Delayed Nausea from Chemotherapy Still a Challenge
Oncologists continue to struggle with how to help their patients ease the nausea that often follows chemotherapy treatment, despite advances in medications designed to quell the uncomfortable queasiness. As a number of as three-quarters of cancer patients experience nausea a day or two after chemotherapy treatment and a quarter of them describe it as severe.
Medications prescribed at the time of chemotherapy infusion can prevent vomiting and nausea, but these new drugs, developed over the last decade, are no better at ending the nausea than long-time drugs that cost a mere fraction at the pharmacy, according to a study by scientists at the University of Rochester Medical Center's James P. Wilmot Cancer Center. The results were published in the October issue of The Lancet Oncology.
"We're very good at preventing vomiting and nausea immediately following chemotherapy, but we can't seem to get a handle on the nausea that people experience two or three days after their treatment," said Jane Hickok, M.D., M.P.H., lead author of the study and research assistant professor of Radiation Oncology. "We need to do better at preventing these symptoms and helping people get back to their normal lives after their treatment.".
Current treatment guidelines for managing nausea and vomiting don't adequately address the prevalence and severity of nausea, especially delayed nausea, and should be updated, she said.
Researchers led a three-year, head-to-head comparison of the new class of medications - short-acting serotonin receptor antagonists, such as Zofran and Kytril - with the long-used nausea drug Compazine - to determine which was better at controlling delayed nausea.
They studied 671 patients at 27 sites across the United States who received doxorubicin to treat newly diagnosed breast cancer or lymphoma. Doxorubicin is considered a moderate emetic on a complex scale rating the severity of vomiting caused by various chemotherapy drugs.
The patients were given the standard antiemetic therapy of a short-acting serotonin receptor antagonist, such as Zofran or Kytril, plus dexamethasone, a synthetic steroid, at the time of their treatment. The three different groups subsequently took Zofran, Kytril or Compazine either regularly or only when they developed nausea or vomiting on the second and third days after the treatment. In each of the study arms, more than 75 percent of the participants still reported delayed nausea.
"Even in the patients who are getting the best drugs available today - from the first day of chemotherapy and each following day - we're finding that it's not working," Hickok said.
And the cost of the drugs is drastically different. A day's dose of Compazine costs less than $4, where as Kytril costs $90 per day and Zofran costs $99 per day.
Hickok led the study as part of a larger group of scientists run by Gary Morrow, Ph.D., at the Community Clinical Oncology Program (CCOP) Research Base at the Wilmot Cancer Center. CCOP is a national cooperative research group funded by the National Cancer Institute. The Wilmot Cancer Center group specializes in improving the quality of life of people who have cancer by studying the symptoms of cancer and the side effects of treatment, such as fatigue, nausea and shortness of breath.
CCOP studies are done in cooperation with community oncologists around the country, which brings the latest experimental treatments to patients in communities nationwide and helps scientists gather enough patients to ask and answer basic questions about cancer.