In a national study of 322 patients led by scientists at the James P. Wilmot Cancer Center at the University of Rochester Medical Center, 43 percent of patients reported being nauseous on the day of their chemotherapy treatment, while 73 percent reported nausea one or more days later. And those patients who felt ill in the days following treatment were twice as likely to report moderate or severe nausea than those who felt queasy on the first day.
"Surprisingly, 18 percent of patients didn't have any nausea at all until the third day. That's astonishing," says Jane T. Hickok, M.D., the lead author of the paper and research assistant professor of oncology and of community and preventive medicine. "And these were all patients who received medications to treat vomiting and nausea.
"Delayed nausea is a huge problem that is much more common than we've realized. People are anxious to get back to work, to get back to their lifestyle, and oftentimes they're surprised that they made it through the day of the treatment just fine, only to find themselves sick a day or two later."
The team studied patients who received one of three common chemotherapy drugs: doxorubicin, cisplatin, or carboplatin. On the day of treatment, all patients received standard therapy to prevent nausea, which included the steroid dexamethasone as well as a type of medication to prevent nausea known as a 5-hydroxytryptamine-3 receptor antagonist (5HT3), such as ondansetron.
These drugs first became available about a decade ago to reduce vomiting, or emesis. And since vomiting and nausea often go together, many patients and doctors assume that the drugs will prevent nausea too. In the study, while only 30 percent of patients experienced vomiting from their first treatment, 76 percent experienced nausea. In other words, even though patients are not stuck in the bathroom vomiting, they're often feeling nauseous and may not even get the relief that can come from finally throwing up.
"Twenty years ago, the most troublesome side effect of chemotherapy for patients was vomiting, but now, for many patients, nausea is much more troubling," says Hickok. "Nausea and vomiting are often treated as one and the same, but they are really very different processes. Many drugs have been very successful in controlling vomiting, but they don't seem so successful in controlling nausea, especially after the first day."
Since the study was completed, a new class of drugs that work differently than 5HT3 medications, known as neurokinin-1 or NK-1 receptor antagonists, has become available to treat nausea, and doctors are hopeful that these will prevent delayed nausea more effectively than the medications used in the study. And Hickok says that if doctors know that nausea is likely once the patient leaves the hospital, even prescribing traditional anti-nausea medicines like compazine may help.
Hickok led the study as part of a larger group run by Gary R. Morrow, Ph.D., who heads the Community Clinical Oncology Program, or CCOP, at the university's James P. Wilmot Cancer Center. The group, funded by the National Cancer Institute, specializes in improving the quality of life of people who have cancer by studying the symptoms of cancer and the side effects of treatment, such as fatigue, nausea, and shortness of breath.
CCOP studies are done in cooperation with community oncologists around the country – the arrangement brings the latest experimental treatments to patients in communities nationwide, and it helps researchers gather enough patients to ask and answer basic questions about cancer. In this study patients came from community practices in Seattle; Tacoma, WA; Columbus, OH; Honolulu; Marshfield, WI; St. Louis Park, MN; Hackensack, NJ; and Syracuse. Among the patients' diseases were leukemia and breast, lung, and uterine cancers.
In addition to Hickok and Morrow, authors of the report, which appeared in the June 1 issue of Cancer, were Joseph A. Roscoe, Ph.D., of the James P. Wilmot Cancer Center; David K. King, M.D., of the Greater Phoenix Community Clinical Oncology Program in Phoenix; James N. Atkins, M.D., of the Southeast Cancer Control Consortium in Winston-Salem, N.C.; and Tom R. Fitch, M.D., of a Mayo Clinic site in Scottsdale, AZ.
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Cancer