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OBJECTIVE：To explore t he risk factors that may lead to the ineff ectiveness of using palonosetron combined with dexamethasone to prevent chemotherapy-induced nausea and vomiting （CINV），and to provide a reference for the rational choice and use of antiemetic drugs. METHODS ：In a retrospective case-control study ，871 patients who used palonosetron combined with dexamethasone to prevent CINV in a tertiary cancer hospital from 2016 to 2020 were selected as the object. Totally 32 related data such as demographic data ，living habits ，medical history ，examination information and treatment information were counted as variables. Combined with single factor regression ，multi-factor regression， likelihood ratio forward or backward stepwise 163.com regression were used to comprehensively screen the factors for many times. The standard target factors screened by stepwise E-mail：kongtiandong@126.com regression were included in the multivariate Logistic regression analysis，and the regression model was evaluated by the ROC c urve. RESULTS ：The multivariate Logistic regression model fitted well（AUC in ROC was 0.83，but 0.82 after screening ）. The results showed that there were 15 statistically significant independent influential factors ，including 12 independent risk factors ，ie. poor nutritional status （OR＝2.11，95％CI（1.05，4.22），P＝0.036）， history of gastrointestinal disease （OR＝2.76，95％CI（1.87，4.07），P＜0.001），abnormal electrolyte level （OR＝2.54，95％CI （1.74，3.69），P＜0.001），nausea and vomiting 24 h before chemotherapy （OR＝8.47，95％CI（3.28，21.91），P＜0.001），history of chemotherapy-induced vomiting （OR＝3.20，95％ CI （2.18，4.71），P＜0.001），high risk level of vomiting caused by chemotherapy（OR＝3.16，95％CI（2.38，4.20），P＜0.001），application of opioid combined with non-steroidal analgesics （OR＝ 4.18，95％CI（2.06，8.49），P＜0.001），the use of other drugs that stimulate the intestine and stomach （OR＝2.49，95％CI（1.28， 4.83），P＝0.007），history of surgery （OR＝1.88，95％CI（1.34，2.63），P＜0.001），high level of albumin （OR＝1.05，95％CI （1.01，1.08），P＝0.015），multiple days of single chemotherapy （OR＝1.69，95％CI（1.11，2.56），P＝0.014），and opioid analgesia medicine （OR＝1.71，95％CI（1.15，2.53），P＝0.007）；and the following 3 independent protective factors included long time of diagnosis （OR＝0.65，95％CI（0.46，0.93），P＝0.019），non-first chemotherapy （OR＝0.52，95％CI（0.33，0.83），P＝ 0.006），and drugs combined chemotherapy （OR＝0.55，95％CI（0.34，0.90），P＝0.018）. CONCLUSIONS ：Patients with the following conditions are more likely to experience CINV prevention ineffectiveness ，ie. single long-term chemotherapy ，application of chemotherapy plan with a higher risk of emesis ，history of chemotherapy-induced vomiting ，history of gastrointestinal diseases ， nausea and vomiting 24 hours prior to chemotherapy ，history of surgery ，within 1 year of diagnosis ，chemotherapy for the first time，use of opioids ，use of 5-HT3 reuptake inhibitors ，malnutrition and electrolyte disorders.
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Background: Chemotherapy induced nausea and vomiting (CINV) remains one of the most common and debilitating complications of highly emetogenic chemotherapy (HEC). This study was undertaken to evaluate palanosetron against other 5-HT3 receptor antagonists in preventing delayed CINV with the aim of achieving complete response (CR) and improving quality of life (QoL).Methods: This was a prospective, observational study conducted on 75 histopathologically proven patients of squamous cell carcinoma of Head and Neck (H&N), who came to the Department of Radiation Oncology, Gandhi Medical College and Hamidia Hospital, Bhopal from January to December 2015. Standard protocol based chemotherapy containing highly emetogenic cisplatin based chemotherapy was administered to all the patients. For prevention of delayed chemotherapy induced nausea and vomiting all patients were prescribed oral 5-HT3 antagonists. Oral Ondansetron 4mg TDS was given to cohort 1, oral Granisetron 1 mg BD to cohort2 and oral Palanosetron 0.5mg OD was given to cohort 3. They were graded as complete response when they did not have complains of nausea and vomiting.Results: In Ondansetron, Granisetron and in Palanosetron cohort 29%, 53% and 98% patients had complete response.Conclusions: Palanosetron appears superior. Our study was conducted on handfull of patients and compared palanosetron against only two 5-HT3 receptor antagonists, so a larger study is suggested to establish the efficacy and better response of palanosetron.
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BACKGROUND@#Chemotherapy is the most important method for cancer treatment. However, chemotherapy induced nausea and vomiting (CINV) has a profound effect on patients. In recent years, there have been new antiemetic drugs, such as aprepitant. We review the curative effect of aprepitant with tropisetron and dexamethasone for prevention of nausea and vomiting in patients receiving Cisplatin chemotherapy.@*METHODS@#Observation is divided into three stages. Whole study phase (0-120 h after chemotherapy administration), acute phases (0-24 h), and delayed phase (24 h-120 h). The primary endpoints were complete response (CR) and complete prevention (CP) during the three different study phase.@*RESULTS@#In the whole study phase, 86.02% of patients achieved CR; in acute phases and delayed phases were 89.25%, 87.1%, respectively. CP were 46.22%, 83.87%, 45.16%, respectively. Anti-CINV effect was significantly associated with age distribution (P=0.008).@*CONCLUSIONS@#Aprepitant with tropisetron and dexamethasone prevented effectively CNIV for patients receiving Cisplatin chemotherapy. This combination could improve the quality of life and the compliance of patient with chemotherapy.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antineoplastic Agents , Aprepitant , Cisplatin , Morpholines , Pharmacology , Nausea , Quality of Life , VomitingABSTRACT
OBJECTIVE: To investigate the application of antiemetics in patients with gynecological cancers during chemotherapy. METHODS: Medical records of 182 patients receiving chemotherapy lor gynecological cancer were evaluated and a descriptive a-nalysis was carried out.Logistic regression was performed to determine the predictors of compliance. RESULTS: The rate of adherence to guideline (CINV) for patients receiving one-day chemotherapy is 80%. prophylactic usage rate in patients receiving multi-days chemotherapy is 95%, with a 47% 5-HT3 receptor antagonist.The adherence to NCCN anti-emesis guideline was better in patients having paclitaxel-based chemotherapy than patients having no paclitaxel. CONCLUSION: As the biggest cancer hospital in China, antiemetics were commonly given as prevention of CINV in the form of 5-HT3 receptor antagonist, but antiemetic effect of dexametha-sone was ignored and needed to be emphasized.
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Chemotherapy is the first line treatment in management of many cancers, both for cure and palliation; hence it’s crucial to minimize the unpleasant side effects of chemotherapy to increase tolerability to chemotherapy. Most of the conventional anti cancer drugs are emetogenic. Patients receiving chemotherapy experience different degrees of nausea and vomiting depending on the emetogenic potential of the anti cancer drugs given and the patient characteristics. With a better understanding of the pathophysiology, distinct phases of chemotherapy-induced nausea and vomiting (CINV) i.e., acute emesis, delayed emesis and anticipatory emesis have been identified. Identification of various mediators has led to the development of different drugs acting through different mechanisms which are useful in the prevention and treatment of CINV. Serotonin receptor three (5-HT3) antagonists, corticosteroids and neurokinin type one receptor (NK-1) antagonists are of proven usefulness and have wide therapeutic indexes in the prevention of CINV. Other drugs like dopamine receptor antagonists & benzodiazepines are not routinely used because of their narrow therapeutic index. Practice guidelines for prevention of CINV will not only improve patient’s tolerability to chemotherapy & wellbeing, but also decrease hospital stay and overall cost of treatment of the patient.
ABSTRACT
Chemotherapy is the first line treatment in management of many cancers, both for cure and palliation; hence it’s crucial to minimize the unpleasant side effects of chemotherapy to increase tolerability to chemotherapy. Most of the conventional anti cancer drugs are emetogenic. Patients receiving chemotherapy experience different degrees of nausea and vomiting depending on the emetogenic potential of the anti cancer drugs given and the patient characteristics. With a better understanding of the pathophysiology, distinct phases of chemotherapy-induced nausea and vomiting (CINV) i.e., acute emesis, delayed emesis and anticipatory emesis have been identified. Identification of various mediators has led to the development of different drugs acting through different mechanisms which are useful in the prevention and treatment of CINV. Serotonin receptor three (5-HT3) antagonists, corticosteroids and neurokinin type one receptor (NK-1) antagonists are of proven usefulness and have wide therapeutic indexes in the prevention of CINV. Other drugs like dopamine receptor antagonists & benzodiazepines are not routinely used because of their narrow therapeutic index. Practice guidelines for prevention of CINV will not only improve patient’s tolerability to chemotherapy & wellbeing, but also decrease hospital stay and overall cost of treatment of the patient.
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Objective: Despite the availability of modern anti-emetics, chemotherapy-induced nausea and vomiting (CINV) symptoms remain distressing to a high number of cancer patients. This study intended to (1) describe the incidence of CINV and antiemetic usage; (2) assess the health-related quality of life (HRQoL) and correlate its components with Global Health Status; (3) evaluate HRQoL status in relation to CINV among breast cancer patients receiving chemotherapy. Methods: A cross sectional study was conducted in two government hospitals located in the East Coast of Peninsular Malaysia (Terengganu, Kelantan). The Morrow Assessment of Nausea and Emesis Follow-up (MANE-FU) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were administered. Descriptive statistics and non-parametric tests were employed (SPSS 16). Results: Respondents included 41 female patients (age = 49 ± 9.6 years; Malay = 92.7%; no family history of breast cancer = 68.3% and on moderately emetogenic chemotherapy = 97.6%). Majority of patients experienced nausea during or after chemotherapy (90.2%) and rated it as ‘severe’. Most patients had taken anti-emetic (87.8%) and considered it ‘somewhat useful’. The median score for Global Health Status was 50 (IqR= 16.7). Emotional Functioning, Fatigue and Pain correlated fairly with HRQoL (rs= +0.435; -0.417; -0.387 respectively). Patients with ‘a lot’ and ‘moderate’ nausea displayed significantly more fatigue compared to those with little nausea (p=0.029). Those who experienced vomiting reported worse HRQoL profile compared to those who did not (p=0.011). Conclusion: These findings generally ascertained that CINV remains poorly controlled and significantly interferes with HRQoL, providing rooms for improvements in therapeutic intervention.
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OBJECTIVE: We compared the impact of chemotherapy-induced nausea and vomiting (CINV) on patients of an aprepitant regimen with an ondansetron regimen, for antiemetic efficacy after highly emetogenic chemotherapy (HEC). METHODS: The study was performed prospective on 61 patients who is diagnosed initially the gynecological cancer during chemotherapy at Gospel hospital of Kosin university between March 2007 and October 2007. The study was divided according to an aprepitant/ondansetron regimen. The efficacy of controlling acute (during the 24 hours after chemotherapy) /delayed (day 2 days thought 5) nausea, vomiting and adverse effects were compared. Statistical analysis was performed using the chi-square test. RESULTS: The efficacy of controlling nausea with an aprepitant regimen and an ondansetron regimen was 86.7%, 83.9% in acute periods (Pvalue= 0.742) and 99%, 83.9% in delayed periods (P-value=0.083), respectively. The efficacy of controlling vomiting with an aprepitant regimen and an ondansetron regimen was 93.3%, 90.3% in acute periods (P-value=0.809) and 96.7%, 83.9% in delayed periods (Pvalue= 0.034), respectively. The efficacy of controlling delayed vomiting with an aprepitant regimen reported significantly. The common adverse effects in both groups were not significantly. CONCLUSION: The regimen including aprepitant was superior in preventing CINV as compared with a regimen in which both ondansetron and dexamethasone were given delayed periods in patients receiving chemotherapy
Subject(s)
Humans , Dexamethasone , Morpholines , Nausea , Ondansetron , Prospective Studies , VomitingABSTRACT
OBJECTIVE: We compared the impact of chemotherapy-induced nausea and vomiting (CINV) on patients of an aprepitant regimen with an ondansetron regimen, for antiemetic efficacy after highly emetogenic chemotherapy (HEC). METHODS: The study was performed prospective on 61 patients who is diagnosed initially the gynecological cancer during chemotherapy at Gospel hospital of Kosin university between March 2007 and October 2007. The study was divided according to an aprepitant/ondansetron regimen. The efficacy of controlling acute (during the 24 hours after chemotherapy) /delayed (day 2 days thought 5) nausea, vomiting and adverse effects were compared. Statistical analysis was performed using the chi-square test. RESULTS: The efficacy of controlling nausea with an aprepitant regimen and an ondansetron regimen was 86.7%, 83.9% in acute periods (Pvalue= 0.742) and 99%, 83.9% in delayed periods (P-value=0.083), respectively. The efficacy of controlling vomiting with an aprepitant regimen and an ondansetron regimen was 93.3%, 90.3% in acute periods (P-value=0.809) and 96.7%, 83.9% in delayed periods (Pvalue= 0.034), respectively. The efficacy of controlling delayed vomiting with an aprepitant regimen reported significantly. The common adverse effects in both groups were not significantly. CONCLUSION: The regimen including aprepitant was superior in preventing CINV as compared with a regimen in which both ondansetron and dexamethasone were given delayed periods in patients receiving chemotherapy