Objective:This review aimed to map and summarize published studies that tested non-pharmacological management for chemotherapyinduced nausea and vomiting(CINV).Methods:We searched for eligible studies in 5 electronic ...Objective:This review aimed to map and summarize published studies that tested non-pharmacological management for chemotherapyinduced nausea and vomiting(CINV).Methods:We searched for eligible studies in 5 electronic databases and screened the retrieved studies using the inclusion and exclusion criteria.Data were then collated according to the types of interventions,measurement tool,and outcomes.Results:The search yielded 2343 records,of which 11 were included.Four categories of non-pharmacological CINV management were made;manipulative and body-based therapy(n=5 studies);mind–body therapy(n=3 studies);biologically based practice(n=1 study),and energy therapy(n=2 studies).Seven different scales were used to measure CINV.Nine studies repor ted improvement in CINV.Conclusions:This scoping review demonstrates the breadth of non-pharmacological management to address CINV.Various types of CINV scales were used to measure CINV severity.The management and scale can be utilized to improve nursing care,par ticularly in cancer care.展开更多
Background: Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting(CINV) at a national level in China or to assess how treatment regimens adhere to current gui...Background: Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting(CINV) at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods: We searched the China Health Insurance Research Association(CHIRA) Database to identify patients with cancer who were ≥18 years old and received either moderately or highly emetogenic chemotherapy(MEC and HEC, respectively) between 2008 and 2012. Patients' characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results: Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC(59.4% vs. 81.3%; P<0.001). The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group(P≤0.012); however, a higher proportion received a mixed regimen containing corticosteroids(P≤0.007). Although more than half of the patients in the HEC group took three antiemetics to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group(both P<0.001). Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions: These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.展开更多
Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinica...Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinical studies on NK1-RAs have shown mixed results in reducing CINV risk. Most studies focused on the use of aprepitant (APR) and casopitant (CAS) in breast cancer patients receiving AC-type (doxorubicin and cyclophosphamide) chemotherapy. In this study, we compared the study design and clinical efficacies of these NK1-RAs in reducing CINV risk. Among the selected eight studies, 4 APR Randomized Controlled Trials (RCTs), 2 APR Observational Studies (OSs) and 2 CAS RCTs were identified. Patient-related characteristics such as the proportion of females (60.0% - 100.0%), age (46.5 - 59.5 years), histories of motion (5.6% - 47.0% in NK1-RA arms) and morning sicknesses (14.2% - 45.0% in NK1-RA arms) and types of antiemetic regimens;as well as chemotherapy-related characteristics such as the proportion of patients on AC chemotherapy (15.0% - 100.0%) varied greatly. In terms of efficacies, both APR and CAS improved overall CR and vomiting in majority of the studies. None of the studies, however, demonstrated that NK1-RA could provide adequate nausea control. To conclude, NK1-RAs are effective in improving vomiting and overall CR, but not useful in controlling nausea or attaining CC, the ideal CINV endpoint. A shift in paradigm is needed for future CINV research. As healthcare providers continue to strive for optimum CINV control in their patients, we hope this review can help them make better informed clinical decisions.展开更多
Background:Highly emetogenic chemotherapy induces emesis in cancer patients without prophylaxis.The purpose of this study was to evaluate the efficacy and safety of a fosaprepitant-based triple antiemetic regimen for ...Background:Highly emetogenic chemotherapy induces emesis in cancer patients without prophylaxis.The purpose of this study was to evaluate the efficacy and safety of a fosaprepitant-based triple antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting(CINV)in patients with solid malignant tumors,determine risk factors and externally validate different personalized risk models for CINV.Methods:This phase III trial was designed to test the non-inferiority of fosaprepitant toward aprepitant in cancer patients who were to receive the first cycle of single-day cisplatin chemotherapy.The primary endpoint was complete response(CR)during the overall phase(OP)with a non-inferiority margin of 10.0%.Logistic regression modelswere used to assess the risk factors ofCRand no nausea.To validate the personalized risk models,the accuracy of the risk scoring systems was determined by measuring the specificity,sensitivity and area under the receiver operating characteristic(ROC)curve(AUC),while the predictive accuracy of the nomogram was measured using concordance index(C-index).Results:A total of 720 patients were randomly assigned.CR during the OP in the fosaprepitant group was not inferior to that in the aprepitant group(78.1%vs.77.7%,P=0.765)with a between-group difference of 0.4%(95%CI,-5.7%to 6.6%).Female sex,higher cisplatin dose(≥70 mg/m2),no history of drinking and larger body surface area(BSA)were significantly associated with nausea.The AUC for the acute and delayed CINV risk indexes was 0.68(95%CI:0.66-0.71)and 0.66(95%CI:0.61-0.70),respectively,and the C-index for nomogram CINV prediction was 0.59(95%CI,0.54-0.64).Using appropriate cutoff points,the three models could stratify patients with high-or low-risk CINV.No nausea and CR rate were significantly higher in the low-risk group than in the high-risk group(P<0.001).Conclusions:Fosaprepitant-based triple prophylaxis demonstrated non-inferior control for preventing CINV in patients treated with cisplatin-base chemotherapy.Female cancer patients without a history of alcohol consumption,with larger BSA and received high-dose cisplatin might be more vulnerable to CINV.Three personalized prediction models were well-validated and could be used to optimize antiemetic therapy for individual patients.展开更多
BACKGROUND Few relevant literature reports on applying acupoint press-needle embedding combined with emotional nursing in patients with a gynecological malignant tumor.AIM To explore the effect of traditional Chinese ...BACKGROUND Few relevant literature reports on applying acupoint press-needle embedding combined with emotional nursing in patients with a gynecological malignant tumor.AIM To explore the effect of traditional Chinese medicine acupoint needle embedding combined with emotional nursing on chemotherapy-related nausea and vomiting(CINV),cancer-related fatigue(CRF)and psychological state in patients with gynecological malignant tumors.METHODS Retrospective analysis of the clinical information of 84 patients with gynecological malignant tumors treated in our hospital from August 2020 to December 2022 Led to the development of an observation group(n=42)and a control group(n=42)based on various nursing approaches.Ondansetron hydrochloride injection was administered to the individuals in the control group.However,the observation group received emotional nursing based on the control group and acupoint pressneedle embedding of traditional Chinese medicine.Patients in both groups received the chemotherapy regimen of paclitaxel liposome+carbo-platin/cisplatin.For four weeks,both groups intervened.The CINV grade,quality of life,CRF,psychological status and sleep quality scores of the two groups before and RESULTS After intervention,the degree of CINV in the observation group was significantly better than that in the control group.After intervention,the scores of each dimension and total score of FLIE scale were significantly higher than those in the control group.After intervention,the scores of each dimension and total score of Piper Fatigue Scale were significantly lower than those in the control group(P<0.05).After intervention,the scores of avoidance and yield dimensions in the observation group were significantly lower than those in the control group,and the scores of confrontation dimension were significantly higher than those in the control group(P<0.05).After intervention,the sleep quality score of the observation group was significantly lower than that of the control group,and the Karnofsky Performance Status scale score was significantly higher than that of the control group(P<0.05).CONCLUSION The acupuncture point needle embedding of traditional Chinese medicine combined with emotional nursing can further reduce the incidence of chemotherapy-related nausea and vomiting in patients with gynecological malignant tumors,improve the quality of life and the degree of CRF,alleviate the bad psychological state,adopt a positive way to face the disease and treatment,and improve the quality of sleep and quality of life.展开更多
目的观察顺铂（Cisplatin，DDP）单次大剂量给药和分次小剂量给药方案引起的化疗所致恶心呕吐（chemotherapy-induced nausea and vomiting，CINV）和对患者生活功能的影响。方法2011年10月-2012年6月间对武汉同济医院肿瘤中心行含DDP...目的观察顺铂（Cisplatin，DDP）单次大剂量给药和分次小剂量给药方案引起的化疗所致恶心呕吐（chemotherapy-induced nausea and vomiting，CINV）和对患者生活功能的影响。方法2011年10月-2012年6月间对武汉同济医院肿瘤中心行含DDP联合化疗方案的101例患者进行问卷调查，根据DDP给药方案，分为两组，A组：DDP75mg／m^2，静脉滴注，d1；B组：DDP25mg／m2，静脉滴注，d1～3。化疗第2天和第6天分别记录CINV事件，并于第6天填写呕吐生活功能指数（functional living indexemesis，FLIE）。结果单次给药组急性期恶心、呕吐缓解率和延迟期恶心、呕吐缓解率依次为69．4％、77．6％、32．7％、55．1％；分次给药组依次为88．5％、92．3％、34．6％、71．2％。对以上指标进行χ^2检验，急性CINV缓解率差异均有统计学意义，延迟性CINV缓解率差异无统计学意义。两组患者生活功能受到CINV负面影响的比例分别为46．9％和28．8％，χ^2检验显示差异无统计学意义。结论与DDP单次给药相比，分次给药能够减轻急性CINV，但是对于延迟性CINV和整个化疗过程CINV对患者生活功能的影响，两种给药方式无明显差别。展开更多
目的评估奥氮平联合托烷司琼及地塞米松三联方案对接受中危致吐方案同时具有高危致吐风险因素的胃肠道肿瘤患者的止吐效果。方法选取2017年9月至2018年9月在北京大学深圳医院肿瘤内科接受化疗的胃肠道肿瘤53例患者为研究对象,所有患者...目的评估奥氮平联合托烷司琼及地塞米松三联方案对接受中危致吐方案同时具有高危致吐风险因素的胃肠道肿瘤患者的止吐效果。方法选取2017年9月至2018年9月在北京大学深圳医院肿瘤内科接受化疗的胃肠道肿瘤53例患者为研究对象,所有患者均接受mFOLFOX6或FOLFIRI方案化疗,观察组接受奥氮平、托烷司琼及地塞米松三联止吐方案预防化疗引起的恶心呕吐(chemotherapy-induced nausea and vomiting,CINV),对照组接受托烷司琼及地塞米松两联止吐方案。比较两者CINV完全缓解率、控制率、对生活质量影响及不良反应。结果奥氮平组在急性期、延迟期及全期完全缓解率均明显高于对照组(88.9%∶69.2%,P=0.078;74.1%∶42.3%,P=0.019;61.5%∶38.5%,P=0.020)。奥氮平组全期无明显恶心患者比例有优于对照组的趋势(70.4%∶30.8%,P=0.075),奥氮平组FLI-E评分更高,生活质量更好。2组最常见不良反应为便秘(66.7%∶61.5%,P=0.697),奥氮平组较对照组有更高的嗜睡(59.3%∶19.2%,P=0.003)、头晕(44.4%∶23.1%,P=0.101)等不良反应的发生,失眠方面,奥氮平组发生率较低(18.5%∶46.2%,P=0.031)。结论本研究首次证实了在接受MEC方案(FOLFOX6/FOLFIRI)化疗同时合并高危致吐风险因素的消化道肿瘤患者中,奥氮平联合5-羟色胺3受体拮抗剂及地塞米松,较好地控制了CINV,特别是对于延迟期及恶心的控制明显优于对照组,提高了患者生活质量。展开更多
基金supported by the Institute of Research and Innovation of Universitas Muhammadiyah Yogyakarta(No.034/PEN-LP3M/II/2021)。
文摘Objective:This review aimed to map and summarize published studies that tested non-pharmacological management for chemotherapyinduced nausea and vomiting(CINV).Methods:We searched for eligible studies in 5 electronic databases and screened the retrieved studies using the inclusion and exclusion criteria.Data were then collated according to the types of interventions,measurement tool,and outcomes.Results:The search yielded 2343 records,of which 11 were included.Four categories of non-pharmacological CINV management were made;manipulative and body-based therapy(n=5 studies);mind–body therapy(n=3 studies);biologically based practice(n=1 study),and energy therapy(n=2 studies).Seven different scales were used to measure CINV.Nine studies repor ted improvement in CINV.Conclusions:This scoping review demonstrates the breadth of non-pharmacological management to address CINV.Various types of CINV scales were used to measure CINV severity.The management and scale can be utilized to improve nursing care,par ticularly in cancer care.
基金supported by MSD Holding Co.,Ltd.The funding was only for the payment of using CHIRA database
文摘Background: Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting(CINV) at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods: We searched the China Health Insurance Research Association(CHIRA) Database to identify patients with cancer who were ≥18 years old and received either moderately or highly emetogenic chemotherapy(MEC and HEC, respectively) between 2008 and 2012. Patients' characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results: Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC(59.4% vs. 81.3%; P<0.001). The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group(P≤0.012); however, a higher proportion received a mixed regimen containing corticosteroids(P≤0.007). Although more than half of the patients in the HEC group took three antiemetics to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group(both P<0.001). Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions: These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.
文摘Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinical studies on NK1-RAs have shown mixed results in reducing CINV risk. Most studies focused on the use of aprepitant (APR) and casopitant (CAS) in breast cancer patients receiving AC-type (doxorubicin and cyclophosphamide) chemotherapy. In this study, we compared the study design and clinical efficacies of these NK1-RAs in reducing CINV risk. Among the selected eight studies, 4 APR Randomized Controlled Trials (RCTs), 2 APR Observational Studies (OSs) and 2 CAS RCTs were identified. Patient-related characteristics such as the proportion of females (60.0% - 100.0%), age (46.5 - 59.5 years), histories of motion (5.6% - 47.0% in NK1-RA arms) and morning sicknesses (14.2% - 45.0% in NK1-RA arms) and types of antiemetic regimens;as well as chemotherapy-related characteristics such as the proportion of patients on AC chemotherapy (15.0% - 100.0%) varied greatly. In terms of efficacies, both APR and CAS improved overall CR and vomiting in majority of the studies. None of the studies, however, demonstrated that NK1-RA could provide adequate nausea control. To conclude, NK1-RAs are effective in improving vomiting and overall CR, but not useful in controlling nausea or attaining CC, the ideal CINV endpoint. A shift in paradigm is needed for future CINV research. As healthcare providers continue to strive for optimum CINV control in their patients, we hope this review can help them make better informed clinical decisions.
文摘Background:Highly emetogenic chemotherapy induces emesis in cancer patients without prophylaxis.The purpose of this study was to evaluate the efficacy and safety of a fosaprepitant-based triple antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting(CINV)in patients with solid malignant tumors,determine risk factors and externally validate different personalized risk models for CINV.Methods:This phase III trial was designed to test the non-inferiority of fosaprepitant toward aprepitant in cancer patients who were to receive the first cycle of single-day cisplatin chemotherapy.The primary endpoint was complete response(CR)during the overall phase(OP)with a non-inferiority margin of 10.0%.Logistic regression modelswere used to assess the risk factors ofCRand no nausea.To validate the personalized risk models,the accuracy of the risk scoring systems was determined by measuring the specificity,sensitivity and area under the receiver operating characteristic(ROC)curve(AUC),while the predictive accuracy of the nomogram was measured using concordance index(C-index).Results:A total of 720 patients were randomly assigned.CR during the OP in the fosaprepitant group was not inferior to that in the aprepitant group(78.1%vs.77.7%,P=0.765)with a between-group difference of 0.4%(95%CI,-5.7%to 6.6%).Female sex,higher cisplatin dose(≥70 mg/m2),no history of drinking and larger body surface area(BSA)were significantly associated with nausea.The AUC for the acute and delayed CINV risk indexes was 0.68(95%CI:0.66-0.71)and 0.66(95%CI:0.61-0.70),respectively,and the C-index for nomogram CINV prediction was 0.59(95%CI,0.54-0.64).Using appropriate cutoff points,the three models could stratify patients with high-or low-risk CINV.No nausea and CR rate were significantly higher in the low-risk group than in the high-risk group(P<0.001).Conclusions:Fosaprepitant-based triple prophylaxis demonstrated non-inferior control for preventing CINV in patients treated with cisplatin-base chemotherapy.Female cancer patients without a history of alcohol consumption,with larger BSA and received high-dose cisplatin might be more vulnerable to CINV.Three personalized prediction models were well-validated and could be used to optimize antiemetic therapy for individual patients.
文摘BACKGROUND Few relevant literature reports on applying acupoint press-needle embedding combined with emotional nursing in patients with a gynecological malignant tumor.AIM To explore the effect of traditional Chinese medicine acupoint needle embedding combined with emotional nursing on chemotherapy-related nausea and vomiting(CINV),cancer-related fatigue(CRF)and psychological state in patients with gynecological malignant tumors.METHODS Retrospective analysis of the clinical information of 84 patients with gynecological malignant tumors treated in our hospital from August 2020 to December 2022 Led to the development of an observation group(n=42)and a control group(n=42)based on various nursing approaches.Ondansetron hydrochloride injection was administered to the individuals in the control group.However,the observation group received emotional nursing based on the control group and acupoint pressneedle embedding of traditional Chinese medicine.Patients in both groups received the chemotherapy regimen of paclitaxel liposome+carbo-platin/cisplatin.For four weeks,both groups intervened.The CINV grade,quality of life,CRF,psychological status and sleep quality scores of the two groups before and RESULTS After intervention,the degree of CINV in the observation group was significantly better than that in the control group.After intervention,the scores of each dimension and total score of FLIE scale were significantly higher than those in the control group.After intervention,the scores of each dimension and total score of Piper Fatigue Scale were significantly lower than those in the control group(P<0.05).After intervention,the scores of avoidance and yield dimensions in the observation group were significantly lower than those in the control group,and the scores of confrontation dimension were significantly higher than those in the control group(P<0.05).After intervention,the sleep quality score of the observation group was significantly lower than that of the control group,and the Karnofsky Performance Status scale score was significantly higher than that of the control group(P<0.05).CONCLUSION The acupuncture point needle embedding of traditional Chinese medicine combined with emotional nursing can further reduce the incidence of chemotherapy-related nausea and vomiting in patients with gynecological malignant tumors,improve the quality of life and the degree of CRF,alleviate the bad psychological state,adopt a positive way to face the disease and treatment,and improve the quality of sleep and quality of life.
文摘目的观察顺铂（Cisplatin，DDP）单次大剂量给药和分次小剂量给药方案引起的化疗所致恶心呕吐（chemotherapy-induced nausea and vomiting，CINV）和对患者生活功能的影响。方法2011年10月-2012年6月间对武汉同济医院肿瘤中心行含DDP联合化疗方案的101例患者进行问卷调查，根据DDP给药方案，分为两组，A组：DDP75mg／m^2，静脉滴注，d1；B组：DDP25mg／m2，静脉滴注，d1～3。化疗第2天和第6天分别记录CINV事件，并于第6天填写呕吐生活功能指数（functional living indexemesis，FLIE）。结果单次给药组急性期恶心、呕吐缓解率和延迟期恶心、呕吐缓解率依次为69．4％、77．6％、32．7％、55．1％；分次给药组依次为88．5％、92．3％、34．6％、71．2％。对以上指标进行χ^2检验，急性CINV缓解率差异均有统计学意义，延迟性CINV缓解率差异无统计学意义。两组患者生活功能受到CINV负面影响的比例分别为46．9％和28．8％，χ^2检验显示差异无统计学意义。结论与DDP单次给药相比，分次给药能够减轻急性CINV，但是对于延迟性CINV和整个化疗过程CINV对患者生活功能的影响，两种给药方式无明显差别。
文摘目的评估奥氮平联合托烷司琼及地塞米松三联方案对接受中危致吐方案同时具有高危致吐风险因素的胃肠道肿瘤患者的止吐效果。方法选取2017年9月至2018年9月在北京大学深圳医院肿瘤内科接受化疗的胃肠道肿瘤53例患者为研究对象,所有患者均接受mFOLFOX6或FOLFIRI方案化疗,观察组接受奥氮平、托烷司琼及地塞米松三联止吐方案预防化疗引起的恶心呕吐(chemotherapy-induced nausea and vomiting,CINV),对照组接受托烷司琼及地塞米松两联止吐方案。比较两者CINV完全缓解率、控制率、对生活质量影响及不良反应。结果奥氮平组在急性期、延迟期及全期完全缓解率均明显高于对照组(88.9%∶69.2%,P=0.078;74.1%∶42.3%,P=0.019;61.5%∶38.5%,P=0.020)。奥氮平组全期无明显恶心患者比例有优于对照组的趋势(70.4%∶30.8%,P=0.075),奥氮平组FLI-E评分更高,生活质量更好。2组最常见不良反应为便秘(66.7%∶61.5%,P=0.697),奥氮平组较对照组有更高的嗜睡(59.3%∶19.2%,P=0.003)、头晕(44.4%∶23.1%,P=0.101)等不良反应的发生,失眠方面,奥氮平组发生率较低(18.5%∶46.2%,P=0.031)。结论本研究首次证实了在接受MEC方案(FOLFOX6/FOLFIRI)化疗同时合并高危致吐风险因素的消化道肿瘤患者中,奥氮平联合5-羟色胺3受体拮抗剂及地塞米松,较好地控制了CINV,特别是对于延迟期及恶心的控制明显优于对照组,提高了患者生活质量。
