1、Patient Perceptions of the Most Severe Side Effects of Cancer ChemotherapyRank 19831 19932 19953 199941. Vomiting Nausea Nausea Nausea2. Nausea Constantly tired Loss of hair Loss of hair3. Loss of hair Loss of hair Vomiting Constantly tired 4. Thought of coming for treatmentEffect on family Constant
2、ly tired Vomiting5. Length of time treatment takesVomiting Having to have an injectionChanges in the way things tasteAdapted from:1Coates A et al. Eur J Cancer Clin Oncol. 1983;19:203-8.2Griffin AM et al. Ann Oncol. 1996;7:189-95.3De Boer-Dennert M et al. Br J Cancer. 1997;76:1055-61.4 Lindley C et
3、al. Cancer Pract 1999;7:59-65.CINV Definitions n Acute within a few minutes to several hours after drug administration and commonly resolves within 24 hours.n Delayed develops in patients more than 24 hours after chemotherapy administration. n May last up to 6 daysn It commonly occurs with cisplatin
4、, carboplatin, cyclophosphamide and/or anthracyclines.n Anticipatory nausea and/or vomiting before patients receive their chemotherapy, after a prior negative experience with chemotherapyn Breakthrough occurs despite prophylactic treatment and/or requires rescue.n Refractory nausea and emesis during
5、 subsequent cycles when antiemetic prophylaxis and/or rescue have failed in earlier cyclesAdapted from:1. ASHP Am J Health Syst Pharm 1999;56:729-7642. NCCN Practice Guidelines in OncologyVersion 3. 2008. AntiemesisRates of CINVAdapted from:1. Hickok JT, et al. Cancer. 2003;97:2880-6.2.ashpadvantage
6、/previous_meetings/mcm_2005/cemornings2005/CEM_CINV_handout.pdfChemotherapyInduced Emesis Risk Factorsn Patient-related risk factors include:n Younger agen Female gendern No/minimal prior history of alcohol usen Prior CINVn Anxiety n High pretreatment expectation of severe nausea Adapted from:1.Greg
7、ory RE et al. Drugs. 1998.; 2. Hesketh PJ et al. J Clin Oncol. 1997.2.Roscoe JA, Bushunnow P, Morrow GR, et al. Patient experience is a strong predictor of severe nausea after chemotherapy: a University of Rochester Community Clinical Oncology Program study of patients with breast carcinoma. Cancer
8、2004;101:2701-2708 Influence of Patient Expectations on CINV n Expectancy of nausea assessed before patients received their first doxorubicin-based chemotherapy treatment was found to be a strong predictor of subsequent nausea.Adapted from Roscoe et al. Cancer. 2004 101(11):2701-8.ChemotherapyInduce
9、d Emesis Risk Factorsn Treatment-related risk factors include: n High drug dose n High emetogenicity of chemotherapy drugsn Of all the known predictive factors, the emetogenicity of a given chemotherapeutic agent is the predominant factor.Adapted from ASHP Am J Health Syst Pharm 1999;56:729-64.Cause
10、s of CINVIn addition to emesis induced by chemotherapy, CINV can be caused by:nPartial or complete bowel obstructionnVestibular DysfunctionnBrain MetastasesnElectrolyte imbalance: hypercalcemia, hyperglycemia, hyponatremia, uremianConcomitant drugs, including opiatesnGastroparesis induced by a tumor
11、 or chemotherapy (such as vincristine)nPsychophysiologic factors, including anxiety as well as anticipatory nausea and vomitingAdapted from NCCN Practice Guidelines in OncologyVersion 3. 2008. Antiemesis.Consequence of Unresolved CINVn Discontinuation of therapy n Serious metabolic derangementsn Nut
12、ritional depletion and anorexian Esophageal tearsn Wound dehiscencen Deterioration of patients physical and mental statusn Degeneration of self-care and functional abilityAdverse sequelae of nausea and vomiting in the cancer patient.Adapted from NCCN Practice Guidelines in OncologyVersion 3. 2008. A
13、ntiemesis.Poll of the audienceAs Health care professionals we often :A. Accurately recognize the incidence of acute and delayed CINV in our own practices.B. Underestimate the incidence of acute and delayed CINV in our own practices.Anti Nausea Chemotherapy Registry (ANCHOR) study n The authors determined the incidence of acute and delayed CINV after modern antiemetics.n Then they compared the actual incidences of CINV to the predictions made by physicians and nurses regarding these patients.Adapted from Grunberg SM et al. Cancer 2004;100:2261-8.
