非药物干预对化疗所致恶心呕吐影响的系统评价再评价

目的 对化疗所致恶心呕吐的非药物干预措施进行系统评价再评价。方法 检索有关非药物干预防治化疗所致恶心呕吐的系统评价或Meta分析文献。检索数据库包括中国知网、万方全文数据库、维普全文数据库、中国生物医学文献数据库、Cochrane Library、卫生保健及护理学数据库(CINAHL)、Embase、Pubmed,检索时间为建库至2022年6月30日。筛选文献后,提取纳入文献的相关资料,并评价分析其方法学质量和证据质量。结果 共纳入19篇系统评价文献,其中中质量等级4篇,低质量等级8篇,极低质量等级7篇。文献共评价8种非药物措施的证据,其中穴位刺激对化疗所致恶心呕吐的积极影响最为显著。结论 通过对目前已发表的系统评价再评价发现,非药物干预可尝试作为临床或居家管理化疗所致恶心呕吐的辅助手段,其中穴位刺激可优先考虑。但纳入文献的方法学质量不高、证据等级偏低,其效果仍需进一步验证。     

穴位按压对恶性肿瘤化疗患者消化道反应影响的Meta分析

目的 系统评价穴位按压对恶性肿瘤化疗患者消化道反应的影响.方法 电子检索Pubmed、Medline、Embase、AMED、Cochrane Library、Cancerlit and Cinahl、中国生物医学文献数据库（CBM）、中国学术期刊网络出版总库（CNKI）、维普数据库（VIP）及万方数据库等,各数据库检索时间均从建库至2014年3月.纳入穴位按压对恶性肿瘤化疗消化道反应影响的随机对照实验（RCT）.结果 最终纳入8个RCT,共有959例患者.Meta分析显示,与不实施穴位按压相比,穴位按压能有效地降低恶性肿瘤化疗恶心、呕吐、干呕的发生频率,缩短经历时间及减轻症状的严重程度;同时,穴位按压可明显减少恶性肿瘤患者止吐药的使用量,但并不能提高其生活质量.结论 穴位按压能够有效改善恶性肿瘤化疗患者消化道反应,减轻患者的痛苦,且不增加患者医疗负担和精神负担.以后的研究应更多关注穴位按压对基线状态焦虑水平、功能性状态等更多结局指标的影响.     

渐进式肌肉放松训练缓解乳腺癌化疗期恶心呕吐的效果

目的探讨渐进式肌肉放松训练对缓解乳腺癌化疗所致恶心呕吐的治疗效果。方法选取2017年1—6月收治于武汉大学人民医院乳腺甲状腺外科,行表阿霉素联合环磷酰胺(EC)方案化疗的乳腺癌术后患者68例,随机分为观察组和对照组各34例。对照组给予托烷司琼注射液、地塞米松止吐治疗;观察组在此基础上指导患者进行渐进式肌肉放松训练。采用MASCCA止吐评价工具比较两组患者化疗后24 h内及4 d后恶心、呕吐的发生情况。结果两组患者化疗后急性恶心、呕吐发生率及延迟性恶心发生率比较,差异均无统计学意义(P 0. 05);观察组患者延迟性呕吐发生率及呕吐频次明显低于对照组,恶心缓解率明显高于对照组,差异有统计学意义(P 0. 05)。结论渐进式肌肉放松训练能显著降低乳腺癌EC方案化疗后延迟性呕吐的发生率及呕吐频次,提高恶心缓解率,对于提高患者化疗依从性有积极促进作用。     

渐进性肌肉放松训练与药物在化疗所致恶心呕吐中应用的比较研究

目的 探讨渐进性肌肉放松训练(PMRT)和引导意想疗法在胃肠道恶性肿瘤化疗所引起恶心和呕吐中的作用.方法 以120例接受FOLFOX方案化疗的胃肠道恶性肿瘤患者为研究对象,分别采用PMRT和引导意想疗法、凯特瑞和胃复安治疗化疗所致的恶心和呕吐,观察其效果,并进行效果分析.结果 急性呕吐组三者防治恶心、呕吐的平均有效率分别为63.6%、90.9%和27.3%;延迟性呕吐组三者防治恶心、呕吐的平均有效率分别为77.8%、33.3%和22.2%,急性呕吐组中PMRT和引导意想疗法与凯特瑞的疗效差异有统计学意义(P＜O.05),凯特瑞与胃复安的疗效有明显的统计学差异;延迟性呕吐组中PMRT和引导意想疗法与凯特瑞、胃复安的疗效有明显的统计学差异,凯特瑞与胃复安的疗效差异无统计学意义.结论 PMRT和引导意想疗法对化疗药物所致的恶心、呕吐有一定的疗效;凯特瑞能有效预防化疗药物所致的急性恶心、呕吐,对延迟性恶心、呕吐有部分疗效;胃复安预防化疗药物所致的恶心、呕吐的效果较差.PMRT和引导意想疗法是肿瘤化疗安全、有效、经济的方法之一.     

穴位疗法缓解急性白血病化疗患儿胃肠道反应的效果观察

目的观察穴位疗法对缓解急性白血病化疗患儿恶心、呕吐的效果。方法将104例行化疗的白血病患儿随机分为观察组和对照组各52例,所有患儿化疗期间均给予常规止吐治疗,观察组同时加用穴位按压及耳穴埋籽。比较两组患儿化疗1周内出现的恶心、呕吐症状有无差异。结果恶心情况:观察组恶心的发生率明显低于对照组,除了第1天两组之间无明显差异外(P=0.083),其余六天两组恶心发生情况的差异均有统计学意义(P0.01);呕吐情况:观察组呕吐的发生率均低于对照组,其中第2~6天观察组呕吐程度明显轻于对照组(P0.05)。结论穴位按压联合耳穴埋籽能有效降低患儿恶心、呕吐的发生频率,减轻其症状的严重程度,临床应用安全有效。     

饮食疗法对肺癌化疗患者恶心呕吐的影响研究

目的探讨饮食疗法对肺癌患者化疗期间恶心、呕吐的影响。方法选取2013年1月~2015年1月入院的82例初次化疗的非小细胞肺癌的患者,化疗方案均为依托泊苷+顺铂,年龄为41~72岁。按照入院的先后顺序分为对照组(44例)和试验组(38例)。对照组给予常规治疗和常规护理,试验组在常规治疗和常规护理的基础上增加饮食疗法。采用止吐评价工具评定两组患者化疗后急性和延迟性恶心、呕吐情况。结果试验组急性呕吐的发生率为63.1%,低于对照组的70.5%,两组比较差异有统计学意义(P0.05);试验组延迟性恶心发生率为52.6%,低于对照组的59.1%(P0.05);对于急性、延迟性恶心、呕吐的次数或评分,实验组均低于对照组(P0.05)。结论对非小细胞肺癌化疗的患者运用饮食疗法配合常规治疗和常规护理方案,能较好地缓解患者因化疗引起的急性、延迟性恶心呕吐的症状,改善患者生活质量,提高患者治疗的依从性。     

托烷斯琼预防全麻术后恶心呕吐有效性和安全性的Meta分析

目的系统评价托烷斯琼预防全麻术后恶心呕吐的临床效果和安全性。方法电子检索PubMed、EBSCO、Springer、Ovid、CNKI等数据库,并查阅所获文献的参考文献,收集1995～2009年发表的有关托烷斯琼预防全麻术后恶心呕吐的随机对照试验（RCT）。按Cochrane Handbook 5.0.1对纳入文献进行质量评价和资料提取,统计学分析采用RavMan 4.2.10软件。结果共纳入17个RCT,包括4？678例患者。Meta分析结果显示：①有效性：托烷司琼单次静注能降低全麻术后恶心呕吐的发生率[RR=0.41,95%CI（0.29,0.60）]和全麻术后应用阿片类药物镇痛患者恶心呕吐的发生率[RR=0.30,95%CI（0.15,0.60）];单次静注或分次泵注均能降低全麻术后应用曲马多镇痛患者恶心呕吐的发生率[RR（95%CI）分别为0.41（0.29,0.56）和0.10（0.06,0.19）];托烷司琼与地塞米松联用较托烷司琼单用能更有效降低全麻术后患者恶心呕吐的发生率[RR=0.27,95%（0.13,0.57）]。②安全性：托烷司琼静注能减少头晕头迷的发生率[RR=0.35,95%CI（0.16,0.75）],但在减少术后瘙痒、嗜睡方面差异无统计学意义;所有纳入研究患者均未出现椎体外系、排尿困难等症状。结论托烷司琼能明显降低全麻患者术后恶心呕吐的发生率,且不增加瘙痒、嗜睡等不良反应,并可减少头晕头迷的发生。     

肿瘤化疗患儿延迟性恶心呕吐的影响因素分析

目的 探讨肿瘤化疗患儿延迟性恶心呕吐的发生情况及影响因素,为护理人员制订居家照护方案提供依据。方法 该研究为前瞻性队列研究,连续选取2022年8月—10月在浙江省某三级甲等儿童专科医院化疗的肿瘤患儿及其照护者作为调查对象,采用巴克斯特干呕脸量表、美国卫生及公共服务部呕吐严重程度评估标准调查患儿延迟性恶心呕吐的发生情况,使用延迟性恶心呕吐影响因素调查表收集相关影响因素,采用二分类Logistic逐步回归进行分析。结果 共纳入378例肿瘤化疗患儿,其中229例（60.6%）发生延迟性恶心,144例（38.1%）发生延迟性呕吐,延迟性呕吐主要发生在化疗后1～2 d(50.7%)。Logistic回归分析显示,体表面积、化疗结束后有无负性情绪、有无延迟性恶心呕吐史、是否处于吸烟环境是肿瘤化疗患儿延迟性恶心的影响因素（P<0.05）;体表面积、有无延迟性恶心呕吐史、是否合并呼吸或消化系统疾病、化疗药物致吐风险、是否处于吸烟环境、肿瘤类型是肿瘤化疗患儿延迟性呕吐的影响因素（P<0.05）。结论 肿瘤化疗患儿延迟性恶心呕吐的发生率较高,尤其在化疗结束后1～2 d。体表面积大、化疗结束后有...     

芳香疗法预防肿瘤患者化疗后恶心及呕吐的系统评价

目的评价芳香疗法对肿瘤患者化疗后恶心、呕吐的预防效果。方法检索数据库包括PubMed、WebofScience、Cochrane Library、Embase、CINAHL、知网、维普、万方和中国生物医学文献数据库,检索时限为从建库至2019年7月17日,收集芳香疗法预防肿瘤患者化疗后恶心、呕吐的随机对照试验,评价和提取信息后,采用RevMan5.3软件进行分析。结果共纳入10篇文献,共计1267例患者,按评估量表的种类分别进行Meta分析。在芳香疗法预防急性恶心的效果分析中,以视觉模拟评分量表(visual analogue scale,VAS)为结局指标的分析结果为[MD=-7.26,95%CI(-13.22,-1.31),P=0.02];以恶心、呕吐、干呕评分为结局指标的分析结果为[MD=-1.05,95%CI(-1.55,-0.55),P<0.0001];以急性恶心的发生率为结局指标的分析结果为[RR=0.69,95%CI(0.52,0.91),P=0.009]。芳香疗法预防急性干呕效果的分析结果为[MD=-0.59,95%CI(-0.97,-0.21),P=0.002],预防延迟性干呕效果的分析结果为[MD=-0.93,95%CI(-1.54,-0.31)=0.003]。结论芳香疗法对化疗后急性恶心、急性干呕及延迟性干呕的预防效果显著优于对照组,对其他时期恶心、呕吐的预防效果仍需要进一步验证。     

放松疗法对白血病患儿化疗性呕吐的影响

目的探讨放松疗法对白血病患儿化疗性呕吐的影响。方法将98例6～14岁的白血病患儿随机分为干预组和对照组(各49例),两组均给予同样的止吐药,干预组同时进行放松疗法。并在干预前后观察两组患儿的恶心呕吐情况。结果两组患儿的前期和延迟期恶心呕吐发生率比较,差异有统计学意义(均P<0.01);两组急性期恶心呕吐发生率比较,差异无统计学意义(P>0.05)。结论放松疗法可降低白血病患儿化疗前期和延迟期恶心呕吐的发生率。     

The impact of chemotherapy-induced nausea and vomiting on health-related quality of life

Goal of work The objectives of this prospective observational study were to estimate the frequency of patients who reported an impact of chemotherapy-induced nausea and vomiting (CINV) on their daily life and to evaluate the determinants of such an impact. Materials and methods Adult cancer patients at seven Italian oncology centers who were receiving cisplatin-containing regimens reported incidence and intensity of CINV for eight consecutive days in a diary and completed a Functional Living Index for Emesis (FLIE) questionnaire. Main results Overall, 34% of patients reported vomiting and 62% reported nausea after chemotherapy. On days 1 to 5 after receiving chemotherapy, 67% of patients who had at least one emetic episode and 77% of those who suffered from at least mild nausea experienced an impact on their daily activities as measured on the FLIE questionnaire. More than 90% of all patients with both acute and delayed nausea or vomiting reported an impact on their daily life. Both acute and delayed vomiting contributed in similar measure to impact daily life; however, the importance of delayed nausea was greater than that of acute nausea. Conclusions Despite antiemetic prophylaxis, CINV is still prevalent and often impacts the daily life of patients in Italy, especially in the delayed phase. The duration more than the severity seems to be responsible for the impact of CINV on the patients’ daily lives.     

A prospective observational study of chemotherapy-related nausea and vomiting in routine practice in a UK cancer centre

Objective The aim of the study was to assess levels of chemotherapy-induced nausea and vomiting (CINV) in routine practice. Materials and methods The study was an observational prospective evaluation using patient self-reports. One hundred and two patients with cancer in a single cancer centre in UK receiving their first chemotherapy treatment participated in the study and were followed up over four cycles, providing a total of 272 assessments of nausea and vomiting. Data was collected with the use of the MASCC Antiemesis Tool (MAT), which is an eight-item short clinical scale assessing acute and delayed nausea and vomiting after chemotherapy. Results Results indicated that acute vomiting was experienced by 15.7% of the patients in cycle 1 and delayed vomiting by 14.7%, while acute nausea was present in 37.3% of the patients and delayed nausea in 47.1%, increasing over the subsequent cycles. Moderately emetogenic and highly emetogenic chemotherapy had the highest incidence of CINV, whereas patients receiving highly emetogenic chemotherapy showed significant levels of delayed nausea. Acute symptoms were more easily controlled than delayed symptoms. Discussion The data suggest that, while vomiting is well controlled, nausea remains a significant problem in practice, and optimal management of CINV is yet to be achieved. Understanding more clearly the biological basis of nausea will assist in managing this complex symptom more effectively in practice.     

Incidence of chemotherapy-induced nausea and vomiting in Taiwan: physicians’ and nurses’ estimation vs. patients’ reported outcomes

Background The major objective of the study was to determine the incidence and prevalence of acute and delayed chemotherapy-induced nausea and vomiting (CINV) among patients receiving chemotherapy and assess the accuracy with which medical providers perceive the incidence of CINV in their practice.Methods Specialists, residents and nurses (medical providers) from two cancer centers in Taiwan estimated the incidence of acute and delayed CINV. Chemotherapy-naïve patients from the same centers then completed a 5-day nausea and vomiting diary following highly and moderately emetogenic chemotherapy (HEC and MEC) to determine the actual incidence of acute and delayed CINV. Daily nausea ratings were recorded on a 100-mm visual analogue scale (VAS). No nausea was defined as a nausea VAS score <5 mm. Vomiting episodes were also recorded. Nausea and vomiting were defined as acute and delayed based on whether they occurred during the first 24 h after chemotherapy, or during days 2–5 after chemotherapy, respectively.Results In the two oncology centers, 37 medical providers (13 specialists, 4 residents, 20 nurses) and 107 patients were enrolled. The mean patient age was 49.2 years with 76% female and 74% having breast cancer. Of the 107 patients, 39% received HEC and 61% received MEC, and 77% received a 5-HT3 receptor antagonist and 94% received dexamethasone. There were no significant differences between patients with acute CINV and delayed CINV in terms of demographics, chemotherapy treatment or antiemetic treatment. The proportion of patients without alcohol use was significantly higher among patients with delayed CINV than among those with non-delayed CINV. Good control of CINV during the acute period correlated with the control of delayed emesis. There were no significant differences between specialists, residents, and nurses estimations of the incidence rates of CINV. For HEC given to chemotherapy-naïve patients, the medical providers estimated acute CINV to be 44/41% and delayed CINV to be 61/53%, respectively. However, patient diaries revealed acute CINV to be 43/21% and delayed CINV to be 64/60%, respectively. For MEC given to chemotherapy-naïve patients, medical providers estimated acute CINV to be 39/36% and delayed CINV to be 44/39%, respectively. However, patient diaries revealed acute CINV to be 55/18% and delayed CINV to be 74/55%, respectively.Conclusions Medical providers significantly overestimated the incidence of acute vomiting by 20% and 18% in HEC and MEC patients, respectively. While they correctly estimated the rate of delayed vomiting in HEC patients, they underestimated it by 16% in MEC patients. With respect to nausea, medical providers correctly estimated rates of both acute and delayed nausea in HEC patients, but significantly underestimated rates of acute and delayed nausea by 16% and 30%, respectively, in MEC patients.     

The cost of chemotherapy-induced nausea and vomiting in Italy

Goals of work The aim of this paper is to analyze the costs of chemotherapy-induced nausea and vomiting (CINV) in Italy. Materials and methods In this prospective observational study at seven public oncology centers, incidence and intensity of CINV daily for 8 days after chemotherapy in consecutive patients receiving cisplatin-containing chemotherapy were recorded. All costs related to CINV (direct medical, direct nonmedical, and indirect) were recorded (in 2003 euros). Main results A total of 172 patients were enrolled; cost data were available for 168 patients. Thirty-seven percent of patients experienced acute CINV, and 57% experienced delayed CINV; 39% achieved total control, defined as no nausea, vomiting, or rescue therapy. Mean per-patient costs of acute and delayed CINV were €30.03 from the hospital perspective, €4.9 from the patient perspective, and €26.85 from the National Health Service (NHS) perspective. Costs of CINV were highly variable among oncology centers, largely because of differences in procedures for preventing delayed CINV. These costs were four times higher when antiemetic drugs were prescribed and paid for by the NHS than when antiemetic prophylaxis was provided directly from hospital pharmacies. Moreover, in the delayed phase, the NHS incurred a 94% increase in costs for patients without total control. Overall costs for patients who did not experience total control of CINV were €35.57 higher than for those who did (85% increase). Conclusions Costs of CINV for the Italian NHS could be reduced if hospitals furnished antiemetic prophylaxis directly to patients. Better control of both acute and delayed CINV would improve patient well-being as well as reduce the budgetary impact of CINV in Italy.     

渐进式肌肉放松训练对乳腺癌高致吐方案化疗所致恶心呕吐的效果观察

目的 探讨渐进式肌肉放松训练对乳腺癌高致吐方案化疗所致恶心呕吐(CINV)的治疗效果。方法 收集我院2017年1月-2017年6月行表阿霉素联合环磷酰胺(EC)方案化疗的乳腺癌患者68例,按照随机数字表法分为观察组和对照组,每组各34例。对照组给予托烷司琼注射液、地塞米松治疗;观察组在此基础上进行渐进式肌肉放松训练,比较两组对预防CINV的临床疗效。结果 急性期两组恶心、呕吐发生率、恶心缓解率及呕吐频次比较,差异均无统计学意义(P>0.05);延迟期两组恶心发生率比较,差异无统计学意义(P>0.05),观察组呕吐发生率、呕吐频次明显低于对照组,恶心缓解率明显高于对照组,差异有统计学意义(P<0.05)。结论 渐进式肌肉放松训练能显著降低乳腺癌高致吐方案化疗延迟期呕吐发生率、呕吐频次和恶心程度,简便易行,可用于临床防治乳腺癌高致吐方案化疗所致CINV。     

Phase II trial of encapsulated ginger as a treatment for chemotherapy-induced nausea and vomiting

Goals of work  Ginger has been used to treat numerous types of nausea and vomiting. Ginger has also been studied for its efficacy for acute chemotherapy-induced nausea and vomiting (CINV). However, its efficacy for delayed CINV in a diverse oncology population is unknown. Materials and methods  We performed a randomized, double-blind, placebo-controlled trial in 162 patients with cancer who were receiving chemotherapy and had experienced CINV during at least one previous round of chemotherapy. All participants were receiving a 5-HT₃ receptor antagonists and/or aprepitant. Participants were randomized to receive either 1.0 g ginger, 2.0 g ginger daily, or matching placebo for 3 days. The primary outcome was change in the prevalence of delayed CINV. Secondary outcomes included acute prevalence of CINV, acute and delayed severity of CINV, and assessment of blinding. Main results  There were no differences between groups in the prevalence of delayed nausea or vomiting, prevalence of acute CINV, or severity of delayed vomiting or acute nausea and vomiting. Participants who took both ginger and aprepitant had more severe acute nausea than participants who took only aprepitant. Participants were able to accurately guess which treatment they had received. Ginger appeared well tolerated, with no difference in all adverse events (AEs) and significantly less fatigue and miscellaneous AEs in the ginger group. Conclusions  Ginger provides no additional benefit for reduction of the prevalence or severity of acute or delayed CINV when given with 5-HT₃ receptor antagonists and/or aprepitant. This trial is registered in ClinicalTrials.gov ID: NCT00065221.     

Olanzapine for chemotherapy-induced nausea and vomiting: a systematic review

Purpose

Newer drugs incorporated in prophylactic regimens for chemotherapy-induced nausea and vomiting (CINV) have resulted in significantly reduced rates of this feared complication of cytotoxic chemotherapy. However, both delayed chemotherapy-induced nausea and breakthrough CINV remain difficult areas of management and require novel treatment strategies. Recent randomized trial evidence has suggested that olanzapine, an atypical antipsychotic, may have a role in both the prevention and treatment of CINV. A systematic review was conducted to assess the efficacy of olanzapine in (a) preventing CINV in highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) and (b) the treatment of breakthrough CINV. The toxicity of olanzapine in this setting was also reviewed.

Methods

MEDLINE, Embase and Cochrane Database of Systematic Reviews databases were searched to identify all randomized clinical trials (RCTs) investigating olanzapine in patients receiving chemotherapy.

Results

A total of 488 patients from three trials of CINV prophylaxis and 323 patients from three trials of breakthrough CINV were included. Regimens including olanzapine were associated with significant improvements in CINV prevention with both HEC and MEC. Single agent olanzapine for breakthrough nausea was superior to standard alternative options.

Conclusion

Data from RCTs support the use of an olanzapine containing combination regimen as an option for CINV prophylaxis and single agent olanzapine for the treatment of breakthrough CINV. In the included trials, the short duration of olanzapine appears safe and well tolerated.     

Granisetron transdermal system and dexamethasone for the prevention of nausea and vomiting in multiple myeloma patients receiving chemo-mobilization: An observational real-world study of effectiveness and safety

PURPOSECyclophosphamide (CY) in a dose of 2–4 g/m² is widely used for hemopoietic progenitor stem cells mobilization. CY administration is associated with several adverse effects, including chemotherapy-induced nausea and vomiting (CINV). This study aimed to evaluate the efficacy and tolerability of granisetron transdermal system (GTDS) plus dexamethasone in the management of CINV in MM patients undergoing chemo-mobilization with CY.METHODSIn this single-center, prospective, observational, real world study, GTDS plus dexamethasone was administered to MM patients receiving chemo-mobilization based on CY 2 g/m2 plus G-CSF in an outpatient setting. The rate of complete response was evaluated as the main outcome. Other outcomes were rate of complete control of CINV, incidence of nausea/vomiting of any grade and safety.RESULTSA total of 88 patients were enrolled. A complete response was achieved in 45.5 % of patients; among them, 39.77 % attained complete control of CINV. Nausea and vomiting never occurred in 34.1 % and 45.5 % of patients, respectively. No episodes of grade 3–4 nausea and/or vomiting were documented. GTDS was safe and well tolerated.CONCLUSIONIn real world, GTDS provided an innovative, effective, and well-tolerated control of CINV in MM patients after chemo-mobilization with CY. The study found out effectiveness of a non-invasive delivery system of antiemetic.