IMPACT OF CHEMOTHERAPY-ASSOCIATED NAUSEA AND VOMITING ON PATIENTS FUNCTIONAL STATUS AND ON COSTS - SURVEY OF 5 CANADIAN CENTERS

Objective: To estimate the effect of chemotherapy-associated nausea an d emesis on patients' functional status and on costs to the health car e system, the patients and society before antagonists to the serotonin (5-hydroxytryptamine) receptor subtype 5-HT3 became available. Design : A 5-day prospective survey between February and May 1991 of patients receiving chemotherapy for cancer. Data were obtained from questionna ires completed by nurses arid patients. Setting: Five Canadian cancer treatment centres in Ontario (three) and Quebec (two). Patients: Outpa tients and inpatients 18 years of age and older who were scheduled to receive chemotherapy with a moderate to high potential for emesis as d efined by standardized criteria. Patients were excluded if they were s cheduled to receive an investigational antiemetic or had received chem otherapy within the previous 7 days. Of the 128 who were eligible, 112 agreed to participate; 107 returned the completed questionnaire, but the data for 15 were excluded because the patients received multiple-d ay chemotherapy. Main outcome measures: The degree of nausea (on a sev en-point scale) and the frequency of emesis (vomiting or retching) wer e recorded for each day of the survey. Functional status was assessed before and after chemotherapy by means of the Functional Living Index- Emesis (FLIE). The direct health care costs and the indirect costs (e. g., of time off work) associated with nausea and emesis were estimated from die survey responses and secondary data sources. Results: On the day of chemotherapy 38 of the 92 patients (41%) experienced emesis wi th or without nausea, and over the 5 days of the survey 72 patients (7 8%) reported at least one episode of nausea or emesis. The absolute ri sk of either problem decreased over time, but the risk of nausea relat ive to emesis increased over time. The FLIE scores indicated significa nt worsening of functional status after chemotherapy. On the day after treatment the main impact was from emesis, particularly with regard t o leisure activities, household tasks and hardship to the family. Naus ea had a significantly greater impact than emesis on overall functioni ng. The additional direct health care cost for managing emesis was est imated to be $63 and the indirect cost $121. Conclusions: Despite prop hylaxis with antiemetic drugs, nausea and emesis were significant prob lems in this population receiving chemotherapy. The management of emes is consumed relatively small amounts of health care resources, but the re were costs outside the hospital for patients and others.