Identifying Patients at High Risk for Nausea and Vomiting After Chemotherapy: The Development of a Practical Validated Prediction Tool: II. Delayed Nausea and Vomiting

Teresa Petrella, MD, MSc, Mark Clemons, MD, Anil Joy, MD, Scott Young, MD, Walter Callaghan, BSC, and George Dranitsaris, BPharm, MS

Odette Cancer Centre, Toronto, Ontario, Canada; Cross Cancer Institute, Edmonton, Alberta, Canada; and Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario, Canada

The aim of this multicenter prospective cohort study was to develop and validate a prediction tool for moderate to severe delayed (days 2 to 5) nausea/vomiting (N&V) after chemotherapy. To develop the initial prediction tool, 200 patients from a single center were enrolled. Clinical, patient, and outcomes data associated with delayed N&V were collected. An additional 146 patients from three cancer centers were prospectively enrolled 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 multivariate regression model was used to develop the initial model. Using backward elimination, we derived a riskscoring algorithm (range 0–62) from the final reduced model. On multivariate analysis, eight predictive factors were identified and validated for delayed N&V: age, type of antiemetic used, prior N&V, a history of morning sickness during pregnancy, chemotherapy cycle, acute N&V, hours of sleep the night before chemotherapy, and use of nonprescription antiemetics. Risk scores of 16–20 were identified as the cutoff scores to maximize the sensitivity (72.0%) and specificity (64.4%) of the prediction tool. The instrument had good predictive accuracy when applied to the validation sample. To our knowledge, this is the first such tool to be developed and validated for the prediction of delayed chemotherapyinduced N&V in patients with different types of solid tumors. This tool may be used to identify a priori patients at high risk for chemotherapyinduced N&V and allow optimization of their antiemetic therapy.

J Support Oncol 2009;7:W9–W16   print e-mail full text 224 kb