Chan Alexandre, Kim Hoon-Kyo, Hsieh Ruey Kuen, Yu Shiying, de Lima Lopes Gilberto, Su Wu-Chou, Baños Ana, Bhatia Sandeep, Burke Thomas A, Keefe Dorothy M K
National University of Singapore, Singapore, Singapore,
Support Care Cancer. 2015 Jan;23(1):283-91. doi: 10.1007/s00520-014-2375-0. Epub 2014 Aug 13.
Some patients experience nausea and/or vomiting (NV) before receipt of chemotherapy. Our objective was to evaluate the impact of prior chemotherapy-induced NV (CINV) on the incidence of anticipatory NV in later cycles.
This multicenter, prospective non-interventional study enrolled chemotherapy-naïve adults scheduled to receive highly or moderately emetogenic chemotherapy (HEC/MEC) for cancer in six Asia Pacific countries, excluding those with emesis within 24 h before cycle 1 chemotherapy. On day 1 before chemotherapy, patients answered four questions regarding emesis in the past 24 h, nausea, expectation of post-chemotherapy nausea, and anxiety in the past 24 h, the latter three scored from 0-10 (none-maximum). Multivariate logistic regression was used to assess the impact of prior CINV on anticipatory NV in cycles 2 and 3.
Five hundred ninety-eight patients (59% female) were evaluable in cycle 2 (49% HEC, 51% MEC). The incidence of anticipatory emesis was low before cycles 2 and 3 (1.5-2.3%). The incidence of clinically significant anticipatory nausea (score of ≥3) was 4.8, 7.9, and 8.3% before cycles 1, 2, and 3, respectively, with adjusted odds ratio (OR), 3.95 (95% confidence interval (CI), 2.23-7.00; p < 0.001) for patients with clinically significant nausea in prior cycles, compared with none. The adjusted ORs for other anticipatory NV endpoints ranged from 4.54-4.74 for patients with prior CINV. The occurrence of clinically significant anxiety in the prior cycle also resulted in a significantly increased likelihood of anticipatory nausea.
These findings highlight the importance of preventing CINV in cycle 1 to reduce anticipatory NV in subsequent cycles.
部分患者在接受化疗前会出现恶心和/或呕吐（NV）。我们的目标是评估先前化疗引起的NV（CINV）对后续周期中预期性NV发生率的影响。
这项多中心、前瞻性非干预性研究纳入了在亚太地区六个国家计划接受高致吐性或中度致吐性化疗（HEC/MEC）的初治成年癌症患者，排除在第1周期化疗前24小时内有呕吐的患者。在化疗前第1天，患者回答了关于过去24小时内呕吐、恶心、对化疗后恶心的预期以及过去24小时内焦虑的四个问题，后三个问题的评分范围为0至10分（无至最高）。采用多变量逻辑回归评估先前CINV对第2和第3周期预期性NV的影响。
598例患者（59%为女性）可在第2周期进行评估（49%为HEC，51%为MEC）。第2和第3周期前预期性呕吐的发生率较低（1.5 - 2.3%）。临床上显著的预期性恶心（评分≥3）在第1、2和3周期前的发生率分别为4.8%、7.9%和8.3%，与无先前显著恶心的患者相比，先前周期中有临床显著恶心的患者调整后的优势比（OR）为3.95（95%置信区间（CI），2.23 - 7.00；p < 0.001）。对于先前有CINV的患者，其他预期性NV终点的调整后OR范围为4.54至4.74。先前周期中临床上显著焦虑的发生也导致预期性恶心的可能性显著增加。
这些发现突出了在第1周期预防CINV以减少后续周期中预期性NV的重要性。
