Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, Hong Kong Cancer Institute, Hong Kong.
State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR.
Oncologist. 2021 Dec;26(12):e2288-e2296. doi: 10.1002/onco.13978. Epub 2021 Sep 25.
There is limited work on the impact of chemotherapy-induced nausea and vomiting (CINV) on quality of life (QoL) in adriamycin-cyclophosphamide (AC)-treated patients with breast cancer. The objectives of the study were the following: (a) to confirm if symptoms of CINV led to lower QoL during AC; (b) to evaluate the pattern of changes in patients' QoL during multiple cycles of AC; and (c) to assess if the QoL in an earlier cycle affected the QoL in subsequent cycles of AC.
This is a secondary pooled data analysis that included 303 Chinese patients with breast cancer who received 1,177 cycles of adjuvant AC in three prospective antiemetic studies. QoL data were based on Functional Living Index-emesis (FLIE) scored over three to four AC cycles. CINV symptoms assessed included "no significant nausea" (NSN), "significant nausea" (SN), "no vomiting" (NoV), "vomiting" (V), and complete response (CR).
Across all AC cycles, the mean scores for the FLIE nausea domain for patients who experienced NSN versus SN were 10.92 versus 53.92, respectively (p < .0001), with lower scores indicating better QoL; the mean scores for the FLIE vomiting domain for patients who experienced NoV versus V were 1.44 versus 19.11, respectively (p < .0001), with similar results across subsequent cycles. Analysis of the effect of the QoL in cycle 1 on the QoL of subsequent cycles revealed the following: for the nausea domain, among patients who had cycle 1 FLIE scores ≥ versus < the mean, the corresponding scores in cycle 2 were 6.87 versus 36.71 (p < .0001); whereas those for cycle 3 were 7.07 versus 36.87 (p < .0001); and those for cycle 4 were 5.92 versus 21.48 (p < .0001). Similar findings were observed for the vomiting domain. Netupitant + palonosetron- or aprepitant/olanzapine-based antiemetics had significantly better QoL outcomes.
CINV had a significant impact on the QoL of patients with breast cancer treated with AC over multiple cycles.
In this post-hoc analysis of three prospective studies on chemotherapy-induced nausea and vomiting (CINV), quality of life (QoL) using contemporary antiemetic regimens in Chinese breast cancer patients receiving doxorubicin-cyclophosphamide (AC) was evaluated. During the first and subsequent AC cycles, QoL was significantly better for patients who did not experience vomiting or significant nausea. QoL in an earlier cycle affected the QoL in subsequent AC cycles. Furthermore, recent regimens involving olanzapine/aprepitant or netupitant-palonosetron were associated with a positive impact in QoL. Antiemetic guideline-consistent practice and higher clinician awareness of the impact of CINV on QoL can further mitigate the negative effects of CINV on QoL.
阿霉素-环磷酰胺（AC）治疗乳腺癌患者的化疗引起的恶心和呕吐（CINV）对生活质量（QoL）的影响方面的研究工作有限。研究的目的如下：（a）确认 CINV 症状是否导致 AC 期间 QoL 下降；（b）评估患者在多个 AC 周期期间 QoL 的变化模式；（c）评估早期周期的 QoL 是否会影响后续 AC 周期的 QoL。
这是一项二次 pooled 数据分析，包括 303 名接受三阳性抗恶心药物研究中 1177 个辅助 AC 周期的中国乳腺癌患者。QoL 数据基于功能生活指数-恶心（FLIE）评分，评分范围为 3 至 4 个 AC 周期。评估的 CINV 症状包括“无明显恶心”（NSN）、“明显恶心”（SN）、“无呕吐”（NoV）、“呕吐”（V）和完全缓解（CR）。
在所有 AC 周期中，经历 NSN 的患者的 FLIE 恶心域的平均得分为 10.92，经历 SN 的患者的平均得分为 53.92（p <.0001），分数越低表示 QoL 越好；经历 NoV 的患者的 FLIE 呕吐域的平均得分为 1.44，经历 V 的患者的平均得分为 19.11（p <.0001），后续周期的结果相似。分析第 1 周期 QoL 对后续周期 QoL 的影响发现：对于恶心域，在第 1 周期 FLIE 评分≥与<平均值的患者中，第 2 周期的相应评分分别为 6.87 与 36.71（p <.0001）；而第 3 周期的分别为 7.07 与 36.87（p <.0001）；第 4 周期的分别为 5.92 与 21.48（p <.0001）。呕吐域也观察到类似的发现。基于奈妥匹坦+帕洛诺司琼或阿瑞匹坦/奥氮平的止吐药物具有显著更好的 QoL 结局。
CINV 对接受多周期阿霉素-环磷酰胺（AC）治疗的乳腺癌患者的 QoL 有显著影响。
在对化疗诱导的恶心和呕吐（CINV）的三项前瞻性研究的 post-hoc 分析中，使用当代止吐药物方案评估了接受多柔比星-环磷酰胺（AC）治疗的中国乳腺癌患者的生活质量（QoL）。在第一和后续的 AC 周期中，未经历呕吐或明显恶心的患者的 QoL 明显更好。早期周期的 QoL 会影响后续的 AC 周期。此外，最近的奥氮平/阿瑞匹坦或奈妥匹坦-帕洛诺司琼方案与 QoL 的积极影响相关。止吐药物治疗符合指南，临床医生进一步提高对 CINV 对 QoL 的影响的认识，可以进一步减轻 CINV 对 QoL 的负面影响。
