medication, hospitalisation and
ambulatory visits) were also
increased by CINV events. 4
Increased knowledge of
the mechanisms underlying
the manifestations of nausea
and vomiting as a result of
administration of cytostatic
agents to oncology patients has
undoubtedly greatly contributed
to the development of improved
drugs to prevent emesis. Although
fairly effective in acute CINV, these
agents are less than ideal in the
control of delayed CINV, which
acts through distinct biochemical
and neurological processes.
Therefore, management strategies
based on more than purely
mechanistic aspects that take into
consideration individual variations
in the development of CINV are
strongly needed in the field. 1
Identification of risk factors
The main risk factors identified
in the literature as predictors
of acute and delayed CINV
regardless of prior use of
chemotherapy include patient
characteristics, such as young age
and history of morning sickness,
pre-chemotherapy stress and
anxiety levels, emesis in
TABLE 1
Important risk factors for development of CINV
identified in the literature
Patient-related risk factors
• Age <55 years
• Female gender
• History of nausea and vomiting
• History of morning sickness
(pregnant women)
• Occurrence of nausea and
vomiting after prior cycles of
chemotherapy
• Symptom distress (pain)
• High anxiety before the
chemotherapy session
• Less sleep during the night prior
to the chemotherapy session
• Use of non-prescription
antiemetic drugs at home
• Low alcohol consumption
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Treatment-related risk factors
• Use of anthracycline/
cyclophosphamide-based regimens
(highly emetogenic)
• Use of platinum-based regimens
(highly emetogenic)
• Initial cycles of chemotherapy
• Adherence to antiemetic therapy