O'Brien B J, Rusthoven J, Rocchi A, Latreille J, Fine S, Vandenberg T, Laberge F
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.
CMAJ. 1993 Aug 1;149(3):296-302.
To estimate the effect of chemotherapy-associated nausea and emesis on patients' functional status and on costs to the health care system, the patients and society before antagonists to the serotonin (5-hydroxytryptamine) receptor subtype 5-HT3 became available.
A 5-day prospective survey between February and May 1991 of patients receiving chemotherapy for cancer. Data were obtained from questionnaires completed by nurses and patients.
Five Canadian cancer treatment centres in Ontario (three) and Quebec (two).
Outpatients and inpatients 18 years of age and older who were scheduled to receive chemotherapy with a moderate to high potential for emesis as defined by standardized criteria. Patients were excluded if they were scheduled to receive an investigational antiemetic or had received chemotherapy within the previous 7 days. Of the 128 who were eligible, 112 agreed to participate; 107 returned the completed questionnaire, but the data for 15 were excluded because the patients received multiple-day chemotherapy.
The degree of nausea (on a seven-point scale) and the frequency of emesis (vomiting or retching) were recorded for each day of the survey. Functional status was assessed before and after chemotherapy by means of the Functional Living Index-Emesis (FLIE). The direct health care costs and the indirect costs (e.g., of time off work) associated with nausea and emesis were estimated from the survey responses and secondary data sources.
On the day of chemotherapy 38 of the 92 patients (41%) experienced emesis with or without nausea, and over the 5 days of the survey 72 patients (78%) reported at least one episode of nausea or emesis. The absolute risk of either problem decreased over time, but the risk of nausea relative to emesis increased over time. The FLIE scores indicated significant worsening of functional status after chemotherapy. On the day after treatment the main impact was from emesis, particularly with regard to leisure activities, household tasks and hardship to the family. Nausea had a significantly greater impact than emesis on overall functioning. The additional direct health care cost for managing emesis was estimated to be $63 and the indirect cost $121.
Despite prophylaxis with antiemetic drugs, nausea and emesis were significant problems in this population receiving chemotherapy. The management of emesis consumed relatively small amounts of health care resources, but there were costs outside the hospital for patients and others.
在5-羟色胺（5-HT3）受体拮抗剂问世之前，评估化疗相关的恶心和呕吐对患者功能状态以及对医疗保健系统、患者和社会成本的影响。
1991年2月至5月对接受癌症化疗的患者进行为期5天的前瞻性调查。数据来自护士和患者填写的问卷。
安大略省（3个）和魁北克省（2个）的5个加拿大癌症治疗中心。
18岁及以上的门诊和住院患者，根据标准化标准，他们计划接受有中度至高呕吐可能性的化疗。如果患者计划接受试验性止吐药治疗或在过去7天内接受过化疗，则将其排除。在符合条件的128名患者中，112名同意参与；107名返回了完整的问卷，但有15名患者的数据被排除，因为这些患者接受了多日化疗。
在调查的每一天记录恶心程度（采用7分制）和呕吐频率（呕吐或干呕）。化疗前后通过功能生活指数-呕吐（FLIE）评估功能状态。根据调查回复和二级数据来源估算与恶心和呕吐相关的直接医疗保健成本和间接成本（如误工成本）。
在化疗当天，92名患者中有38名（41%）出现呕吐，伴有或不伴有恶心，在调查的5天内，72名患者（78%）报告至少有一次恶心或呕吐发作。任何一种问题的绝对风险随时间降低，但恶心相对于呕吐的风险随时间增加。FLIE评分表明化疗后功能状态显著恶化。治疗后的第一天，主要影响来自呕吐，特别是在休闲活动、家务和给家庭带来的困难方面。恶心对整体功能的影响比呕吐大得多。管理呕吐的额外直接医疗保健成本估计为63美元，间接成本为121美元。
尽管使用了止吐药进行预防，但恶心和呕吐在接受化疗的人群中仍然是严重问题。呕吐的管理消耗的医疗保健资源相对较少，但患者和其他人在医院外有成本支出。
