Evaluation of risk factors predicting delayed chemotherapy-induced nausea and vomiting in patients receiving low emetic risk chemotherapy (LEC): A prospective, observational, multicenter study

Introduction: Chemotherapy-induced nausea and vomiting (CINV) are major adverse effects of cancer chemotherapy, and delayed CINV is a particular problem. The incidence of and the risk factors for delayed CINV in patients undergoing low emetic risk chemotherapy (LEC) are unclear. The aim of this study was to provide information on these topics. Methods: This prospective, observational, and multicenter study was conducted on cancer patients undergoing LEC in 13 medical practices. Between September 2013 and November 2014, 222 patients treated with LEC were enrolled in this study. The participants completed a daily patient diary for 5 days during the first cycle of LEC, describing the daily incidence of CINV (yes/no), severity of nausea (0–100 mm, visual analog scale [VAS]), and the amount of food intake (VAS). Results: A total of 210 patients were assessable. The incidence rate of delayed CINV was 21.4%. A multivariate logistic regression model for delayed CINV demonstrated that the independent risk factors were a history of nausea/vomiting (odds ratio [OR] = 3.22, 95% confidence interval [CI] 1.45–7.13, P = 0.004), Eastern Cooperative Oncology Group performance status score > 1 (OR = 2.23, 95% CI 1.04–4.78, P = 0.04), development of acute CINV (OR = 7.40, 95% CI 2.76–19.80, P < 0.0001), and single-day antiemetic prophylaxis (OR = 3.74, 95% CI 1.49–9.42, P = 0.005). An increase in the number of risk factors was significantly associated with an increased cumulative risk of treatment failure (P < 0.05). The mean VAS scores per day for the severity of nausea and food intake in patients who developed acute CINV and those receiving multiple-day antiemetic prophylaxis tended to be better than those who received single-day antiemetic prophylaxis. Conclusion: Guideline-recommended prophylaxis appeared to control delayed CINV effectively in patients undergoing LEC. However, patients with the risk factors listed above should be carefully observed and treatment should be adjusted according to their symptoms. These data can assist clinicians in making decisions about antiemetic management in the delayed phase for patients undergoing LEC.