Nausea and vomiting caused by chemotherapy that occurs 24-hours or more after treatment remains underestimated and consequently under-treated by clinicians. A new study published in the journal Cancer confirms that most physicians underestimate the incidence of delayed chemotherapy-induced nausea and vomiting (CINV) in their own patients more than one quarter of the time.

Nausea and vomiting remain some of the most feared consequences of chemotherapy. Since the 1980s with the development of new antiemetics, these symptoms are increasingly but not yet optimally controlled. In part, this is because the symptoms must first be recognized or reported before treated. The major problem with CINV is that it can occur acutely in the first 24 hours after treatment, often in an observed setting, or can appear days later, often at home without physician or nurse observation.

Dr. Steven Grunberg of the University of Vermont led a team of international investigators to assess whether 14 oncology practices worldwide accurately recognized CINV in their own practices by surveying both practices and patients.

Comparing survey results from patients and practices, physicians and nurses accurately predicted the incidence of acute CINV, but more than 75 percent of physicians and nurses underestimated the incidence of delayed CINV.

Among patients taking known highly emetic chemotherapy, clinical practices underestimated delayed nausea by 21 percent and delayed vomiting by 28 percent. Among patients taking known moderately emetic chemotherapy, practices underestimated delayed nausea by 28 percent.

The authors conclude, "an increased appreciation of the incidence and duration of delayed nausea and vomiting, both through physician/nurse education and through structured reporting by patients of their experience during chemotherapy, will be necessary to achieve optimal control of this problem using currently available tools and techniques."

SOURCE:
Cancer, May 15, 2004, published online April 12, 2004