Impact of chemotherapy-induced nausea and vomiting on health-related quality of life and resource utilization: A systematic review

https://doi.org/10.1016/j.critrevonc.2015.12.001Get rights and content

Highlights

  • Chemotherapy-induced nausea and vomiting (CINV) is a particularly distressing event for oncology patients.

  • Evidence supports the notion that CINV continues to have a negative impact on HRQoL of patients, even for those receiving moderately emetic chemotherapy.

  • Preventive care of CINV and its appropriate management are crucial for both maintaining patients’ quality of life and limiting costs.

Abstract

Background

Chemotherapy-induced nausea and vomiting (CINV) is a particularly distressing event for oncology patients. This review aims at analyzing the impact of CINV on Health-Related Quality of Life (QoL) and on the use of healthcare resources.

Methods

A systematic search was conducted according to the PRISMA statement on MEDLINE, EMBASE and NHS EED.

Results

Sixty-seven studies were included in the final selection. Despite the availability of numerous treatment options, CINV was found to have a strong impact on HRQoL of patients. Direct costs are particularly affected, but this result could be due to scarcity of studies assessing indirect costs.

Conclusions

Evidence supports the notion that CINV continues to have a negative impact on HRQoL of patients, even for those receiving moderately emetic chemotherapy. Further studies need also to collect data on the cost of CINV, particularly indirect costs, to ensure that decisions on use of healthcare resources are better supported.

Section snippets

Background

Nausea and vomiting represent a common side-effect of chemotherapy, potentially affecting 60–80% of oncology patients (ONS, 2014, de Boer-Dennert et al., 1997). Nausea is defined as the unpleasant feeling causing the desire to vomit, and can be accompanied by symptoms such as tachycardia, dizziness and weakness (Camp-Sorrell, 2005). Vomiting is defined as the contraction of the muscles of the abdomen and diaphragm that triggers the expulsion of stomach contents (Baker et al., 2005).

Identification of studies

This review adopts the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement (Moher et al., 2010). A systematic search was conducted on MEDLINE, EMBASE and the National Health System Economic Evaluation Database (NHS EED). Reference lists of the most relevant retrieved articles were screened to find additional studies not identified through the database search. The search strategy was developed using the PICOS (Patient, Intervention, Comparator, Study) framework.

Literature search

A total of 394 studies were found through MEDLINE (285), EMBASE (55) and NHS EED databases (54). After duplicates removal (27) and addition of potentially relevant papers from bibliography search (30), 397 studies were screened by two reviewers. Sixty-seven studies were included in the final selection. Kappa statistic was good for title screening (0.78), moderate for the abstract screening phase (0.50) and good for full-text screening (0.74). Fig. 1 shows the selection process and reasons for

Discussion

CINV represents a common and serious side effect for oncology patients (Dikken and Wildman, 2013). Anxiety, poor nutrition, dehydration, difficulty to eat and even physical damage to the stomach are some of the consequences of CINV. Despite significant improvements thanks to the introduction of treatments in the 1990s, CINV remains a substantial problem for oncology patients (Grunberg et al., 2002) and with the rapid development of new chemotherapy treatments, it becomes more and more important

Author contributions

This review is a joint effort of all the co-authors and the paper has been written jointly by them. SS contributed to the design of the review, screening, review of the data and writing of the manuscript. BP contributed to the screening and extraction of the data and writing of the manuscript. RT contributed to the design of the review, to the final recommendations and to the writing of the manuscript. All authors have approved the final article.

Conflict of interest statement

We declare that none of the authors or their organisations has any conflict of interest in the publication of this paper.

Acknowledgements

This work was supported by an unrestricted grant from Helsinn Group. The authors were responsible for all content and Helsinn had no involvement in the development of this publication. The authors thank the anonymous reviewers for their insightful comments.

Silvia Sommariva is a researcher at the Centre for Research on Health and Social Care Management, Bocconi University. She graduated in Business Administration from Bocconi University, and obtained an MSc in Management of Public Administration and International Institutions from Bocconi University and a Master of Public Administration with major in health and social policy from State University of New York. Her main research areas of interest are policies related to biotechnologies in

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  • Cited by (0)

    Silvia Sommariva is a researcher at the Centre for Research on Health and Social Care Management, Bocconi University. She graduated in Business Administration from Bocconi University, and obtained an MSc in Management of Public Administration and International Institutions from Bocconi University and a Master of Public Administration with major in health and social policy from State University of New York. Her main research areas of interest are policies related to biotechnologies in healthcare, healthcare research funding policies and health economics.

    Benedetta Pongiglione is a PhD student at the London School of Hygiene and Tropical Medicine. She obtained a MSc in Economic and Social Sciences from Bocconi University and went on to attend the European Doctoral School of Demography program. Her main research interest is the study of health inequalities, particularly inequalities in healthy ageing, with a focus on the role of health-related behaviours. She is currently developing a measurement model to estimate the burden of diseases and disability on mortality, and assess socioeconomic inequalities in healthy survival and the role of health-related behaviour in mediating this association.

    Rosanna Tarricone is an Associate Professor at the Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy. She graduated in Business Administration from Bocconi University, obtained an MSc in Health Services Management and a PhD in Economics from the University of London. She is the Director of the Centre for Health and Social Care Management (CERGAS) at Bocconi University and the Scientific Director of the European Health Technology Institute for Socio-Economic Research. Her main areas of research include healthcare management, health economics, economic analysis of healthcare services, health policy and health technology assessment. Rosanna is a member of the International Association of Health Economics (iHEA), the International Health Technology Assessment (HTAi), and the International Society for Pharmacoeconomics and Outcome Research (ISPOR). She is the author of numerous papers and books on healthcare management and economics.

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