Nausea still the poor relation in antiemetic therapy? The symptom cluster triad of nausea, vomiting and appetite loss: individual and combined effects on quality of life during cancer treatment (#31)
Aims: Despite significant antiemetic advances, almost 50% of treated cancer patients still experience nausea and vomiting (N&V). Potentially, N&V may be part of a symptom cluster where co-occurring symptoms negatively affect antiemetic management. Consequently, we examined TIN+/-V incidence and the impact of nausea, vomiting and symptom cluster(s) containing them, respectively, on quality of life (QoL) across treatment.
Methods: A longitudinal secondary analysis involving 200 cancer patients who underwent combined modality treatment was performed.1
Results: Overall, 62% of patients experienced TIN+/-V, with TIN (60%) doubling TIV incidence (27%). Exploratory factor analyses of QoL scores at pretreatment, on-treatment (8 weeks) and post-treatment identified a recurrent gastrointestinal symptom cluster comprising nausea, vomiting and appetite loss. Two-thirds of patients reported co-occurrence of all three symptoms, which exerted synergistic effects of multiplicative proportions on overall QoL. Patients who reported co-occurrence of these symptoms during treatment experienced significantly greater QoL impairment (physical/role/social functioning, fatigue, N&V, appetite loss, overall QOL/physical health) and psychological distress than those unaffected (.001 > p ≤ .05). Moreover, nausea was more pervasive than vomiting or appetite loss across treatment, and had a greater impact on overall QoL. While antiemetic therapy was effective for vomiting and helped prevent/relieve associated appetite loss, the benefits for appetite loss were constrained by its failure to exert adequate control over nausea in many patients.
Conclusions: Uncontrolled TIN+/-V often results in significant appetite/weight loss, leading to increased risk for malnutrition. Malnutrition and weight loss, in turn, are associated with poorer prognosis, treatment tolerance/response, performance status, QoL and survival. Consequently, a multiple symptom intervention approach focusing on N&V as core symptoms is recommended. Clinicians should genuinely consider combining essential antiemetic therapies with other evidence-based pharmacological (e.g. nausea: olanzapine) and non-pharmacological approaches (e.g. N&V: relaxation), in attempts to not only improve prevention/control of N&V for their patients, but reduce the synergistic impact of cluster symptoms as a whole and resultant QoL impairment also. Where associated symptoms are not adequately controlled by these antiemetic-based interventions, targeted evidence-based strategies should be supplemented.
- Pirri C, Bayliss E, Trotter J, Olver IN, Katris P, Drummond P, Bennett R. (in press). Nausea still the poor relation in antiemetic therapy? The impact on cancer patients’ quality of life and psychological adjustment of nausea, vomiting and appetite loss, individually and concurrently as part of a symptom cluster. Manuscript accepted for publication on 12 August, 2012 by Supportive Care in Cancer.