Healthcare providers underestimate rate of nausea after chemotherapy

Physicians and nurses greatly underestimate the incidence of delayed chemotherapy-induced nausea and emesis, according to a report in the April 12th online issue of Cancer. This holds true for both highly and moderately emetogenic chemotherapy.

The findings are based on a survey of 24 healthcare providers and 298 patients recruited from 14 oncology practices in 6 countries. All of the patients had been exposed to chemotherapy for the first time, which included highly emetogenic chemotherapy in 67 and moderately emetogenic chemotherapy in 231 patients. Despite receiving antiemetics, more than 35% of the patients experienced acute nausea and 13% experienced emesis, lead author Dr. Steven M. Grunberg, from Fletcher Allen Health Care in Burlington, Vermont, and colleagues note.The rates of delayed nausea and vomiting in the highly emetogenic chemotherapy group were 60% and 50%, respectively, and in the moderately emetogenic chemotherapy group were 52% and 28%. In a substantial proportion of patients in each group, no acute symptoms were present prior to the delayed nausea and vomiting.Physicians and nurses were accurate in predicting acute nausea and emesis, but typically underestimated the incidence of delayed symptoms, the authors point out. For example, delayed nausea after highly emetogenic chemotherapy and moderately emetogenic chemotherapy were underestimated by 21 and 28 percentage points, respectively. Seventy-five percent of providers underestimated the rates with both highly emetogenic chemotherapy and moderately emetogenic chemotherapy.Increased use of newer antiemetic agents could further reduce rates of nausea and vomiting after chemotherapy, the authors note. “However, an increased appreciation of the incidence and duration of delayed nausea and emesis, both through physician/nurse education and through structured reporting by patients of their experienced during chemotherapy, will be necessary to achieve optimal control of this problem.” The study was sponsored by Merck & Co. of Whitehouse Station, New Jersey, which employs about half of the study authors.(Source: Cancer 2004;100:000-000: Reuters Health: April 2004: Oncolink)