Liau Chi-Ting, Chu Nei-Min, Liu Hsueh-Erh, Deuson Robert, Lien Jade, Chen Jen-Shi
Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Sungshan Chiu, Taipei, Taiwan 105, Republic of China.
Support Care Cancer. 2005 May;13(5):277-86. doi: 10.1007/s00520-005-0788-5. Epub 2005 Mar 16.
The major objective of the study was to determine the incidence and prevalence of acute and delayed chemotherapy-induced nausea and vomiting (CINV) among patients receiving chemotherapy and assess the accuracy with which medical providers perceive the incidence of CINV in their practice.
Specialists, residents and nurses (medical providers) from two cancer centers in Taiwan estimated the incidence of acute and delayed CINV. Chemotherapy-naive patients from the same centers then completed a 5-day nausea and vomiting diary following highly and moderately emetogenic chemotherapy (HEC and MEC) to determine the actual incidence of acute and delayed CINV. Daily nausea ratings were recorded on a 100-mm visual analogue scale (VAS). No nausea was defined as a nausea VAS score <5 mm. Vomiting episodes were also recorded. Nausea and vomiting were defined as acute and delayed based on whether they occurred during the first 24 h after chemotherapy, or during days 2-5 after chemotherapy, respectively.
In the two oncology centers, 37 medical providers (13 specialists, 4 residents, 20 nurses) and 107 patients were enrolled. The mean patient age was 49.2 years with 76% female and 74% having breast cancer. Of the 107 patients, 39% received HEC and 61% received MEC, and 77% received a 5-HT3 receptor antagonist and 94% received dexamethasone. There were no significant differences between patients with acute CINV and delayed CINV in terms of demographics, chemotherapy treatment or antiemetic treatment. The proportion of patients without alcohol use was significantly higher among patients with delayed CINV than among those with non-delayed CINV. Good control of CINV during the acute period correlated with the control of delayed emesis. There were no significant differences between specialists', residents', and nurses' estimations of the incidence rates of CINV. For HEC given to chemotherapy-naïve patients, the medical providers estimated acute CINV to be 44/41% and delayed CINV to be 61/53%, respectively. However, patient diaries revealed acute CINV to be 43/21% and delayed CINV to be 64/60%, respectively. For MEC given to chemotherapy-naive patients, medical providers estimated acute CINV to be 39/36% and delayed CINV to be 44/39%, respectively. However, patient diaries revealed acute CINV to be 55/18% and delayed CINV to be 74/55%, respectively.
Medical providers significantly overestimated the incidence of acute vomiting by 20% and 18% in HEC and MEC patients, respectively. While they correctly estimated the rate of delayed vomiting in HEC patients, they underestimated it by 16% in MEC patients. With respect to nausea, medical providers correctly estimated rates of both acute and delayed nausea in HEC patients, but significantly underestimated rates of acute and delayed nausea by 16% and 30%, respectively, in MEC patients.
本研究的主要目的是确定接受化疗患者中急性和延迟性化疗引起的恶心和呕吐（CINV）的发生率及患病率，并评估医疗服务提供者对其所在医疗机构中CINV发生率认知的准确性。
台湾两家癌症中心的专家、住院医师和护士（医疗服务提供者）估计急性和延迟性CINV的发生率。来自同一中心的初治化疗患者在接受高度和中度致吐性化疗（HEC和MEC）后，完成一份为期5天的恶心和呕吐日记，以确定急性和延迟性CINV的实际发生率。每日恶心程度采用100毫米视觉模拟量表（VAS）记录。恶心程度评分为VAS＜5毫米定义为无恶心。呕吐发作情况也进行记录。根据恶心和呕吐是否分别发生在化疗后的前24小时内或化疗后第2 - 5天，将其定义为急性和延迟性。
在这两家肿瘤中心，共纳入37名医疗服务提供者（13名专家、4名住院医师、20名护士）和107名患者。患者平均年龄为49.2岁，76%为女性，74%患有乳腺癌。107例患者中，39%接受HEC，6 l%接受MEC，77%接受5 - HT3受体拮抗剂，94%接受地塞米松。急性CINV患者和延迟性CINV患者在人口统计学、化疗方案或止吐治疗方面无显著差异。延迟性CINV患者中不饮酒者的比例显著高于非延迟性CINV患者。急性期CINV的良好控制与延迟性呕吐的控制相关。专家、住院医师和护士对CINV发生率的估计无显著差异。对于初治化疗患者接受HEC，医疗服务提供者估计急性CINV发生率分别为44%/41%，延迟性CINV发生率分别为61%/53%。然而，患者日记显示急性CINV发生率分别为43%/21%，延迟性CINV发生率分别为64%/60%。对于初治化疗患者接受MEC，医疗服务提供者估计急性CINV发生率分别为39%/36%，延迟性CINV发生率分别为44%/39%。然而，患者日记显示急性CINV发生率分别为55%/18%，延迟性CINV发生率分别为74%/55%。
医疗服务提供者分别将HEC和MEC患者的急性呕吐发生率高估了20%和18%。虽然他们正确估计了HEC患者延迟性呕吐发生率，但将MEC患者的该发生率低估了16%。关于恶心，医疗服务提供者正确估计了HEC患者急性和延迟性恶心的发生率，但将MEC患者急性和延迟性恶心的发生率分别显著低估了16%和30%。
