The severity and impact of nausea and vomiting (NV) on patients undergoing chemotherapy and radiotherapy is greater than estimated by oncology physicians and nurses, according to research presented by Cheryl Vidall at the 2015 Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology International Symposium on Supportive Care in Cancer.
Chemotherapy/radiotherapy-induced NV (CINV/RINV) is estimated to affect up to half of oncology patients, significantly impacting their quality of life. Nausea is reported more frequently by patients, but it has only recently been regarded as a distinct condition. Therefore, nausea incidence is often underestimated.
“I think we lump nausea together with emesis, but it is a distinct symptom and we should be managing it differently,” said Vidall, past president of the United Kingdom Oncology Nursing Society (UKONS) and head of nursing and governance at Alcura UK Limited. “Many patients report that once they get the physical feeling of being sick out of their systems they feel better, whereas nausea goes on and on.”
Vidall and her colleagues sought to investigate the incidence and impact that CINV/RINV have on patients’ lives, to compare estimates of impact between patients and physicians/nurses to determine if there is a perceptual gap, and to identify current antiemetic practices and patient compliance.
Large European Survey Conducted
An online research survey of oncologists, oncology nurses, and patients was conducted across 5 European countries. A total of 947 respondents (375 oncologists, 186 oncology nurses, and 386 patients) participated in this survey. “Significant numbers of patients joined the survey, so obviously it is a problem patients wanted to tell us about,” said Vidall.
The incidence of nausea was greater than vomiting: 60% of patients reported nausea alone, 4% reported vomiting alone, and 14% reported NV. The incidence of NV was higher in the acute phase than in the delayed phase: 55% of patients reported nausea and 15% reported vomiting in the acute phase, whereas 37% and 6% reported delayed-phase nausea or vomiting, respectively. However, physicians and nurses estimated the incidence of patients’ NV to be higher overall and to be comparable between the acute and delayed phases.
Physicians and oncology nurses overestimated the incidence of mild/moderate CINV/RINV but underestimated its impact on patients’ daily lives. No difference in perception was observed regarding the impact of severe CINV/RINV. “I think we’ve got it right in the severe groups, so we’re learning lessons,” Vidall added.
Of the patients surveyed, 51% believed CINV had to be tolerated and did not report it. “If you ask patients what they expect from chemotherapy, they tell you ‘you’re going to go bald and you’re going to get sick.’ So a lot of them didn’t actually report it because they thought it had to be endured as part of their treatment,” she said.
Physicians and nurses estimated that around 60% of patients adhered to their antiemetic regimen at home, but only 38% of patients reported full compliance with prescribed guidelines when taking their medications. Primary factors for poor compliance included reluctance to add to their pill burden and fear that swallowing medications would induce NV.
Vidall and her co-investigators did identify a perceptual gap between oncology physicians/nurses and patients in terms of the incidence and impact of CINV/RINV on daily life. Further, the lack of distinction between acute and delayed CINV/RINV by healthcare professionals could lead to its suboptimal management.
Reducing the pill burden and the need to swallow medication could improve poor patient compliance with antiemetic regimens. “Patients don’t want to take more pills unless they absolutely have to,” said Vidall. “And when you’re feeling sick, giving a patient a pill to swallow really is a hard pill to swallow.”
Vidall C, Fernández-Ortega P, Cortinovis D, et al. Impact and management of chemotherapy/radiotherapy-induced nausea and vomiting and the perceptual gap between oncologists/oncology nurses and patients: a cross-sectional multinational survey. Presented at: 2015 Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology International Symposium on Supportive Care in Cancer; June 25-27, 2015; Copenhagen, Denmark. Abstract 11-01-O.