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User:MTFFTM/Cancer and nausea

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Article Draft

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lead: Section on PROs

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Article body: Patient reported outcomes (PROs) ←- wikilink allow patients to voice their perspective on health and behavioral status through self administered questionnaires. (PCORI source) Cancer and nausea have been measured with the Patient Reported Outcomes Measurement System (PROMIS) using surveys with questions such as “in the last 7 days, how severe was your nausea?” (PCORI) These questions can aid clinicians in tailoring nausea treatment specific to variations in severity of chemotherapy induced emesis from patient to patient. (Cella). One notable benefit of PROs is that surveys can be administered electronically, meaning patients who are too sick to go to the doctor can do it from home. (Broderick)

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Limitations

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While helpful, PROs are subject to bias since they are reported after the symptoms are experienced. (cella) Errors in patients’ memories can influence their PROs compared to if they had been asked while experiencing nausea rather than afterwards. (cella) This can lead to ratings which may not accurately reflect how patients perceive their nausea at the moment. (cella)

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Common side effects:

Depending on the type and dose of antiemetics prescribed, common side effects may include: headache, constipation, diarrhea, insomnia, agitation, acne, weight loss, weight gain, dizziness, or drowsiness. In addition, a small percentage of patients opting to use medical cannabis have shown to become dependent on it after treatment concludes.

Section on psychosocial intervention:

  • Diet: Small palatable meals are normally tolerated better than big meals in people affected by nausea and vomiting in cancer. Carbohydrate meals are better tolerated than spicy, fatty and sweet foods. Cool, fizzy drinks are found to be more palatable than still or hot drinks.
  • The avoidance of environmental stimuli, such as sights, sounds, or smells that may initiate nausea.
  • Behavioral approaches, such as distraction, relaxation training and Cognitive behavioural therapy, Yoga, and Guided imagery may also be useful.
  • Classical Conditioning ← wikilink pairing nausea symptoms with certain flavors or odors have shown to restrict nausea symptoms to those contexts.
  • Placebos were found to have varying effects on nausea symptom severity but there is not enough evidence to give a definitive answer
  • Expectation: Clinicians who attempted to manipulate expectations of nausea in chemotherapy patients found that interventions with people who highly expected to experience nausea lowered their actual nausea severity. On the other hand, interventions done on patients with low expectations actually had higher levels of nausea.
  • Alternative medicine: Acupuncture and ginger have been shown to have some anti emetic effects on chemotherapy-induced emesis and anticipatory nausea, but have not been evaluated in the nausea of far advanced disease.  

Financial Implications

-Nausea can lead to rehospitalization for dehydration, weight loss, etc.

-Cost of antiemetic drugs

-Individual cost

-cost to the healthcare system

CINV has shown to bring a heavy financial burden on cancer patients. These costs may discourage patients from seeking treatment or purchasing medication despite nausea being one of the most debilitating side effects of chemotherapy. (Gupta) In addition to hospital fees, studies have found that costs incurred for prescription antiemetics averaged between $100-1400 per chemotherapy cycle depending on the drugs prescribed. (Gupta)

In addition to patient costs, CINV also takes a heavy financial toll on the healthcare system at large. General cancer symptom management has shown to make up 5% of annual hospital expenses, with the cost of CINV changing with antiemetic treatment. (Corlotto et al.) It was found that people receiving prophylactic treatment posed a significantly lower burden on the healthcare system. In contrast, patients who received no prophylactic treatment were shown to pose a substantial cost to the healthcare system (corlotto These additional costs have shown to be associated with repeated hospital visits and emergency medication for uncontrolled CINV. (Corlotto).  

No numbers and just cite trends across studies

-Is this on the healthcare system or the patients? Difficult to interpret data

Ways to prevent dehydration

Cautions against cannabis

Adding a source from 2016 because the existing source on the benefits of cannabis is from 2007 (wilkie)

Although medical cannabis has shown to have these benefits, 9% of patients using it for palliative treatment have reported becoming dependent on it after treatment has concluded. (Wilkie)

Added new source at other measures and included yoga and guided imagery

Bibliography

  1. Stover AM, Urick BY, Jansen J, et al. (2022). Developing Patient-Reported Outcome Measures to Assess Side Effects of Cancer Treatment. Patient-Centered Outcomes Research Institute (PCORI). https://doi.org/10.25302/09.2021.ME.150732079 Patient reported outcomes from cancer treatments to be used in the new section on PROs

-PCORI nausea PRO questions

  1. https://mmshub.cms.gov/sites/default/files/Patient-Reported-Outcome-Measures.pdf PRO definitions
  1. Veronica F Quinn, Ben Colagiuri, Placebo Interventions for Nausea: a Systematic Review, Annals of Behavioral Medicine, Volume 49, Issue 3, June 2015, Pages 449–462, https://doi.org/10.1007/s12160-014-9670-3

-systematic review of nonmedical interventions in nausea to be used in other measures section for placebo citation and several other experiments

  • 4. Samami E., Shahhosseini Z., Hamzehgardeshi Z., Elyasi F. Psychological interventions in chemotherapy-induced nausea and vomiting in women with breast cancer: a systematic review. Iran J Med Sci. 2022;47(2):95. - PMC - PubMed (small edit)

Arjun Gupta et al.

5.  Financial Burden of Drugs Prescribed for Cancer-Associated Symptoms. JCO Oncol Pract 18, 140-147(2022).

DOI:10.1200/OP.21.00466

-study of financial cost of antiemetic pills for cancer patients between 181 -1400 dollars

Analyzed cost of medications for several different cancer symptoms

-Can I use this one?

6. Cella, D., & Stone, A. A. (2015). Health-related quality of life measurement in oncology: Advances and opportunities. American Psychologist, 70(2), 175–185. https://doi.org/10.1037/a0037821

-limitations of PROs

8. Wilkie G, Sakr B, Rizack T. Medical Marijuana Use in Oncology: A Review. JAMA Oncol. 2016;2(5):670–675. doi:10.1001/jamaoncol.2016.0155

-9% cannabis cancer users report becoming dependent on it after treatment concluded.

9. Broderick JE, DeWitt EM, Rothrock N, Crane PK, Forrest CB. Advances in Patient-Reported Outcomes: The NIH PROMIS(®) Measures. EGEMS (Wash DC). 2013 Aug 2;1(1):1015. doi: 10.13063/2327-9214.1015. PMID: 25848562; PMCID: PMC4371419.

-PROMIS reasons why it is good for treatments

https://www.cancer.org/cancer/managing-cancer/side-effects/eating-problems/nausea-and-vomiting/what-is-it.html

I noticed the third source on the reference list was dead so I found the same article on a live website and changed  it.

Carlotto, A., Hogsett, V.L., Maiorini, E.M. et al. The Economic Burden of Toxicities Associated with Cancer Treatment: Review of the Literature and Analysis of Nausea and Vomiting, Diarrhoea, Oral Mucositis and Fatigue. PharmacoEconomics 31, 753–766 (2013). https://doi.org/10.1007/s40273-013-0081-2

-Systematic review of financial toxicity of nausea, fatigue, mucositis, diarrhea, and others. Use to gauge cost of nausea to patients and healthcare system.

Karin Jordan, Hans J. Schmoll, Matti S. Aapro,

Comparative activity of antiemetic drugs,

Critical Reviews in Oncology/Hematology,

Volume 61, Issue 2,

2007,

Pages 162-175,

ISSN 1040-8428,

https://doi.org/10.1016/j.critrevonc.2006.08.003

-side effects of antiemetic drugs

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