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PubMed1998

Mail-in questionnaire for monitoring nausea and vomiting in oncology outpatients.

A patient questionnaire designed to help pharmacists monitor nausea and vomiting in outpatients receiving cancer chemotherapy was studied. A 12-item questionnaire was designed by combining items from the Morrow Assessment of Nausea and Emesis (MANE) and the Functional Living Index-Emesis (FLIE). Items included number of vomiting episodes, duration of nausea, number of antiemetics, severity of nausea and vomiting, impact on quality of life, and adverse effects. The questionnaire was printed on an addressed, postage-paid card. Over an eight-week period, outpatients in a hospital's oncology clinic were asked to complete the questionnaire at home during the three days after chemotherapy. Of 48 patients asked, 42 (88%) agreed to complete the questionnaire, and 36 (86%) of these patients mailed it back to the clinic. Of the respondents, 11 reported at least one episode of vomiting, and 22 reported nausea. Thirteen respondents logged nausea ratings of 3 or higher on a 7-point scale. Twenty respondents used antiemetics. Responses given by the patients in follow-up telephone interviews did not differ significantly from the responses collected with the questionnaire. More than 90% of patients who returned the questionnaire rated it as simple to complete. Pharmacists used the self-reports of nausea or vomiting in 7 (17%) of 42 cases to recommend alternative antiemetic regimens. A mail-in questionnaire for monitoring nausea and vomiting in outpatients undergoing chemotherapy was completed and returned by a high percentage of patients and was useful to clinic pharmacists.

Adult↗

PubMed2003

Acupuncture to reduce nausea during chemotherapy treatment of rheumatic diseases.

OBJECTIVE: To study if acupuncture, combined with ondansetron treatment, reduces nausea and vomiting associated with cyclophosphamide infusion in patients with rheumatic diseases. METHODS: Thirty-nine patients were treated with acupuncture at point PC 6 and/or in the ear to decrease nausea and vomiting. The patients reported the severity of nausea and number of bouts of vomiting at the start of chemotherapy and after 4, 8, 24, 48 and 72 h. RESULTS: Compared with ondansetron treatment alone, the combined acupuncture-ondansetron treatment significantly decreased both the severity of nausea and the number of bouts of vomiting 24 and 48 h after the subjects had received acupuncture at the first treatment session (nausea: P < 0.0001; vomiting: P < 0.0035). Nearly the same results were seen 48 and 72 h after the subjects had had their last treatment of acupuncture (nausea P < 0.0080). Similar results were found after 24 to 48 h, when a comparison was made between two sessions close in time (nausea: P < 0.0001 after 24 h, P < 0.0003 after 48 h; vomiting: P < 0.0007). CONCLUSIONS: Our results clearly indicate that combined treatment with acupuncture and ondansetron reduces the severity and the duration of chemotherapy-induced nausea as well as the number of bouts of vomiting as compared with ondansetron therapy alone, in patients with rheumatic diseases.

Acupuncture Therapy↗

PubMed1987

Role of nitrous oxide and other factors in postoperative nausea and vomiting: a randomized and blinded prospective study.

Postoperative nausea and vomiting have been reported to be associated with the use of nitrous oxide. To further investigate this possibility, 780 patients undergoing anesthesia and surgery were randomly divided into four groups: group I: enflurane/nitrous oxide/oxygen; group II: enflurane/air/oxygen; group III: isoflurane/nitrous oxide/oxygen; and group IV: isoflurane/air/oxygen. The frequency of postoperative nausea and vomiting was ascertained in the recovery room and at 24-h follow-up by blinded observers. Other data collected included gender, age, body mass index, previous history of postoperative nausea and vomiting, and postoperative narcotic use. The authors found no association between the use of nitrous oxide and subsequent development of postoperative nausea and vomiting. Use of the 95% confidence interval allowed the authors to project a maximum potential increase in the frequency of postoperative nausea and vomiting associated with nitrous oxide to be 5.4% with enflurane and 9.7% with isoflurane in the immediate postoperative period. Female gender, younger age, and a previous history of postoperative nausea and vomiting, but not body mass index, were found to be associated with postoperative nausea and vomiting (P less than 0.05). It is concluded that there is no association between the use of nitrous oxide and the development of postoperative nausea and vomiting.

Adult↗

PubMed2002

A randomized, double-blind comparison of ondansetron versus placebo for prevention of nausea and vomiting after infratentorial craniotomy.

Ondansetron was compared with placebo for nausea and vomiting prophylaxis after fentanyl/isoflurane/relaxant anesthesia and infratentorial craniotomy. Eight milligrams intravenous ondansetron or vehicle was administered at skin closure. Nausea, emesis, and antiemetic use were recorded at 0, 0.5, 1, 4, 8, 12, 24, and 48 hours. There were no significant intergroup differences for nausea incidence at any interval, but cumulatively the placebo group was 3.2 times more likely to develop nausea during the first 12 hours (P = .04). Nausea incidence was bimodal in both groups, peaking during the first 1 to 4 hours. A nadir occurred at 8 to 12 hours, but nausea increased during the next 36 hours. By 48 hours, approximately 40% of patients in both groups were still nauseated. Reduced vomiting frequency was seen with ondansetron at 4, 8, 12, and 24 hours (P < .05). Despite rescue antiemetics, emesis occurred in an irregular pattern with episodes still observed in 35% of placebo patients at 48 hours. For ondansetron, emesis was infrequent for the first 12 hours but then a persistent increase was observed (48 hours, 22%). The incidence of rescue antiemetic use was 65% for both groups. There was no effect of gender. Nausea and vomiting are frequent and protracted after infratentorial craniotomy. Administration of single-dose ondansetron (8 mg intravenously) at wound closure was partially effective in reducing acute nausea and vomiting but had little delayed benefit. Scheduled prophylactic administration of antiemetic therapy during the first 48 hours after infratentorial craniotomy should be evaluated for efficacy and safety.

Adolescent↗

PubMed1994

Studies in postoperative sequelae. Nausea and vomiting--still a problem.

We collected data on postoperative nausea and vomiting from 3850 patients aged 11-91 years. Thirty-seven percent of the 3244 patients who received a general anaesthetic reported nausea and 23.2% vomited. Twenty percent of the 606 patients who received a local anaesthetic reported nausea and 11.4% vomited. Of the general anaesthetic patients reporting nausea, 72.2% were women, and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 74.0% were women and again the mean age was lower (p < 0.001). Of the local anaesthetic patients reporting nausea, 62.0% were women and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 68.1% were women and again the mean age was lower (p < 0.001). Anxiety before general, but not local, anaesthesia was associated with postoperative nausea (p < 0.001) but not vomiting. Patients from the gynaecological, orthopaedic, ENT and general surgical wards had higher incidences of postoperative nausea and vomiting. Linear visual analogue pain scores were higher in patients with postoperative nausea and vomiting in both general and local anaesthesia groups (p < 0.001).

Adolescent↗

PubMed1984

Nausea and vomiting in pregnancy.

Prospective data on 86 pregnant women were analysed to investigate the relationship between the pregnancy symptoms of nausea and vomiting and various demographic, social and psychological factors. In contrast to previous research findings no significant differences were discovered along demographic or social dimensions between women reporting no nausea, mild nausea and severe nausea during the first trimester of pregnancy. Not surprisingly, those women experiencing severe nausea reported significantly more sleep disturbances, fatigue and irritability. Women having both nausea and vomiting during the first trimester, reported significantly more unplanned, undesired pregnancies and negative relationships with their own mothers, than first trimester groups experiencing nausea only or no symptoms. Finally, those with continuing nausea and vomiting in the third trimester, when compared with those having no symptoms, tended to have reported significantly more psychological/psychiatric problems in the first trimester and were significantly more negative in their assessment of their own maternal relationship.

Adult↗

PubMed1997

Role of plasma vasopressin as a mediator of nausea and gastric slow wave dysrhythmias in motion sickness.

The possible role of vasopressin in nausea and gastric dysrhythmias in motion sickness was tested by electrogastrography in 14 subjects during circular vection (60 degrees/s) and vasopressin infusion. Tachygastria was expressed as the signal percent >4.5 cycles/min. Vection evoked nausea scores of 2.6 +/- 0.2 (0 = none to 3 = severe) in 10 subjects with increases in tachygastric activity (15 +/- 2 to 45 +/- 3%) and plasma vasopressin (4.5 +/- 1.5 to 8.4 +/- 2.5 pg/ml) that were blocked by atropine but not indomethacin. Four asymptomatic subjects had no tachygastria or vasopressin release. Vasopressin at 0.2 U/min (plasma level = 322.1 +/- 10.3 pg/ml) evoked nausea (2.6 +/- 0.4) and increases in tachyarrhythmic activity (41 +/- 5%) that were blunted by atropine but not indomethacin. There were no differences in nausea or dysrhythmias with vasopressin infusion in subjects who noted nausea during vection versus those who did not. To conclude, vection evokes nausea, dysrhythmias, and vasopressin release in motion sickness-susceptible humans via cholinergic prostaglandin-independent pathways. Supraphysiological vasopressin infusions evoke nausea and dysrhythmias by similar pathways to equal degrees in motion sickness-susceptible and -resistant subjects. Thus central but not peripheral actions of vasopressin may contribute to nausea and slow wave disruption with vection. Blunting of both the release and action of vasopressin by atropine may explain its beneficial action in motion sickness.

Adult↗

PubMedDate not supplied

Does dexamethasone enhance the efficacy of alizapride in cis-platinum-induced delayed vomiting and nausea?

At the present time 5-HT3 antagonists in combination with corticosteroids represent the best prophylaxis and treatment of acute vomiting and nausea in highly emetogenic cancer chemotherapy. However, 24 h after chemotherapy 5-HT3 antagonists are no longer superior to benzamides for prevention of delayed symptoms. All recommendations for use of corticosteroids in delayed nausea and vomiting basically rely on one small study by Kris et al. [J Clin Oncol 1989;7:108-114]. Since the use of corticosteroids in cancer chemotherapy remains controversial, this single-blind, randomised, prospective trial was initiated to re-evaluate the benefits of corticosteroids during the days after chemotherapy. Thus patients treated for ovarian cancer received 5 mg tropisetron (Navoban) plus 20 mg dexamethasone for the prevention of acute vomiting and nausea in cis-platinum-containing chemotherapy (50 mg). Twenty-four hours after the beginning of chemotherapy 49 patients were randomised to receive 3 x 100 mg alizapride (Vergentan) plus a placebo medication (group A) and 47 patients to receive 3 x 100 mg alizapride plus 3 x 4 mg dexamethasone (group B) for 3 days depending on the incidence of acute vomiting beginning on day 2. The well-being of both groups was compared using objective and subjective parameters (Rotterdam Symptom Checklist). Major control of acute vomiting was achieved in 87.5% of the cases. The study was stopped after this interim analysis of 96 patients revealed no advantage of corticosteroids during the days after chemotherapy. Significant differences between both groups were detected only on a few days (day 6: objective nausea in favour of group A, day 4: objective vomiting in favour of group B, day 6: objective vomiting in favour of group A, day 3: constipation in favour of group A, days 4 and 5: difficulty concentrating in favour of group A, day 3: dry mouth in favour of group B). In contrast to acute nausea and vomiting the addition of corticosteroids is not beneficial in the prevention of delayed nausea and vomiting. Until better strategies are available the best prophylaxis of delayed symptoms is the control of acute nausea and vomiting using 5-HT3 antagonists plus corticosteroids. The use of benzamides has to be considered efficacious in the prevention of delayed vomiting and nausea.

Adult↗

PubMed2002

Characteristics of nausea reported by HIV-infected patients initiating combination antiretroviral regimens.

Reliable data on the incidence and severity of nausea accompanying combination antiretroviral therapies is lacking. A prospective time series design was used to assess the rate, severity, and distress of nausea in a cohort of 75 HIV-positive patients who were beginning or changing a combination of two or more antiretroviral medications. Data were collected via telephone at weekly intervals for 12 weeks. The rate of nausea across regimens was greatest at Week 1 (39%) and declined progressively over time. By Week 12, the rate of nausea was only 5%. Severity of nausea was ranked as moderate or severe by a substantial proportion of patients through Week 10; however, nausea severity and distress were also found to diminish over time. The nausea associated with combination antiretroviral therapy is quite common and may adversely affect medication adherence. Findings indicate that clinicians should consider initiating interventions for management of antiretroviral-related nausea at baseline.

Adult↗

PubMed1989

Incidence and duration of chemotherapy-induced nausea and vomiting in the outpatient oncology population.

Nausea and vomiting are commonly recognized side effects of chemotherapy. However, the incidence and duration of these effects have not been systematically studied in a large outpatient oncology population. This survey was conducted over two consecutive 6-week periods in the adult oncology clinics of two university teaching hospitals. The objectives were: (1) to document the incidence and duration of chemotherapy-induced nausea and vomiting; (2) to identify variables that influence nausea and vomiting; and (3) to describe patterns of antiemetic prescribing and compliance. One hundred thirty-eight completed patient-maintained diaries were returned (70% response rate). Anticipatory nausea and vomiting were reported by 9.4% and 6.5% of patients, respectively. Fifty percent and 27% of patients reported nausea and vomiting, respectively, on the day chemotherapy was administered (day 1: acute nausea and vomiting phase). Percentages fell to 22% and 11% by day three and 14% and 2.5% on day 5. Of patients who reported nausea and vomiting during the five-day period, 52% and 33% experienced nausea and vomiting, respectively, during the delayed period only (days 2 through 5: delayed emesis phase). Emetogenicity of chemotherapy significantly influenced incidence and duration of those symptoms. Sixty-seven percent of patients reported taking antiemetics on one or more days during the survey period. Of patients who reported antiemetic use, 92% reported antiemetics on day 1, 51% on day 3, and 31% on day 5. At-home antiemetic use was related to the emetogenicity of chemotherapy received. Patients who receive moderate to strong emetogens as defined in this report should receive antiemetic therapy for a minimum of three days. Increasing the dose of antiemetic prescribed both in the clinic and at home may be of benefit.

Adult↗

PubMed2005

Continuous gastric decompression for postoperative nausea and vomiting after coronary revascularization surgery.

Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. In a prospective, randomized, cohort study, 104 patients with at least 2 Apfel's risk factors for postoperative nausea and vomiting were allocated to receive a gastric tube on free gravity drainage after induction of anesthesia (n = 52) or to a control group (n = 52). The gastric tube was removed simultaneously with tracheal extubation postoperatively. The primary outcome measure was the incidence of vomiting or retching. Secondary outcomes included the incidence and severity of nausea measured on a visual analog scale. The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0-55 mm versus 30; range, 0-60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.

Aged↗

PubMed1997

Gastroesophageal reflux disease presenting with intractable nausea.

BACKGROUND: Typical symptoms of gastroesophageal reflux disease are heartburn and regurgitation. A subset of patients present with atypical symptoms, such as chest pain, cough, wheezing, and hoarseness. OBJECTIVE: To review the clinical presentation and treatment of patients who presented with nausea as the primary symptom of gastroesophageal reflux disease. DESIGN: Case series. SETTING: Outpatient department of a university hospital. PATIENTS: 10 outpatients who had chronic, intractable nausea and had not responded to empirical therapies. MEASUREMENTS: Patients were evaluated by esophagogastroduodenoscopy, 24-hour esophageal pH studies, gastric-emptying tests, electrogastrography, or a Bernstein test. RESULTS: Abnormal acid reflux was found to be the cause of intractable nausea in all 10 patients. In 5 of the 10 patients, esophagitis was documented by esophagogastroduodenoscopy. Six patients had abnormal results on the 24-hour esophageal pH study. In these 6 patients, 32 of 33 episodes of nausea were accompanied by an episode of acid reflux. One patient had positive results on the Bernstein test. Nausea resolved after treatment with omeprazole in 7 patients, after treatment with cisapride or ranitidine in 2 patients, and after Nissen fundoplication in 1 patient. CONCLUSIONS: Intractable nausea is an atypical symptom that can occur in a subset of patients with gastroesophageal reflux disease. A 24-hour esophageal pH study should be considered in patients who have unexplained nausea but normal findings on esophagogastroduodenoscopy, a gastric-emptying test, and electrogastrography. Nausea related to gastroesophageal reflux disease resolves or is markedly reduced with proton-pump inhibitors or promotility drugs.

Adult↗

PubMedDate not supplied

Swallowing topically administered 4% lidocaine results in nausea and vomiting.

In preparing adult volunteers for insertion of an upper airway device, we observed a high incidence of nausea and vomiting in the first 16 consecutive volunteers who were allowed to swallow topically administered 4% lidocaine (50% and 31%, respectively). We tested the hypothesis that swallowing the topically administered 4% lidocaine caused the nausea and vomiting by comparing the incidence of nausea and vomiting in these first 16 volunteers with the incidence of nausea and vomiting in the next 162 consecutive awake adult volunteers who were not allowed to swallow the 4% lidocaine. All 178 volunteers were prepared by administering 2 mg midazolam and 100 micrograms fentanyl intravenously, spraying 10 to 15 mL of 4% lidocaine into the upper airway, and bilaterally blocking the lingual branch of nerve IX and the superior laryngeal branch of nerve X. The first 16 volunteers were allowed to swallow the 4% lidocaine (swallow/no suction, group A); the next 162 volunteers were not allowed to swallow the 4% lidocaine, and all of the 4% lidocaine was suctioned out of the upper airway (no swallow/suction, group B). Groups A and B were otherwise and subsequently treated identically. The incidence of nausea and vomiting in group A was 50% (8/16) and 31% (5/16), respectively, and in group B, 4% (7/162) and 1% (2/162), respectively. The difference in the incidence of nausea and vomiting between group A and group B was highly significant by chi-square analysis (P < 0.01). We found that swallowing topically administered 4% lidocaine results in a significant increase in the incidence of nausea and vomiting. Our experimental design did not allow us to rule out either of two basic mechanisms, higher blood levels and a direct toxic effect, or to distinguish between them. The clinical implication of this study is that suctioning all topically administered 4% lidocaine will decrease the incidence of nausea and vomiting.

Adolescent↗

PubMed1999

Illusory self-motion and motion sickness: a model for brain-gut interactions and nausea.

Motion sickness provides a unique setting for the study of nausea. Studies of illusory self-motion have linked nausea and objective measures of gastric dysrhythmias and the stress hormones vasopressin and epinephrine. Electrogastrographic methods utilize Ag-AgCl electrodes placed on the abdominal surface in the epigastric region to record electrogastrograms (EGGs), a noninvasive measure of gastric myoelectrical activity. The EGG frequencies of interest are the normal range (2.4-3.6 cpm), tachygastrias (3.6-9.9 cpm), and bradygastrias (1.0-2.4 cpm), and duodenal respiratory frequencies (10.0-15.0 cpm). Illusory self-motion or vection is produced with a rotating drum. Minutes before vection-induced nausea is reported, the baseline EGG signal shifts into tachygastrias or mixed tachygastrias and bradygastrias. Quantitative analyses show that the percentage of power in the tachygastria range correlates with the intensity of nausea. Plasma vasopressin levels correlate positively with intensity of nausea. Asian subjects have higher intensity nausea and higher vasopressin levels compared with Caucasian subjects, indicating a potential genetic susceptibility to vection-induced motion sickness and nausea. Vection-induced motion sickness represents an experimental model of acute-onset nausea with accompanying symptoms such as headache, drowsiness, cold sweating, and fatigue. Illusory self-motion is a purely central nervous system (visual-vestibular) stimulation that evokes dramatic shifts in gastric electrical activity and significant release of the posterior pituitary hormone vasopressin. Central nervous systems pathways that evoke gastric dysrhythmias and release vasopressin may also have a pathophysiologic role in the cyclic vomiting syndrome.

Brain↗

PubMed2000

The experience of nausea during sustained hyper-gravity flight with negligible angular velocity.

BACKGROUND: The purpose of this study was to investigate nausea and vomiting during hyper-gravity flight at a slow rate of turn. During head-movements under these conditions, the semi-circular canals of the vestibular system function normally whereas the otoliths experience a G-excess effect, displacing further and moving faster than in a 1 G field. HYPOTHESIS: Nausea and vomiting are greater during hyper-gravity flight compared with historical data collected in a 1 G field at a similar rate of turn. METHODS: There were 27 subjects who were exposed to 1.8 G (hyper-G) during a slow rate turn on three NASA KC-135 flights. Subjects participated in one of three experimental periods, each period consisting of two 5.5-min hyper-G runs: 1) rest, with only incidental head movements; 2) active roll and pitch head movements; or 3) passive roll head movements. Subjective symptom data were collected pre-flight, following each experimental period and post-flight using a standardized nausea questionnaire. Electrogastrograms were obtained from eight subjects. RESULTS: Seven subjects (26%) vomited during the flight. Nausea initially increased but was then stable throughout the flight. Nausea appeared highest during active head movements. In subjects who vomited, greater gastrointestinal distress and somatic distress were reported. CONCLUSIONS: The levels of nausea and vomiting observed during hyper-G cannot be explained by Coriolis cross coupling and are likely due to the G-excess effect on the otoliths. The nausea profiles observed in individuals who vomit during hyper-G appear similar to those previously observed during nausea produced by an optokinetic drum stimulus in a 1-G field.

Adult↗

PubMed1991

[Comparison of methylprednisolone and droperidol in the prevention of nausea and vomiting following major gynaecological surgery].

The efficacy of methylprednisolone (MP) (500 or 250 mg) or droperidol 2.5 mg administered i.v., was studied in 200 women undergoing major gynaecological surgery. Following a standardised general anaesthesia technique with intrathecal morphine, the incidence of nausea and vomiting was assessed. The frequency of postoperative nausea and vomiting in the non-treated group was 59% and 35%; the group of MP 500 mg has a significant reduction of nausea and vomiting to 21% and 13%. Droperidol 2.5 mg decreased the incidence of postoperative nausea alone (nausea: 36%, vomiting: 19%). MP 250 mg was not effective in reducing either nausea or vomiting (nausea: 44%, vomiting: 38%). It was concluded that, of the drugs studied, MP 500 mg was most effective in preventing nausea and vomiting after major gynaecological surgery.

Adult↗

PubMed1994

On the relationship between nausea and vomiting in patients undergoing chemotherapy. Italian Group for Antiemetic Research.

In comparative trials on antiemetic efficacy of different regimens, the positive correlation between the probabilities of vomiting and of nausea could hide some confounding effect. Our work seeks to detect such effects. The data from two large studies on prevention of cisplatin-induced emesis were re-analyzed using two multifactorial logistic models. The first study compared ondansetron + dexamethasone (Ond+Dex) with metoclopramide+dexamethasone+diphenhydramine (Mtc+Dex+Dip), the second compared Mtc+Dex+Dip with Mtc+prednisolone. A group of 267 patients in the first study and 343 in the second, all evaluable for clinical efficacy, were followed for three subsequent cycles of chemotherapy. The antiemetic regimen administered and the complete protection from acute vomiting and nausea were recorded. In the first study (cycle 1), after adjustment for the presence/absence of vomiting, the two therapies were no longer found significantly different on complete protection from nausea: the greater efficacy of Ond+Dex in preventing nausea was due to a confounding effect. Instead, in the second study, the greater efficacy of Mtc/Dex/Dip in preventing both nausea and vomiting was confirmed. The results indicate that, when a correlation between two responses is detected, multifactorial analyses should be performed to identify the possible presence of some confounding effect. The proof that the presence/absence of vomiting is a confounding factor for the relationship between the different efficacy of the two antiemetic regimens for complete protection from nausea, highlighting the same efficacy of the two therapies in preventing nausea, supports the hypothesis of the existence of two kinds of nausea, one independent of vomiting, the other concomitant with it.

Antiemetics↗

PubMed1993

Impact of chemotherapy-associated nausea and vomiting on patients' functional status and on costs: survey of five Canadian centres.

OBJECTIVE: 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. DESIGN: 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. SETTING: Five Canadian cancer treatment centres in Ontario (three) and Quebec (two). PATIENTS: 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. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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.

Activities of Daily Living↗