Chemotherapy-induced nausea and vomiting

Introduction
Among several side effects of chemotherapy in patients of cancer, nausea and vomiting are very
distressing to the patients (Breen, Baravelli, Schofield, Jefford, &
Yates, 2009). Chemotherapy-induced nausea and vomiting (CINV) adversely impacts
the daily functioning of patients and their quality of life as well, in terms of health outcome. It is
found in literature that management of nausea is more challenging than management of vomiting
(Andrews & Sanger, 2014). Healthcare professionals including oncology
physicians and RNs can decrease the intensity and distressing impact of CINV through suitable
health care practices and prescription of antiemetic regimes for patients who are at risk. This
assignment will present a review of the current evidence for the management of CINV. It will
also have an annotated bibliography for relevant primary research articles with a conclusion
regarding the suitability of applying the evidence based management of CINV at a clinical
setting.
Articles
Keywords
Keywords used to search the appropriate article are: Nausea, vomiting, chemotherapy,
chemotherapy induced nausea and vomiting, emesis, CINV, antiemetic, cancer.
Inclusion criteria for the search
Criteria for the search included articles which described and assessed the management of CINV
among cancer patients, studies published in English language and within 5 years.

Exclusion criteria for the search
Articles with irrelevant information and outdated.
Search strategy
PubMed database was searched by making use of the above-mentioned search terms. Literature
search included the date restriction of last 5 years and language restriction of English language.
Relevancy of the articles were also checked by specifying them with management of CINV.
Reference lists of the selected articles were searched manually to include all the relevant studies
for this review. Relevancy of the titles and abstracts of the identified studies were checked. Full-
text of articles were obtained for the articles which met the inclusion criteria, or if the title and
abstract were not clear. Identical articles of same study were removed. Data were extracted of 8
articles after obtaining full-text and finding them relevant to research topic. The data in each
study that dealt with research topic was identified.
Annotated bibliography and critique
Meissner, K., Talsky, N., Olliges, E., Jacob, C., Stötzer, O. J., Salat, C., . . . Flondor, R. (2019).
Individual Factors Contributing to Nausea in First-Time Chemotherapy Patients: A Prospective
Cohort Study. Front Pharmacol, 10. doi:https://doi.org/10.3389/fphar.2019.00410
A. Nocebo effect is a phenomena in which the anticipation of having side effects can
increase the chances of developing them. This prospective study was conducted with the
aim of understanding about the factors which are a source of expectations of nausea and
their possible role in actual development of nausea among patients going through
chemotherapy for the first time. 121 female patients participated to fill the questionnaires
which assessed the anxiety and quality of life and rated the expectation of nausea as a

side effect of chemotherapy and patient diaries were also checked. Previous episodes of
nausea in other conditions and state anxiety were the two factors which contributed to
nausea expectancy. Patients of young age with reduced initial quality of life and a history
of nausea were had greater likelihood to have nausea after first session of chemotherapy.
Study has limitations of lack of control for the various types of chemotherapeutic
regimens and antiemetic drugs, inclusion of only female patients suffering mostly (85%)
from breast cancer which limited the representativeness and chances of eliciting a nocebo
effect on being asked the expectations to the patients.
B. Healthcare professionals including the RN must investigate the factors addressed in the
study before performing first chemotherapy so that risk of post-chemotherapy nausea can
be estimated (Meissner, et al., 2019).
Rha, Park, Song, Lee, & Lee. (2016). Controlling chemotherapy-induced nausea requires further
improvement: symptom experience and risk factors among Korean patients. Support
Care Cancer, 24(8), 3379-89. doi:10.1007/s00520-016-3146-x
A. The study was conducted with the aim of describing the rate and intensity of CINV and
patterns of symptom change post-chemotherapy in the Korean population suffering from
cancer and utilizing antiemetic guidelines. This prospective observational descriptive
study also ascertained the impact of established risk factors of CINV on the frequency
and severity of CINV. Multinational Association of Supportive Care in Cancer
Antiemesis Tool was used to produce a symptom diary for 332 adult patients of cancer. It
was found that certain risk factors were identified for chemotherapy-induced nausea
including younger age, less alcohol consumption, and expectancy of nausea. These risk
factors must be regarded from the initiation of the chemotherapy. The study did not

consider certain variables including type of cancer, education level and sex of the
patients.
B. RN must consider the fact that since first chemotherapy-induced nausea experience lead
to a following symptom experience. So, during chemotherapy management strict
regulation must be induced since the initiation of chemotherapy and all the individual
patient-related risk factors must be considered. (Rha, Park, Song, Lee, & Lee, 2016).
Hilarius, D. L. et al., 2012. Chemotherapy-induced nausea and vomiting in daily clinical
practice: a community hospital-based study. Support Care Cancer, 20(1), pp. 107-117.
doi: 10.1007/s00520-010-1073-9
A. The prospective, multicenter study was aimed at investigating the effect of CINV on the
quality of life of patients in terms of health status in routine clinical practice. It also
ascertained the relation between characteristics of patient and type of antiemetic and
CINV. Lastly it aimed at examining the role of CINV in decision of the physician to alter
antiemetic treatment. A diary was kept by 277 patients to document nausea events,
vomiting and use of antiemetic for three consecutive chemotherapy sessions. On sixth
day of all the treatment cycles, the impact of CINV on the quality of life of patients in
terms of health status life was assessed with the Functional Living Index-Emesis
questionnaire. 39% and 68% patients reported acute and delayed nausea, respectively.
For acute and delayed vomiting, patient’s figure were 12% and 23%. Nearly 33% patients
reported of having a significant effect of CINV on their daily lives. Study concluded that
CINV hamper the daily lives of the patients adversely. It affects female gender and
younger age group more than the male gender and older age groups.