A personalized approach to treating nausea and vomiting, the most expected side effects of chemotherapy, is far more effective than the existing one-size-fits-all guidelines. This randomized trial was published in JAMA Oncology (doi:10.1001/jamaoncol.2015.3730).
Nausea and vomiting are among the most feared side effects of chemotherapy for patients with cancer. In some cases, the symptoms can be so debilitating that patients stop treatment. To date, physicians treat these side effects by following an established set of guidelines that offer a range of antinausea medications.
“Unfortunately, these guidelines don’t take into account the personal factors that put patients at higher risk of nausea and vomiting,” said study leader Mark Clemons, MD, oncologist and associate cancer research scientist at The Ottawa Hospital and associate professor of medicine at the University of Ottawa in Ontario, Canada. His study included 324 breast cancer patients receiving chemotherapy at The Ottawa Hospital and the Irving Greenburg Cancer Centre.
The study demonstrated that when personal risk factors for chemotherapy-induced nausea and vomiting (eg, age younger 40 years, a history of pregnancy-associated morning sickness or travel sickness, or lower alcohol consumption) are considered when prescribing antiemetic medications, nausea and vomiting control was significantly improved compared with using the standard physician’s choice of antiemetics.
“This is the first time it’s been shown anywhere in the world that using personal risk factors significantly improves nausea and vomiting control,” explained Clemons. “Antinausea drugs potentially have their own side effects, and it’s very expensive for the health care system to simply give them to every patient regardless of effectiveness. We think these findings can lead to a much better, much kinder, much gentler way of treating cancer patients.”
The approach is also important because, some patients at particularly high risk still had poor control of nausea and vomiting despite optimal antiemetic prescribing. For these patients new treatment strategies need to be developed. On the other hand, patients at low risk may not require all the antinausea drugs currently recommended.
“These results are very straightforward, but they challenge the dogma of the way the guidelines are written,” Clemons said. “It’s very easy to simply follow a guideline. Now we’re suggesting that physicians just ask their patients a few key questions first.”