Likelihood of a subsequent chemotherapy-induced nausea and vomiting (CINV) event in patients receiving low, moderately or highly emetogenic chemotherapy (LEC/MEC/HEC)

Abstract

Objective:

To assess the likelihood of subsequent chemotherapy-induced nausea and vomiting (CINV) events following a first chemotherapy administration CINV event in patients receiving single-day low, moderately, or highly emetogenic chemotherapy (LEC, MEC, or HEC).

Methods:

A retrospective analysis was conducted utilizing Georgia Cancer Specialists, Florida Cancer Specialists, and ACORN electronic medical records databases (April 2006 through July 2009). Patients were included who received more than one single-day LEC, MEC, or HEC administration (oral or intravenous) with no chemotherapy 3 months prior to the first LEC, MEC, or HEC administration. Two cohorts, patients with a first administration CINV and no first administration CINV, were created and followed for 6 months. A multivariate logistic regression assessed the likelihood of subsequent CINV, controlling for age, gender, Charlson comorbidity index, cancer type, number of chemotherapy administrations, gap between LEC, MEC, or HEC administrations, and number of different LEC, MEC, or HEC agents administered.

Results:

A total of 10,586 patients met the inclusion criteria (LEC = 3099; MEC = 5172; HEC = 2315). Of those patients, 4.4% (n = 136), 7.8% (n = 402), and 13.8% (n = 320) experienced a CINV event with their initial single-day LEC, MEC, or HEC administration, respectively. The unadjusted subsequent CINV rate was higher in the cohorts with first LEC, MEC, or HEC administration CINV for all groups receiving LEC (33.1% vs. 16.0%; p < 0.0001), MEC (46.5% vs. 18.9%; p < 0.0001), or HEC (59.1% vs. 26.9%; p < 0.0001). After controlling for covariates, patients with first LEC, MEC, or HEC administration CINV were 3.1, 3.8, and 3.7 times more likely to have a subsequent CINV compared to patients without a first LEC, MEC, or HEC administration CINV (Odds Ratio: 3.05 [95% CI: 2.08–4.48, p < 0.0001]; 3.77 [95% CI: 3.04–4.68, p < 0.0001]; and 3.70 [95% CI: 2.88–4.74, p < 0.0001], respectively).

Conclusion:

In this retrospective analysis, patients receiving single-day LEC, MEC, or HEC who had a prior CINV were at increased risk of subsequent CINV. Further studies assessing increased risk of a subsequent CINV events are warranted given this study represents an assessment of electronic medical record data within select community-based populations under usual care.

Key words::

• Antiemetic
• Emetogenic
• Nausea
• Single-day chemotherapy
• Vomiting

Transparency

Declaration of funding

This study was funded by Eisai.

Declaration of financial/other relationships

L.S., S.S. and S.H. have disclosed that they have no relevant financial relationships. J.G. has disclosed that he serves on an Eisai speakers bureau. J.J. and G.J. have disclosed that they are employees of Xcenda, a company that received funding from Eisai to conduct this study. D.B. and S.B. have disclosed that they are employees of Eisai, Inc.

CMRO peer reviewers may receive honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

Results of this study were presented, in part, at the 2010 International Cancer Education Conference, San Diego, CA, October 25–27, 2010 and the 13th Annual International Society for Pharmacoeconomics and Outcomes Research (ISPOR) European Congress, Prague, Czech Republic, November 6–9, 2010.