Vol. 47 No. 5 May 2014
Journal of Pain and Symptom Management
827
Promoting Evidence in Practice Series Editor: Sydney M. Dy, MD, MS
Important Clinical Findings for Chemotherapy-Induced Nausea and Vomiting: Commentary on Molassiotis et al. Lucas Vieira dos Santos, MD, and Jo~ao Paulo Lima, MD, PhD Instituto de Ensino e Pesquisa S~ a o Lucas (L.V.d.S.); and Hemomed Instituto de Oncologia e Hematologia (L.V.d.S.), S~ a o Paulo; and Clinical Research Unit (J.P.L.), Barretos Cancer Hospital, Barretos, Brazil
In this issue, Molassiotis et al.1 report the predictors of chemotherapy-induced nausea and vomiting (CINV) in the largest prospective observational study to date. The impact of Multinational Association of Supportive Care in Cancer (MASCC) guideline compliance on CINV has been reported in a previous publication using the same data set.2 This well-conducted study found that female gender was not a key predictor of CINV. Three other predictors of CINV emerged and must be appraised by every physician involved in cancer care. Complete response in the first cycle of chemotherapy, as defined by the study, was a determinant factor for CINV in the following cycles. This suggests that complete response in the first cycle of chemotherapy may be a more important clinical goal. Second, factors related to the patients themselves, such as anticipatory nausea and prechemotherapy anxiety, were demonstrated for the first time in a prospective study to be important risk factors for CINV. This illustrates a possible role of behavioral and symptomatic therapy during treatment planning and before the start of chemotherapy.
Address correspondence to: Lucas Vieira dos Santos, MD, Hemomed Instituto de Oncologia e Hematologia, Av. Arnolfo de Azevedo, 108, 01236-030 S~ao Paulo-SP, Brazil. E-mail: [email protected] Ó 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
However, the most striking and important finding is the use of primary antiemetics beyond MASCC guidelines. The upfront start of drugs commonly used as rescue therapy may improve CINV control if added to the standard prophylactic regimen. The understanding of CINV risk factors is a key condition for adequate patient care in oncology. This study identifies some windows of opportunity for new interventional studies on CINV, which remains, despite recent advances, a significant issue for many patients.
References 1. Molassiotis A, Aapro M, Dicato M, et al. Evaluation of risk factors predicting chemotherapyrelated nausea and vomiting: results from a European prospective observational study. J Pain Symptom Manage 2013;47:839e848. 2. Aapro M, Molassiotis A, Dicato M, et al. The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER). Ann Oncol 2012;23:1986e1992.
Accepted for publication: October 3, 2013.
0885-3924/$ - see front matter http://dx.doi.org/10.1016/j.jpainsymman.2013.10.001
Journal of Pain and Symptom Management
827
Promoting Evidence in Practice Series Editor: Sydney M. Dy, MD, MS
Important Clinical Findings for Chemotherapy-Induced Nausea and Vomiting: Commentary on Molassiotis et al. Lucas Vieira dos Santos, MD, and Jo~ao Paulo Lima, MD, PhD Instituto de Ensino e Pesquisa S~ a o Lucas (L.V.d.S.); and Hemomed Instituto de Oncologia e Hematologia (L.V.d.S.), S~ a o Paulo; and Clinical Research Unit (J.P.L.), Barretos Cancer Hospital, Barretos, Brazil
In this issue, Molassiotis et al.1 report the predictors of chemotherapy-induced nausea and vomiting (CINV) in the largest prospective observational study to date. The impact of Multinational Association of Supportive Care in Cancer (MASCC) guideline compliance on CINV has been reported in a previous publication using the same data set.2 This well-conducted study found that female gender was not a key predictor of CINV. Three other predictors of CINV emerged and must be appraised by every physician involved in cancer care. Complete response in the first cycle of chemotherapy, as defined by the study, was a determinant factor for CINV in the following cycles. This suggests that complete response in the first cycle of chemotherapy may be a more important clinical goal. Second, factors related to the patients themselves, such as anticipatory nausea and prechemotherapy anxiety, were demonstrated for the first time in a prospective study to be important risk factors for CINV. This illustrates a possible role of behavioral and symptomatic therapy during treatment planning and before the start of chemotherapy.
Address correspondence to: Lucas Vieira dos Santos, MD, Hemomed Instituto de Oncologia e Hematologia, Av. Arnolfo de Azevedo, 108, 01236-030 S~ao Paulo-SP, Brazil. E-mail: [email protected] Ó 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
However, the most striking and important finding is the use of primary antiemetics beyond MASCC guidelines. The upfront start of drugs commonly used as rescue therapy may improve CINV control if added to the standard prophylactic regimen. The understanding of CINV risk factors is a key condition for adequate patient care in oncology. This study identifies some windows of opportunity for new interventional studies on CINV, which remains, despite recent advances, a significant issue for many patients.
References 1. Molassiotis A, Aapro M, Dicato M, et al. Evaluation of risk factors predicting chemotherapyrelated nausea and vomiting: results from a European prospective observational study. J Pain Symptom Manage 2013;47:839e848. 2. Aapro M, Molassiotis A, Dicato M, et al. The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER). Ann Oncol 2012;23:1986e1992.
Accepted for publication: October 3, 2013.
0885-3924/$ - see front matter http://dx.doi.org/10.1016/j.jpainsymman.2013.10.001
