study. A 7-day diary for CINV was provided to the patient prior to chemotherapy to record daily occurrence and severity of CINV and an amount of food intake. Acute and delayed CINV was defined as nausea and vomiting which developed within or after 24 hours after the start of chemotherapy, respectively. The medical staffs also filled out questionnaires about their patient’s CINV. Results: A total 103 HBP cancer patients of 1,952 patients registered in this study during the period from April 2011 to December 2012 were analyzed. These patients’ diary and their medical staffs' report were sent to the central office. Underlying diseases were biliary tract cancer (70 patients), hepatocellular carcinoma (23) and pancreatic cancer (10). There were 62 males with a median age of 69 (range: 37-83) and 41 females with a median age of 63 (range: 41-80). MEC was given to 4 as was HEC to 99 patients. Acute nausea was experienced in 6 (5.8%), while was noted delayed nausea in 25 (24.3%). Acute vomiting was noted in 2 (1.9%) patients, while delayed vomiting was experienced in 6 (5.8%). The predictive factors for delayed nausea were female and motion sickness. The predictive factor for delayed vomiting was morning sickness. Medical staffs overestimated the incidence of acute and delayed nausea/vomiting. Conclusions: CINV seems to be under control with management by the guideline, but delayed nausea remained to be high and needs further investigation.

A prospective observational study on chemotherapy-induced nausea and vomiting for esophageal cancer patients in Japan.

135 Background: Chemotherapy-induced nausea and vomiting (CINV) is still one of the major problems in cancer treatment. However detailed profile of CINV in patients with esophageal cancer is not known. Prospective multi-center observational study was conducted to assess the current status of CINV in Japan. Methods: Between May 2011 and December 2012, 193 patients with esophageal cancer who underwent systemic chemotherapy with high (HEC) or moderate emetogenic agents (MEC) were registered. Antiemetic drugs (5-HT3 receptor antagonists, dexamethasone and NK1receptor antagonist) were used to suppress CINV. Occurrence and severity of CINV were assessed with a diary provided to the patients prior to chemotherapy. Acute phase (within 24 hours from the start of chemotherapy) and late phase CINV (24 hours or later) were assessed separately. Multivariate logistic regression analysis was conducted to identify the predictive factors for acute and late phase CINV. Results: Of 193 patients 165 were male and 28 were female. Median age was 66 (range 40-84). HEC and MEC were administered in 180 and 13 patients, respectively. Acute phase nausea and vomiting were observed in 9 (4.7%) and 7 (3.6%) of 193 patients, respectively. Late-phase nausea and vomiting were observed in 75 (38.9%) and 18 (9.3%) of 193 patients, respectively. Risk factors for acute phase nausea, acute phase vomiting, late phase nausea and late-phase vomiting were assessed separately. By multivariate analysis for late-phase vomiting, younger age (Odds ratio 0.523 [every 10 years]; 95%CI 0.278-0.986; p=0.045) and male gender (Odds ratio 5.796; 95%CI 1.806-18.603; p=0.003) were independent predictive factors. By multivariate analyses for acute phase nausea, acute phase vomiting and late-phase nausea, no independent predictive factor was identified. Conclusions: Acute phase CINV was effectively suppressed by antiemetic drugs, while late phase CINV was not sufficiently suppressed. Further intervention to suppress late phase CINV should be considered, especially in high-risk patients. Clinical trial information: UMIN000005971.

P1-096 - Clinical Significance of Preventing Chemotherapy-Induced Nausea and Vomiting (CINV) in Outpatient'S Chemotherapy Center

ABSTRACT Background To prevent chemotherapy-induced nausea and vomiting (CINV), it is important to use effective antiemetic drugs according to the risk of emetogenicity. 5-HT3 inhibitors and antagonist of NK1 receptor, including palonosetron and aprepitant, which are new approved drugs with long acting function, are available in cancer chemotherapy. Aim and methods To evaluate the usage of antiemetic drugs in outpatient's chemotherapy center of Kumamoto University Hospital, frequency and severity of CINV were analyzed according to the risk of emetic regimen (high, moderate and low) in two periods of 6 months around approval of palonosetron and aprepitant [from April to September 2009 (before approval of drugs) (n = 1439) and from April to September 2011 (after approval of drugs)(n = 1852)]. Results In high emetic risk regimens, half of all patients (38/76 cases) were used aprepitant and the percentage of the administration of palonosetron was 30% (23/76 cases). In the moderate emetic risk group, the usage of aprepitant and palonosetron was 24% (114/484 cases) and 5% (26/484 cases), respectively. The incidence of CINV was higher in the moderate-risk group than the high-risk group. The episode of CINV was significantly reduced in all of the risk group of patients in 2011 compared with them in 2009. Conclusion This study indicated that the incidence of CINV in high emetic risk regimens was reduced by the administration of aprepitant and palonosetron. The aggressive use of antiemetic drugs would be better to improve the quality of life in outpatient's chemotherapy, even if moderate risk of emetic regimens.