Likelihood of a Subsequent Chemotherapy Induced Nausea and Vomiting Event In Patients with Hematologic Malignancies Receiving Chemotherapy.

Chemotherapy induced nausea and vomiting (CINV) is a common side effect and can have a substantial impact on patient quality of life and subsequent health-related resource utilization. In addition to other risk factors including chemotherapy emetogenicity, patient age, gender, and alcohol use, patients with prior history of CINV may have an increased risk of CINV. This study assessed the increased likelihood of a subsequent CINV following a first chemotherapy administration CINV in patients with a hematologic cancer diagnosis receiving single-day low emetogenic chemotherapy (LEC), moderately emetogenic chemotherapy (MEC), or high emetogenic chemotherapy (HEC).

A retrospective analysis was conducted utilizing a merged data set comprised of Georgia Cancer Specialists, Florida Cancer Specialists, and ACORN's electronic medical records databases (April 2006 – June 2010). Patients with any hematologic malignancy (those diagnosed with any leukemia, lymphoma, and/or myeloma (ICD-9-CM 200.xx-208.xx) who received at least two single-day chemotherapy administrations (oral or intravenous) and had no chemotherapy 3 months prior to first chemotherapy administration [index date] were included. Two cohorts: 1) patients with a first chemotherapy administration CINV event and 2) those with no first chemotherapy administration CINV event, were identified and followed for six months. Uncontrolled CINV events were identified through ICD-9-CM codes [nausea and vomiting (N&V)], CPT codes (hydration), rescue medications, N&V hospitalizations, and/or antiemetic therapy after last chemotherapy administration of the cycle. A multivariate logistic regression was conducted to assess the likelihood of subsequent CINV. The model controlled for differences in demographic and clinical variables between the two cohorts including age, gender, Charlson comorbidity index, number of chemotherapy administrations, days between chemotherapy administrations, anti-emetic prophylaxis use with first chemotherapy administration, and chemotherapy emetogenicity.

A total of 1,121 patients met the inclusion criteria; 247 (22.0%) experienced a CINV within six months. Of those patients with CINV, 68 patients (27.5%) encountered a CINV event with the first chemotherapy administration. These 68 patients were younger [55.9 (SD: 16.5) vs. 60.8 (SD: 16.1) years; p=0.016] and had fewer chemotherapy administrations [6.4 (SD: 3.0) vs. 8.1 (SD: 5.9); p=0.0189] as compared to patients with no CINV with the first chemotherapy administration. Unadjusted subsequent CINV rate was higher for patients with first chemotherapy administration CINV (33.8% vs. 17.0%; p=0.0005) as compared to patients without a CINV event during first chemotherapy administration. After controlling for differences in covariates, patients with first chemotherapy administration CINV were 2.8 times more likely to have a subsequent CINV compared to patients without a first chemotherapy administration CINV [Odds Ratio (OR): 2.84 (95% CI: 1.63 – 4.96); p=0.0002].

In this retrospective analysis using merged electronic medical records data, patients with hematologic malignancies receiving single-day chemotherapy who had a first chemotherapy administration CINV event were at increased risk of a subsequent CINV event versus those without a CINV event during the first chemotherapy administration.

Jackson:Xcenda: Xcenda received funding to conduct the study. Jain:Xcenda: Xcenda received funding to conduct the study. Balu:Eisai, Inc.: Employment. Buchner:Eisai, Inc: Employment.