Screening A Series Of Predictive Symptoms Before Chemotherapy Induced Vomiting

Objective Chemotherapy-induced vomiting(CIV) has been one of the most frequent trentment-related adverse reactions in cancer therapy, and it affects negatively patients’quality of life (QOL), motivation to follow recommended treatment regimens. Many CIV associated risk factors have been identified, such as gender, age, dringking history, nausea and vomiting during pregnancy, PS status, the emetogenic potential of chemotheropy agents. But in clinical practice, we also observe that patients receiving systematic chemotherapy exhibit multiple symptoms before CIV, such as appetite loss, nausea, fatigue, abdominal distention, constipation, the relationship with CIV is still unknown. Cancer patients always experience mutiple symptoms that are associated with disease itself or treatment. Dodd coined the concept of symptom cluster in order to study interactions of mutiple symptoms. It was defined as three or more concurrent symptoms are related to each other, and it is not necessary for them to share common causing machanism, for example, the disease itself cause pain, the disease and treatment cause fague, however sleepless can be caused by chemotherapy or anxiety, but those symptoms can be a cluster. The presence of multiple symptoms can have an adverse effect on patients outcome and may have synergistic effect as a predictor of patient morbidity. Identification of symptom cluster which may serve to elucidate the pathophysiology of the disease and aid in symptom management, resulting greater therapeutic benefit, we conduct such a study is to explore whether pre-vomiting symptoms are associated with the occurrence of CIV, to determine the close correlative symptoms. and to provide the evidence for relieving CIV, improving quality of life.Methods A prospective, observational study was carried out. An observation was carried out firstly. The symptoms before CIV were recorded in250patients, Symptoms experience were assessed using the Chinese version of the M.D. Anderson Symptom Inventory. and all variables including all symptoms, age, gender, dringking history, KPS status of patients were analyzed in a univariate analysis; and then a multivariate analysis using step-wise logistic regression was performed for those variables of statistical significance to further determine the factors mostly correlated with CIV, the key is to screen symptom cluster. Another continuous experimental study was performed secondly in157cases. Designed medical interventions were given on such correlated symptoms in70patients but not in87control subjects, A comparison of development of correlative symptoms and occurrence of CIV between in interventional and control groups in order to further validate CIV correlative symptoms.Results Among the250patients to clarify a series of predictive symptoms before chemotherapy induced vomiting, occurrence rate of CIV is67.2%, Univariate analysis showed age, the emetogenic potential of chemotheropy agents, dringking history, vomiting during pregnancy, nausea (χ2=17.744), appetite loss (χ2=19.113), constipation (χ2=9.494), abdominal distention (χ2=5.421), difficulty sleeping (χ2=14.400), difficulty concentrating (χ2=5.237), hiccups (χ2=8.294), acid reflex (χ2=7.311), sad (χ2=7.504), and diarrhea(χ2=6.845) were of statistical significance, further multivariate analysis by step-wise logistic regression indicated that constipation (HR=1.931), nausea (HR=2.196), appetite loss(HR=2.410), hiccups (HR=2390) and difficulty sleeping (HR=2.209), and history of drinking (HR=0.511) were correlated with CIV(P<0.05). And the incidence72.0%,45.6%,36.0%,27.6%respectively, of such a series of symptoms, is also high. After medical interventions, the severity scores of pre-vomiting symptoms excepting hiccup decrease significantly than before interventions; and severity scores of symptoms were assuaged significantly than those in control group with the exception of nause and hiccup. Moreover, the occurrence of CIV (30.0%vs50.6%) in the group of intervention decreased remarkably (P=0.009) in comparison with control group.Conclusion Lung cancer patients who receive systmatic chemotheropy often experience mutiple symptoms and symptoms seldom occur isolatedly. CIV is closely related to additional’pre-vomiting symptoms’, such as constipation, nausea, appetite loss, hiccups and difficulty sleeping. It is important to identify those symptoms before CIV for timely intervention on them to relieve CIV and to improve QOF.