Background

There is limited work on the impact of CINV on Quality of Life (QoL) in Adriamycin-Cyclophosphamide (AC)-treated breast cancer patients. The objectives of the study were: 1) to confirm if symptoms of CINV led to lower QoL during AC; 2) to evaluate the pattern of changes in patients’ QoL during multiple cycles of AC; and 3) to assess if the QoL in an earlier cycle affected the QOL in subsequent cycles of AC.

Methods

This is a secondary pooled data analysis that included 303 Chinese breast cancer patients who received 1177 cycles of adjuvant AC in three prospective antiemetic studies. QoL data was based on Functional Living Index- Emesis (FLIE) scored over three to four AC cycles. CINV symptoms assessed included ‘no significant nausea’ (NSN), ‘significant nausea’ (SN), ‘no vomiting’(NoV), ‘vomiting’(V) and complete response (CR).

Results

Across all AC cycles, the mean scores for the FLIE nausea domain for patients who experienced NSN vs SN were 10.92 vs 53.92 respectively (p<0.0001), with lower scores indicating better QoL; the mean scores for the FLIE vomiting domain for patients who experienced NoV vs V were 1.44 vs 19.11 respectively (p<0.0001), with similar results across subsequent cycles. Analysis of the effect of the QoL in Cycle 1 on the QoL of subsequent cycles revealed the following: for the nausea domain, amongst patients who had cycle 1 FLIE scores >/= vs < the mean, the corresponding scores in Cycle 2 were 6.87 vs 36.71 (p<0.0001); while those for Cycle 3 were 7.07 vs 36.87 (p<0.0001); and those for Cycle 4 were 5.92 vs 21.48 (p<0.0001). Similar findings were observed for the vomiting domain. NEPA- or aprepitant/olanzapine-based antiemetics had significantly better QoL outcomes.

Conclusion

CINV had a significant impact on the QoL of breast cancer patients treated with AC over multiple cycles. 

Implications for Practice

This is a post-hoc analysis of 3 prospective studies for the control of chemotherapy-induced nausea and vomiting (CINV); quality of life (QoL) using contemporary antiemetic regimens in a homogenous group of Chinese breast cancer patients who were receiving a uniform (neo)adjuvant chemotherapy regimen of doxorubicin and cyclophosphamide were evaluated. The results reveal that QoL (based on mean scores for the FLIE) were significantly better for patients who did not experience vomiting or significant nausea than those who did during the first as well as subsequent cycles of chemotherapy. In addition, QoL in an earlier cycle affected the QOL in subsequent cycles of AC. Further, more recent regimens involving olanzapine/aprepitant or NEPA was also associated with a positive impact in patients’ quality of life. Antiemetic guideline-consistent practice and higher clinician awareness of the impact of CINV on patients QoL can further mitigate the negative effects of CINV on patients QoL.