Incidence and severity of delayed nausea and vomiting
Delayed nausea was reported by 70 (33%) patients, of whom 27 (38.5%) experienced mild, 23 (33%) experienced moderate, and 20 (28.5%) experienced severe nausea (table 1, 4). A total of 39 (55.7%) patients who experienced delayed nausea had received highly emetogenic chemotherapy (HEC), while 21 (30%) underwent moderate, 4 (5.8%) low, and 6 (8.5%) minimal emetogenic chemotherapy. Furthermore, a significant association was observed between HEC and frequency of delayed nausea (P=0.001). Patients treated in the inpatient setting were more likely to experience delayed nausea compared to the outpatients (P=0.001). The correlation between age, sex, and presence of delayed nausea was not statistically significant. Surprisingly, guideline adherence was not associated with the incidence or degree of delayed nausea (P=0.001). A strong association was found between delayed nausea and delayed vomiting (P=0.001), and intolerance to food intake (P=0.001) ) (table 6 and 7).
Delayed vomiting was reported in 39 (19%) patients, of whom 28 (72%) experienced 1–2 vomiting episodes while 11 (28%) experienced ≥3 vomiting episodes. The survey scores for high, moderate, low, and minimal emetogenic chemotherapy associated with delayed vomiting were 51.3%, 30.7%, 7.6%, and 10.3%, respectively) (table 5) . Notably, patients who received high and moderate emetogenic regimens showed a high association with the development of delayed nausea (P=0.037). Similar to delayed nausea, sex, age, treatment setting, and the rate of delayed vomiting were not found to be significantly related. No association was found between underlying diagnosis and delayed vomiting (P=0.185). The association between adherence to guidelines and the presence of delayed vomiting was not statistically significant (P=0.123).
A total of 106 patients experienced food intake intolerance during the later phase of their chemotherapy course. Thirty-seven (35%) of these patients reported severe intolerance i.e., tolerated <25% of normal intake), 24 (22.5%) showed moderate (tolerated 25–50% of normal intake), and 44 (42.5%) exhibited mild intolerance (tolerated 50–75% of normal intake). Logically, a strong association was found between food intolerance and type of chemotherapy regimen (P=0.002) ) (table 6, 7).
Adherence to the CINV guidelines published by POGO was achieved for all 236 assessments. We only examined adherence as the number of patients who were prescribed the correct antiemetic agent(s)/class irrespective of the dose. A total of 73 patients were prescribed proper antiemetics (31%) as compared to 163 (69%) who were not prescribed proper antiemetics. Only 22% of patients who received highly emetogenic regimens and 27% of patients who received moderate regimens presented proper antiemetics’ prescriptions. Analysis by age was not statistically significantly (P=0.774). This poor compliance remained the same regardless of whether the patient was in an outpatient or inpatient setting (P=0.221). The rate of adherence was statistically significant for patients diagnosed with solid tumors as compared to those diagnosed with CNS and leukemia (P=0.034). Association between nausea and adherence to guidelines (P=0.289), and between the presence of vomiting and non-adherence in the acute (P=0.052) and delayed phases (P=0.123) were not statistically significant ) (table 6,7).