DETERMINANTS OF POSTCHEMOTHERAPY NAUSEA AND VOMITING IN PATIENTS WITHCANCER

Purpose: To assess whether prechemotherapy health-related quality-of-l ife (HQL) variables are associated with postchemotherapy nausea and vo miting (PCNV), and to determine their relationship to patient and trea tment variables. Patients and Methods: Eight hundred thirty-two chemot herapy-naive patients scheduled to receive antiemetic regimens contain ing a 5-hydroxytryplamine (5-HT3) antagonist with or without dexametha sone for moderately or highly emetogenic chemotherapy were enrolled. H QL was measured by the self-report European Organization for Research and Treatment of Cancer (EORTC) Care Quality of Life Questionnaire (QL Q-C30) within 7 days before chemotherapy. Prechemotherapy HQL scores, as well as other patient, disease, and treatment variables were compar ed in the groups of patients who had PCNV and chose who did nor have P CNV. All variables were assessed initially in ct univariate analysis a nd then together in a multivariate analysis using stepwise logistic re gression, The final model generated by the multivariate analyses was u sed in a risk factor analysis to predict PCNV. Results: Univariate ana lyses identified 10 HQL variables and five patient and treatment chara cteristics that were associated with PCNV, In the multivariate analysi s, the variables remaining in the final model included low social func tioning, prechemotherapy nausea, female gender, highly emetogenic chem otherapy, and the lack of maintenance antiemetics (5-HT3 antagonists w ith or without dexamethasone) after chemotherapy, A history of low alc ohol use was also associated with PCV, whereas increased fatigue and l ower performance status were associated with PCN, In the risk factor a nalysis, the incidence of PCV increased from 20% in those having no ri sk factors to 76% in those having any four of the six risk factors. Co nclusion: Several pretreatment HQL, patient, and treatment characteris tics are associated with the occurrence of PCNV. Patients about to rec eive moderately or highly emetogenic chemotherapy should be screened f or these factors and additional measures, such as behavior modificatio n and modification of antiemetic therapy, should be considered in atte mpts to improve the control of PCNV. (C) 1997 by American Society of C linical