Delayed Chemotherapy-Induced Nausea in Women Treated for Breast Cancer

Suzanne L. Dibble

Jill Israel

Brenda Nussey

Karen Casey

Judith Luce

ONF 2003, 30(2), E40-E47. DOI: 10.1188/03.ONF.E40-E47

Purpose/Objectives: To describe the experience and intensity of delayed nausea in women undergoing chemotherapy for breast cancer since the advent of the 5-HT3 antagonists.

Design: Multisite, longitudinal, descriptive.

Setting: 7 outpatient oncology clinics situated in hospitals, 5 outpatient oncology clinics associated with major teaching universities, 27 private outpatient oncology practices, and 1 outpatient clinic located in a county hospital.

Sample: Typical participants (N = 303) were 51.9 years old, Caucasian (79%), married or partnered (65%), born U.S. citizens (92%), heterosexual (96%), living with someone (83%), and high school graduates (82%).

Methods: Baseline and poststudy questionnaires plus a daily diary of nausea through two cycles of chemotherapy (approximately two months) were used to collect data. The Rhodes Inventory of Nausea, Vomiting, and Retching was used to assess the nausea experience.

Main Research Variables: Nausea.

Findings: The worst nausea occurred on the third day after having chemotherapy for breast cancer. The types of oral antiemetics ordered for home use were changed between the two cycles of the study only 8% (n = 24) of the time. Younger, heavier women experienced more delayed nausea. Women who had a history of nausea with stress and women receiving cyclophosphamide experienced more delayed nausea during both time periods.

Conclusions: Delayed nausea is a significant problem for women receiving chemotherapy for breast cancer.

Implications for Nursing: Oncology nurses can use the results from this study to provide anticipatory guidance for patients undergoing chemotherapy for breast cancer.

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    American Cancer Society. (2003). Cancer facts and figures 2003. Atlanta, GA: Author.

    Clavel, M., Soukop, M., & Greenstreet, Y.L.A. (1993). Improved control of emesis and quality of life with ondansetron in breast cancer. Oncology, 50, 180-185.

    Dawson-Saunders, B., & Trapp, R.G. (1994). Basic and clinical biostatistics. Norwalk, CT: Appleton and Lange.

    Dicato, M. (1996). Mechanisms and management of nausea and emesis. Oncology, 53(Suppl. 1), 1-3.

    Fessele, K.S. (1996). Managing the multiple causes of nausea and vomiting in the patient with cancer. Oncology Nursing Forum, 23, 1409-1415.

    Gandara, D.R., Roila, F., Warr, D., Edelman, M.J., Perez, E.A., & Gralla, R.J. (1998). Consensus proposal for 5HT3 antagonists in the prevention of acute emesis related to highly emetogenic chemotherapy. Dose, schedule, and route of administration. Supportive Care in Cancer, 6, 237-243.

    Goodman, M. (1997). Risk factors and antiemetic management of chemotherapy-induced nausea and vomiting. Oncology Nursing Forum, 24, 20-32.

    Gralla, R.J., Osoba, D., Kris, M.G., Kirkbride, P., Hesketh, P.J., Chinnery, L.W., et al. (1999). Recommendations for the use of antiemetics: Evidence-based, clinical practice guidelines. Journal of Clinical Oncology, 17, 2971-2994.

    Greene, D., Nail, L.M., Fieler, V.K., Dudgeon, D., & Jones, L.S. (1994). A comparison of patient-reported side effects among three chemotherapy regimens for breast cancer. Cancer Practice, 2, 57-62.

    Italian Group for Antiemetic Research. (2000). Dexamethasone alone or in combination with ondansetron for the prevention of delayed nausea and vomiting induced by chemotherapy. New England Journal of Medicine, 342, 1554-1559.

    Luebbert, K., Dahme, B., & Hasenbring, M. (2001). The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: A meta-analytical review. Psychooncology, 10, 490-502.

    Maisano, R., Spadaro, P., Toscano, G., Caristi, N., Pergolizzi, S., & Salimbeni, V. (2000). Cisapride and dexamethasone in the prevention of delayed emesis after cisplatinum administration. Supportive Care in Cancer, 9, 61-64.

    Molassiotis, A., Yung, H.P., Yam, B.M., Chan, F.Y., & Mok, T.S. (2002). The effectiveness of progressive muscle relaxation training in managing chemotherapy-induced nausea and vomiting in Chinese breast cancer patients: A randomized controlled trial. Supportive Care in Cancer, 10, 237-246.

    National Comprehensive Care Network. (2001). Nausea and vomiting: Treatment guidelines for patients with cancer. Atlanta, GA: American Cancer Society and Author.

    National Institutes of Health Consensus Development Panel on Acupuncture. (1998). Acupuncture. JAMA, 280, 1518-1524.

    Oettle, H., & Riess, H. (2001). Treatment of chemotherapy-induced nausea and vomiting. Journal of Cancer Research and Clinical Oncology, 127, 340-345.

    Osoba, D., Zee, B., Warr, D., Latrelle, J., Kaizer, L., & Pater, J. (1997). Effect of postchemotherapy nausea and vomiting on health-related quality of life. Supportive Care in Cancer, 5, 307-313.

    Pendergrass, K.B. (1998). Options in the treatment of chemotherapy-induced emesis. Cancer Practice, 6, 276-281.

    Rhodes, V.A., & McDaniel, R.W. (1997). Measuring nausea, vomiting and retching. In M. Frank-Stromborg & S.J. Olsen (Eds.), Instruments for clinical health-care research (2nd ed., pp. 509-518). Boston: Jones and Bartlett.

    Rhodes, V.A., Watson, P.M., & Johnson, M.H. (1984). Development of reliable and valid measures of nausea and vomiting. Cancer Nursing, 7, 33-41.

    Rhodes, V.A., Watson, P.M., Johnson, M.H., Madsen, R.W., & Beck, N.C. (1987). Patterns of nausea, vomiting and distress in patients receiving antineoplastic drug protocols. Oncology Nursing Forum, 14, 35-44.

    Stewart, A. (1996). Optimal control of cyclophosphamide-induced emesis. Oncology, 53(Suppl. 1), 32-38.

    Uyl-de Groot, C.A., Wait, S., & Buijt, I. (2000). Economics and health-related quality of life in antiemetic therapy: Recommendations for trial design. European Journal of Cancer, 36, 1522-1535.