Investigating Patient-Specific Risk Factors for Chemotherapy-Induced Nausea and Vomiting in Patients with Cance

Abstract

Chemotherapy-induced nausea and vomiting (CINV) is the most common side effect of cancer treatment. Despite adequate antiemesis prophylaxis, this side effect remains poorly controlled and may decrease a patient’s quality of life and affect adherence to treatment, leading to poor therapeutic outcomes. Patients experiencing CINV are also susceptible to malnutrition, electrolyte imbalances and dehydration, hence, adequate control of this side effect is imperative. Studies have reported that patient-specific risk factors can contribute to the development of CINV. Tailoring CINV regimens to mitigate patient-specific risk factors could decrease the incidence of nausea and vomiting. Comprehensive treatment regimens could potentially be developed by utilising antiemetic guidelines in conjunction with patient-risk factor assessment allowing for further optimisation of antiemetic treatment regimens in patients that are high risk. This study was designed to investigate whether evaluating patient-specific risk factors for personalised antiemetic prophylaxis selection could aid in CINV treatment optimisation. A prescription record review and researcher-administered survey were conducted among cancer patients receiving chemotherapy at the outpatient department of a large academic hospital. The questionnaire comprised both open-and close-ended questions designed to investigate the incidence of CINV and the risk factors presenting in this cohort of patients. A total of 222 patients diagnosed with cancer participated in the study. Among them, 22.5% experienced isolated nausea, 45% reported both nausea and vomiting, and 32.4% remained asymptomatic during the overall phase of treatment. Adherence to antiemetic treatment guidelines was 75.2%, with the highest adherence rates observed in patients who did not develop CINV (p < 0.001). This underscores the essential role of appropriate prescribing practices in effectively managing CINV. Significant associations between race and CINV incidence (p=0.033) were evident. Patients who received four or more cycles of chemotherapy reported a higher incidence of nausea (44.0%) and nausea accompanied by vomiting (49.0%) during the overall phase. Anticipatory nausea and vomiting was significantly associated with CINV incidence (p < 0.001). The use of non-prescription medications, marijuana, and complementary therapies like ginger also influenced CINV prevalence, while alcohol consumption appeared to potentially mitigate these symptoms. This study underscores the pivotal role of adherence to established antiemetic guidelines in mitigating the burden of CINV, emphasising the need for individualised risk assessment to iv optimise antiemetic regimen selection. Incorporating patient-specific risk factors into treatment selection, may potentially enhance the effectiveness of antiemetic therapies and improve overall patient outcomes in the oncology setting.