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. 2023 Mar-Apr;46(2):92-102.
doi: 10.1097/NCC.0000000000001076. Epub 2022 Mar 4.

Distinct Nausea Profiles Are Associated With Gastrointestinal Symptoms in Oncology Patients Receiving Chemotherapy

Komal Singh  1 , Keenan Pituch, Qiyun Zhu, Haiwei Gu, Brenda Ernst, Cindy Tofthagen, Melanie Brewer, Kord M Kober, Bruce A Cooper, Steven M Paul, Yvette P Conley, Marilyn Hammer, Jon D Levine, Christine Miaskowski
Affiliations

Distinct Nausea Profiles Are Associated With Gastrointestinal Symptoms in Oncology Patients Receiving Chemotherapy

Komal Singh et al. Cancer Nurs. 2023 Mar-Apr.

Abstract

Background: Unrelieved chemotherapy-induced nausea (CIN) occurs 48% of patients undergoing chemotherapy and is one of the most debilitating symptoms that patients report.

Objective: The aims of this study were to identify subgroups of patients with distinct CIN profiles and determine how these subgroups differed on demographic and clinical characteristics; severity, frequency, and distress of CIN; and the co-occurrence of common gastrointestinal symptoms.

Methods: Patients (n = 1343) completed demographic questionnaire and Memorial Symptom Assessment Scale 6 times over 2 cycles of chemotherapy. Latent class analysis was used to identify subgroups of patients with distinct CIN profiles. Differences among these subgroups were evaluated using parametric and nonparametric statistics.

Results: Four distinct CIN profiles were identified: none (40.8%), increasing-decreasing (21.5%), decreasing (8.9%), and high (28.8%). Compared with the none class, patients in the high class were younger, had a lower annual household income, had child care responsibilities, had a lower Karnofsky Performance Status score and a higher Self-administered Comorbidity Questionnaire score, and were more likely to have received chemotherapy on a 14-day cycle and a highly emetogenic chemotherapy regimen. In addition, patients in the high class reported high occurrence rates for dry mouth, feeling bloated, diarrhea, lack of appetite, abdominal cramps, difficulty swallowing, mouth sores, weight loss, and change in the way food tastes.

Conclusions: That 60% of the patients reported moderate to high CIN occurrence rates confirms that this unrelieved symptom is a significant clinical problem.

Implications for practice: Nurses need to evaluate patients' level of adherence to their antiemetic regimen and make appropriate referrals for physical therapy, psychological services, and dietary counseling.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1 –
Figure 1 –
Chemotherapy-induced nausea trajectories for patients in each of the latent classes.
Figure 2 –
Figure 2 –
Percentage of patients in the increasing-decreasing, decreasing, and high classes who rated the frequency (a), severity (b), and distress (c) associated with chemotherapy-induced nausea at enrollment (i.e., prior to their second or third dose of chemotherapy). For frequency (a), post hoc contrasts found that compared with the increasing-decreasing and decreasing classes, the patients in the high class reported a higher frequency of CIN. For severity (b), post hoc contrasts found that compared with the increasing-decreasing and decreasing classes, the patients in the high class had more severe CIN. In addition, compared with the increasing-decreasing class, patients in the decreasing class had more severe CIN. For distress (c), post hoc contrasts found that compared with increasing-decreasing and decreasing classes, patients in the high class reported higher distress ratings for CIN (all p<.05>
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