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Identifying Patients at High Risk for Nausea and Vomiting After Chemotherapy: The Development of a Practical Prediction Tool: I. Acute Nausea and Vomiting
Odette Cancer Centre, Toronto, Ontario, Canada; Cross Cancer Institute, Edmonton, Alberta, Canada; and Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario, Canada
Nausea and vomiting (N&V) remain among the most feared side effects of cancer chemotherapy. In this study, the development and validation of a cycle-based prediction model for moderate to severe N&V within the first 24 hours following chemotherapy, despite the use of standard antiemetic prophylaxis, is described. To develop the initial prediction tool, 200 patients from a single cancer center were enrolled in a prospective cohort study. Clinical and outcomes data from 146 patients from our institution and from two other centers were then prospectively collected to externally validate the instrument. All patients received standard antiemetic prophylaxis that was consistent with the guidelines of the American Society of Clinical Oncology. A generalized estimating equations regression model was used to develop the initial model. Using backward elimination, we derived a risk-scoring algorithm (range 0–20) from the final reduced model. Patient age, disease site and stage, anthracycline- or platinum-based chemotherapy, low alcohol consumption, cycle number, and use of nonprescription antiemetics were identified as important predictors for moderate to severe N&V. A prechemotherapy risk score of ≥ 7 to < 9 for a given patient was identified as being the optimal cutoff to maximize both the sensitivity (78.6%) and specificity (64.8%) of the prediction tool. Patients with a score at or beyond this threshold would be considered at high risk for developing moderate to severe acute N&V in subsequent cycles. The application of this prediction tool may be an important source of risk information for practicing oncologists and may enhance patient care by optimizing preventative therapies in a proactive manner.
| J Support Oncol 2009;7:W1–W8 | full text |  225 kb |