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.