Chemotherapy- and Radiation-Induced Nausea and Vomiting: An Overview

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A review of treatment options for patients experiencing chemotherapy- cr radiation-induced nausea and vomiting.
A review of treatment options for patients experiencing chemotherapy- cr radiation-induced nausea and vomiting.

Nausea and vomiting (N/V) are two of the most common and serious adverse effects of cancer treatments: chemotherapy and radiation.1,2 N/V negatively affects patients' quality of life and are significant factors in treatment adherence. N/V can result in several complications, including electrolyte imbalance, poor nutrition, dehydration, physical and mental deterioration, anorexia, and wound dehiscence.1,2 Nausea is a more frequent occurrence than vomiting (emesis); however, it is subjective in nature and is regarded as a precursor to or an after-effect of vomiting.

Incidence

The incidence and severity of N/V associated with patients receiving chemotherapy, radiation, or chemoradiation are dependent on patient-related and treatment-related factors. Female sex and a history of motion sickness are associated with a higher risk for N/V. Alcohol intake is inversely related to risk for N/V.3

Of 4 million patients receiving chemotherapy each year, an estimated 70% to 80% of them will experience chemotherapy-induced N/V.4 The chemotherapy regimen used, dosage, schedule, and route of administration all contribute to the severity of chemotherapy-induced N/V (CINV).

Incidence rates for radiation-induced N/V (RINV) are less certain. In a prospective Italian study that enrolled 1020 patients from 45 radiation oncology centers, nausea was reported in 27% of patients and vomiting was reported in 11% of patients; N/V was reported in 28% of patients.5 Concomitant chemotherapy and a previous experience of chemotherapy-induced vomiting were statistically significant risk factors.5 With RINV, site of irradiation, dosing, fractionation, irradiated volume, and radiotherapy techniques are known to contribute to the significance of N/V experienced.5,6

Categories of CINV

Four categories of CINV have been defined3:

Acute emesis

Occurs within a few minutes to hours after patients receive chemotherapy; it typically peaks in the 4 to 6 hours following chemotherapy

Delayed emesis

Occurs more than 24 hours after chemotherapy

Anticipatory emesis

Occurs before chemotherapy as a conditioned response in patients who have had episodic experiences from previous treatment cycles

Breakthrough or refractory emesis

Occurs in patients despite prophylactic treatment and requires rescue medications for treatment

The patterns of CINV manifestation are variable. Patients who experience acute emesis may or may not experience delayed emesis. In a study of 153 patients across 10 community oncology clinics, during cycle 1, 33% of patients did not experience acute or delayed CINV. Thirty-six percent of patients experienced acute CINV; of these, 8% developed only acute symptoms. Fifty-nine percent of patients experienced delayed CINV; of these, 53% experienced only delayed CINV and 47% experienced acute and delayed CINV. Occurrence of CINV in cycle 1 was shown to be associated with CINV developing at subsequent cycles.7

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