The Burden of Chemotherapy Induced Nausea and Vomiting on Patients’ Daily Lives: Italian Perspectives
The Italian Group for Antiemetic Research evaluated the appropriateness of antiemetic prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in two large observational studies carried out in Italy in 1996 (antiemetic guidelines not yet published) and 1999 (MASCC guidelines published in 1998). The pattern of prescription had improved, but less than expected, given the published guidelines. A further study performed on cisplatin treated patients showed that almost all patients received the recommended prophylaxis of acute emesis, but only about half of them were treated according to the current guidelines.
The impact of CINV on patients’ daily lives was investigated using the Functional Living Index or Emesis / FLIE) questionnaire. Both acute and delayed CINV were responsible for the impact of CINV on patients’ daily lives, but their interaction was not significant: their impact on patients’ daily lives is a simple sum of effects. About 50% of patients who experienced either acute or delayed CINV had an impact on their daily life. This percentage increased to up to 90% in patients who suffered from both acute and delayed CINV.
At a unifactorial analysis both intensity and duration of CINV were found significant in determining the impact of CINV on patients’ daily lives, but at a multifactorial analysis adjusting for the effect of each variable on the other, only duration remained significant. This finding suggests that the duration of CINV should be assessed with an accuracy much greater than that currently used.
Despite the improved antiemetic prophylaxis, CINV is still prevalent and often impacts the patients’ daily lives, especially in the delayed phase. A further effort should be made to reduce the incidence of CINV not only by strengthening antiemetic research, but also by utilizing the best antiemetic treatments in daily clinical practice.
KeywordsDaily Clinical Practice Emetogenic Chemotherapy Antiemetic Prophylaxis Acute Emesis Acute Nausea
List of Abbreviations:
American Society of Clinical Oncology
chemotherapy induced nausea and vomiting
European Organization for Research and Treatment of Cancer
European Society of Medical Oncology
Functional Living Index for Emesis
health-related quality of life
Italian Group for Antiemetic Research
Multinational Association of Supportive Care in Cancer
no (or minimal) impact on daily life; 30 items r.a., receptor antagonists
EORTC Quality of Life Questionnaire-Core 30 items
- Beeckwith MC, Mullin S. (2001). Hosp Pharm. 36: 67–82.Google Scholar
- ESMO guidelines task force. (2001). Ann Oncol. 12: 1059–1060.Google Scholar
- IGAR. (1998). Ann Oncol. 9: 759–765.Google Scholar
- IGAR. (1992). Lancet. 340: 96–99.Google Scholar
- IGAR. (1995). N Engl J Med. 332: 1–5.Google Scholar
- Lindley CM, Hirsch JD. (1992a). Br J Cancer. 66(suppl XIX): S26–S29.Google Scholar
- MASCC. (1998). Ann Oncol 15: 2966–2973.Google Scholar
- The Antiemetic Subcommittee of the MASCC. (2006). Ann Oncol. 17: 20–28.Google Scholar