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
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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:
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Acute emesis |
Occurs within a few minutes to hours after patients receive chemotherapy; it typically peaks in the 4 to 6 hours following chemotherapy |
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Delayed emesis |
Occurs more than 24 hours after chemotherapy |
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Anticipatory emesis |
Occurs before chemotherapy as a conditioned response in patients who have had episodic experiences from previous treatment cycles |
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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
