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Questions and Answers
What percentage of patients with cancer may be affected by CINV if left untreated?
Nausea is always accompanied by vomiting.
False
What is retching?
The labored movement of abdominal and thoracic muscles associated with vomiting without the expulsion of vomitus.
Acute onset of vomiting occurs ___ hours after chemotherapy administration.
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What is the peak time for delayed vomiting after chemotherapy administration?
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What is anticipatory vomiting?
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Which of the following is a patient-related risk factor for CINV?
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What does the emetogenicity of chemotherapy refer to?
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How is the drug dosage related to the emetogenicity of chemotherapy?
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Study Notes
Chemotherapy Induced Nausea and Vomiting (CINV)
- CINV is a common side effect of chemotherapy, affecting 60% to 80% of patients.
- CINV impacts the quality of life (QOL) of cancer patients and their families.
- Without CINV prevention and control, patients may discontinue chemotherapy, experience reduced self-care and workdays, weight loss and more.
Definition of CINV
- Nausea: Feeling of discomfort, may or may not precede vomiting.
- Retching: Labored abdominal and thoracic muscle movements associated with vomiting without the expulsion of vomitus.
- Vomiting (emesis): Ejection of gastric contents through the mouth.
Onset of Vomiting
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Acute onset: Occurs within 0-24 hours after chemotherapy administration.
- Begins 1-2 hours after IV administration and peaks 5-6 hours later.
- Resolves within 24 hours.
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Delayed onset: Occurs more than 24 hours after chemotherapy, often peaks 2-3 days later.
- Can last up to 5 days.
- May blur with consecutive days of chemotherapy.
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Anticipatory Vomiting (or Nausea): Conditioned response triggered by sights, smells or sounds.
- More likely to occur when previous CINV was poorly controlled.
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Breakthrough Emesis: Emesis despite prophylactic treatment.
- Requires additional rescue medications.
- Refractory Emesis: Emesis during treatment cycles when antiemetic prophylaxis or rescue therapy failed in previous cycles.
Risk Factors for CINV
Patient-related factors:
- Age (under 50 years)
- History of nausea or vomiting during pregnancy.
- History of motion sickness.
- Poor control of nausea or vomiting in previous chemotherapy cycles.
- History of chronic alcoholism (positive risk factor, decreases incidence of emesis).
- Female sex.
- Anxiety/high pretreatment expectation of nausea.
Chemotherapy-related factors:
-
Emetogenicity of Chemotherapy Regimen:
- Depends on the type, dosage and route of administration, as well as scheduling.
Chemotherapy Emetogenicity
- Classification includes four levels for IV and two for oral chemotherapy.
- High Emetogenicity: Greater than 90% of patients experience acute emesis if untreated
- Moderate Emetogenicity: 30% to 90% of patients experience acute emesis if untreated
- Low Emetogenicity: 10% to 30% of patients experience acute emesis if untreated.
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