Chemotherapy-Induced Vomiting in Women Treated for Breast Cancer
Purpose/Objectives: To describe the incidence and intensity of vomiting in women receiving chemotherapy treatment for breast cancer since the advent of 5-HT3 antagonists.
Design: Longitudinal, descriptive.
Setting: 7 outpatient oncology clinics situated in hospitals, 5 outpatient oncology clinics associated with major teaching universities, 27 private outpatient oncology practices, and 1 outpatient clinic located in a county hospital.
Sample: Typical participants (N = 303) were 51.9 years, Caucasian (79%), married or partnered (65%), born U.S. citizens (93%), heterosexual (96%), living with someone (84%), and high school graduates (82%).
Methods: Baseline and poststudy questionnaires and a daily diary of vomiting through two cycles of chemotherapy (approximately two months) were used to collect data.
Main Research Variable: Vomiting experience.
Findings: The worst vomiting occurs three days after having chemotherapy for breast cancer. The types of oral antiemetics ordered for home use were changed between the two cycles of the study only 8% (n = 24) of the time. No demographic factors were associated with acute vomiting at times 1 or 2; younger age (r = -0.16; p = 0.012) was associated with more vomiting. Delayed vomiting was associated with age and body mass index, and younger, heavier women experienced more vomiting. Minority women (n = 55) reported significantly more delayed vomiting than did Caucasian women (XM = 6.56 versus 2.82; t = 2.02; p < 0.05).
Conclusions: Vomiting continues to be a significant problem for some women receiving chemotherapy for breast cancer.
Implications for Nursing: Oncology nurses can use the results from this study to provide anticipatory guidance for patients undergoing chemotherapy for breast cancer and to support efforts to provide appropriate symptom management for these women.
American Cancer Society. (2003). <i>Cancer facts and figures, 2003</i>. Atlanta, GA: Author.
American Cancer Society & National Comprehensive Care Network. (2001). <i>Nausea and vomiting: Treatment guidelines for patients with cancer</i>. Atlanta, GA: American Cancer Society.
Bartlett, N., & Koczwara, B. (2002). Control of nausea and vomiting after chemotherapy: What is the evidence? <i>Internal Medicine Journal, 32</i>, 401-407.
Clavel, M., Soukop, M., & Greenstreet, Y.L.A. (1993). Improved control of emesis and quality of life with ondansetron in breast cancer. <i>Oncology, 50</i>, 180-185.
Dawson-Saunders, B., & Trapp, R.G. (1994). <i>Basic and clinical biostatistics</i>. Norwalk, CT: Appleton and Lange.
Dibble, S., Israel, J., Nussey, B., Casey, K., & Luce, J. (2003). Delayed chemotherapy-induced nausea in women treated for breast cancer. <i>Oncology Nursing Forum, 30</i>, E40-E47. Retrieved March 7, 2003, from http://www.ons.org/ONF/2003/March_April_03/E40-E47.pdf
Dicato, M. (1996). Mechanisms and management of nausea and emesis. <i>Oncology, 53</i>(Suppl. 1), 1-3.
Fessele, K.S. (1996). Managing the multiple causes of nausea and vomiting in the patient with cancer. <i>Oncology Nursing Forum, 23</i>, 1409-1415.
Goodman, M. (1997). Risk factors and antiemetic management of chemotherapy-induced nausea and vomiting. <i>Oncology Nursing Forum, 24</i>, 20-32.
Greene, D., Nail, L.M., Fieler, V.K., Dudgeon, D., & Jones, L.S. (1994). A comparison of patient-reported side effects among three chemotherapy regimens for breast cancer. <i>Cancer Practice, 2</i>, 57-62.
Italian Group for Antiemetic Research. (1999). Prevention of cisplatin-induced delayed emesis: Still unsatisfactory. <i>Supportive Care in Cancer, 8</i>, 229-232.
Italian Group for Antiemetic Research. (2000). Dexamethasone alone or in combination with ondansetron for the prevention of delayed nausea and vomiting induced by chemotherapy. <i>New England Journal of Medicine, 342</i>, 1554-1559.
Kaiser, R., Sezer, O., Papies, A., Bauer, S., Schelenz, C., Tremblay, P.B., et al. (2002). Patient-tailored antiemetic treatment with 5-hydroxytryptamine type 3 receptor antagonists according to cytochrome P-450 2D6 genotypes. <i>Journal of Clinical Oncology, 20</i>, 2805-2811.
Kris, M.G., Roila, F., De Mulder, P.H.M., & Marty, M. (1998). Delayed emesis following anticancer chemotherapy. <i>Supportive Care in Cancer, 6</i>, 228-232.
Maisano, R., Spadaro, P., Toscano, G., Caristi, N., Pergolizzi, S., & Salimbeni, V. (2000). Cisapride and dexamethasone in the prevention of delayed emesis after cisplatin administration. <i>Supportive Care in Cancer, 9</i>, 61-64.
McCollum, A.D., Catalano, P.J., Haller, D.G., Mayer, R.J., Macdonald, J.S., Benson, A.B., et al. (2002). Outcomes and toxicity in African American and Caucasian patients in a randomized adjuvant chemotherapy trial for colon cancer. <i>Journal of the National Cancer Institute, 94</i>, 1160-1167.
Oettle, H., & Riess, H. (2001). Treatment of chemotherapy-induced nausea and vomiting. <i>Journal of Cancer Research and Clinical Oncology, 127</i>, 340-345.
Osoba, D., Zee, B., Warr, D., Latrelle, J., Kaizer, L., & Pater, J. (1997). Effect of postchemotherapy nausea and vomiting on health-related quality of life. <i>Supportive Care in Cancer, 5</i>, 307-313.
Pendergrass, K.B. (1998). Options in the treatment of chemotherapy-induced emesis. <i>Cancer Practice, 6</i>, 276-281.
Rhodes, V.A., Watson, P.M., & Johnson, M.H. (1984). Development of reliable and valid measures of nausea and vomiting. <i>Cancer Nursing, 7</i>, 33-41.
Rhodes, V.A., Watson, P.M., Johnson, M.H., Madsen, R.W., & Beck, N.C. (1987). Patterns of nausea, vomiting, and distress in patients receiving antineoplastic drug protocols. <i>Oncology Nursing Forum, 14</i>(4), 35-44.
Stewart, A. (1996). Optimal control of cyclophosphamide-induced emesis. <i>Oncology, 53</i>(Suppl. 1), 32-38.
Uyl-de Groot, C.A., Wait, S., & Buijt, I. (2000). Economics and health-related quality of life in antiemetic therapy: Recommendations for trial design. <i>European Journal of Cancer, 36</i>, 1522-1535.