Xiu Hui Low

Computational prediction of state anxiety in Asian patients with cancer susceptible to chemotherapy-induced nausea and vomiting.

Abstract State anxiety, a risk factor for chemotherapy-induced nausea and vomiting (CINV), is a subjective symptom and difficult to quantify. Clinicians need appropriate anxiety measures to assess patients’ risks of CINV. This study aimed to determine the anxiety characteristics that can predict CINV based on computational analysis of an objective assessment tool. A single-center, prospective, observational study was carried out between January 2007 and July 2010. Patients with breast, head and neck, and gastrointestinal cancers were recruited and treated with a variety of chemotherapy protocols and appropriate antiemetics. Chemotherapy-induced nausea and vomiting characteristics and antiemetic use were recorded using a standardized diary, whereas patients’ anxiety characteristics were evaluated using the Beck Anxiety Inventory. Principal component (PC) analysis was performed to analyze the anxiety characteristics. A subset known as principal variables, which had the highest PC weightings, was identified for patients with and without complete response, complete protection, and complete control. Chemotherapy-induced nausea and vomiting events and anxiety characteristics of 710 patients were collated; 51%, 30%, and 20% were on anthracycline-, oxaliplatin-, and cisplatin-based therapies, respectively. Most patients suffered from delayed CINV, with decreasing proportions achieving complete response (58%), complete protection (42%), and complete control (27%). Seven symptoms (fear of dying, fear of the worst, unable to relax, hot/cold sweats, nervousness, faintness, numbness) were identified as potential CINV predictors. This study demonstrates the usefulness of PC analysis, an unsupervised machine learning technique, to identify 7 anxiety characteristics that are useful as clinical CINV predictors. Clinicians should be aware of these characteristics when assessing CINV in patients on emetogenic chemotherapies.

Electronic database to detect drug–drug interactions between antidepressants and oral anticancer drugs from a cancer center in Singapore: implications to clinicians

Electronic drug interaction databases are often utilized in clinical practice to detect for possible drug–drug interactions between drug pairs. It is uncertain, however, whether most of these detections interactions are clinically important in practice. To demonstrate these issues, this study utilized a comprehensive drug–drug interaction (DDI) electronic database to elucidate the prevalence of DDIs at a cancer centre between antidepressants and oral anticancer drugs (ACDs).

Impact of cancer-related fatigue on chemotherapy-induced nausea and vomiting in Asian cancer patients†

Cancer‐related fatigue (CRF) has been suggested to be associated with the occurrence of chemotherapy‐induced nausea and vomiting (CINV). This study aims to evaluate the potential of CRF in predicting the occurrence of CINV.

Antiemetic Effectiveness and Nausea and Vomiting Incidence During Capecitabine and Oxaliplatin Chemotherapy

Background:Capecitabine and oxaliplatin (XELOX) chemotherapy causes nausea and vomiting, despite adequate administration of antiemetics. Furthermore, specific risk factors that increase this risk are not elucidated. Objective:To appraise the effectiveness of antiemetics to prevent XELOX-induced nausea and vomiting. Methods:This was a single-center, prospective, cohort study. Patients were recruited on the day of chemotherapy and received follow-up after 5 days to assess nausea and vomiting and use of antiemetics. Patients were assessed for nausea and vomiting control and clinical endpoints of complete response, complete protection, and complete control. Multivariate logistic regression was used to evaluate the risk factors. Results:Mean age of the 156 patients analyzed was 60 years (SD = 9.0) with 88 men (56.4%) and 68 women (43.6%). Patient proportions achieving complete response (87.8%), complete protection (80.8%), and complete control (62.8%) within 24 hours after chemotherapy declined throughout the follow-up period to 76.9%, 64.7%, and 48.7%, respectively. Patients with fewer than three risk factors (odds ratio [OR] = 3.13, p = .006), those receiving oxaliplatin less than 100 mg/m2 (OR = 3.23, p = .009) and capecitabine less than 1,500 mg/m2 (OR = 5.00, p = .04), were more likely to achieve complete response. Conclusions:An unacceptably high proportion of patients receiving XELOX were identified as being unable to attain adequate control of nausea because of inadequate usage of delayed antiemetic prophylaxis. Clinicians should be aware of the chemotherapy-induced nausea and vomiting patterns in this subgroup of patients on XELOX and tailor appropriate management plans. Incorporation of delayed antiemetics to existing institutional guidelines for chemotherapy-induced nausea and vomiting management may improve patients’ tolerance of XELOX.

3072 POSTER Impact of Adherence to Antiemetic Regimens on Outcome of Nausea and Vomiting Control Among Asian Breast Cancer Patients Receiving Anthracycline-based Chemotherapy

Background: Non-adherence to oral anticancer agents has been identified as a prevalent behavior amongst breast cancer patients. However, the prevalence of non adherence to outpatient antiemetic regimens that are prescribed for delayed emesis prevention in breast cancer patients is limited in the literature. Hence, this study was conducted to evaluate the impact of adherence to delayed antiemetic regimens on chemotherapy induced nausea and vomiting (CINV) control in breast cancer patients, and to identify patient characteristics that may be associated with non-adherence to antiemetic regimens. Methods: This was a prospective, observational study conducted at the largest ambulatory cancer center in Singapore from December 2006 to January 2011. All breast cancer patients receiving anthracycline-based chemotherapy and standardized outpatient antiemetic regimens were recruited. On the day of chemotherapy, patients were given a standardized 5-day diary to document their emesis events and their demographics obtained via interview. Pearson Chi-square test and multiple logistic regression were performed to analyze the impact of adherence on CINV control. Results: A total of 361 eligible patients were included in the final analysis (mean = 50.0±8.9 years). Majority of the patients were Chinese (80.1%) and diagnosed with Stage 2 and above breast cancer (88.1%). Almost half of the patients (42.1%) were non-adherent to their prescribed delayed antiemetics regimens, with dexamethasone usage being the least adhered to (non adherence: 37.4%). After adjusting for potential confounders (ethnicity, education level and stage of disease), patients who were adherent to antiemetics were more likely to achieve complete CINV control (defined as no emetic episodes, no nausea, and no rescue therapy required) than patients who were non adherent (NNT=9.6; Adjusted OR=1.74, 95% CI: 1.01 3.01). In addition, young women aged between 21−40 years old, pursued higher education, and diagnosed with Stage 1 breast cancer were associated with non adherence to antiemetics (p < 0.05). Conclusion: This is the largest study to date to evaluate the prevalence of non-adherence to delayed antiemetics among breast cancer patients. Our findings indicate that a substantial amount of Asian breast cancer patients (42.1%) were not adherent to their antiemetic regimens, which may have resulted into poor control of CINV.

Clinical predictors of chemotherapy-induced nausea and vomiting through identification of principal variables in patients undergoing AC and XELOX regimens

Objectives: State anxiety is a risk factor for chemotherapy-induced nausea (N) and vomiting (V). However, objective assessments are not routinely performed to assess patients’ anxiety statuses. This study identifies anxiety characteristics that distinguish patients with and without CINV based on the Beck Anxiety Inventory (BAI), an objective assessment tool. Methods: NV events were collated from 127 cancer patients undergoing moderately-emetogenic chemotherapy (MEC) consisting of intravenous oxaliplatin (130mg/m2 on day 1, every 21 days) and oral capecitabine (2000mg/m2/day, days 1–14) (XELOX). These events were correlated with 21 anxiety characteristics belonging to the subjective, neuro physiological, autonomic and panic domains of the BAI. Principal Components (PCs) analysis, a mathematical projection method used for investigating relationships among multiple correlated variables and explaining causes of variation in datasets, was used for analysis. An 80% cut-off was used to determine the number of PCs retained. Statistical analysis was performed using the Student’s t-test. Results: Majority of patients were Chinese (90%) and over 50 years old (87%). Approximately half were males (56%). Higher proportions of patients suffered from delayed than acute NV. Females were significantly more anxious than males (BAI scores: 12.1±9.4 versus 6.7±6.5, p=0.001). Over a third of the variation in anxiety experienced by patients with and without NV was explained by subjective characteristics, including ‘being scared’ (40.1–48.5%) and ‘helplessness’ (34.7–41.4%). ‘Nervousness’ was experienced solely by patients who experienced N. In addition, two neuro-physiological symptoms could be used to distinguish between patients who suffered from acute NV (‘dizziness’, 7.9–8.3% variation in non-sufferers) and delayed NV (‘unsteady gait’, 6.8–11.5% variation in sufferers). Conclusions: Patients with and without chemotherapy-induced NV while on XELOX therapy report different types of anxiety symptoms. These symptoms are useful as potential measures of state anxiety for clinicians to assess a patient’s CINV risk in their daily practice.

Utilizing a pharmacoinformatics tool for the prediction of chemotherapy-induced nausea and vomiting in Asian patients on emetogenic chemotherapies

Objectives: A pharmacoinformatics tool was employed in this prospective, cohort study to determine its utility in identifying risk factors that are useful as predictors of chemotherapy-induced nausea and vomiting (CINV). Methods: Asian patients on a variety of chemotherapy regimens and appropriate antiemetic treatment were recruited from January 2007–July 2010. CINV events were recorded using a CINV diary. Pharmacoinformatics analysis involved principal component analysis of 12 risk factors to differentiate patients with and without complete response (CR), complete protection (CP) and complete control (CC). Results: 710 patients were recruited. Mean age was 52.9±10.3 years. Majority were females (67%) and Chinese (84%). Patient proportions that achieved CR, CP and CC were 58%, 42% and 27% respectively. Five risk factors were identified as potential predictors of these endpoints. Period of alcohol drinking and history of CIV were predictive in cisplatin-based regimens, while drinking frequency and history of CIN were predictive in anthracycline-based and oxaliplain-based regimens. Fatigue interference was a better predictor than severity generally Conclusions: This study has successfully utilized a pharmacoinformatics tool to pinpoint 5 clinical predictors in patients whose CINV are not well managed. Future research should further optimize antiemetic therapies in these populations.S Support Care Cancer (2011) 19 (Suppl 2):S67–S370 DOI 10.1007/s00520-011-1184-yObjectives: Patients with and without CINV report different anxiety symptoms. This study utilized a novel pharmacoinformatics approach to identify anxiety symptoms that could predict chemotherapy-induced nausea and vomiting (CINV) based on a 21-item objective assessment tool (Beck Anxiety Inventory). Methods: Asian patients on a variety of chemotherapy regimens and appropriate antiemetic treatment were recruited from January 2007–July 2010. CINV events were recorded in a CINV diary. The principal variable (PV) approach was used for pharmacoinformatic analysis of 21 anxiety symptoms to differentiate patients with and without complete response (CR), complete protection (CP) and complete control (CC). Results: 710 patients were recruited. Mean age was 52.9±10.3 years. Majority were females (67%) and Chinese (84%). Patient proportions that achieved CR, CP and CC were 58%, 42% and 27% respectively. Seven items (33%) were identified as clinical predictors of the CINV endpoints. ‘Fear of dying’ was a predictor for CINV in head-and-neck and gastrointestinal cancer patients receiving platinum-based chemotherapies. In addition, ‘hot/cold sweats’ was associated with head-and-neck cancer patients, while ‘nervousness’ and ‘faintness’ were mainly observed in gastrointestinal cancer patients. On the other hand, ‘fear of the worst’, ‘numbness’ and ‘unable to relax’ predicted for poor CINV control in breast cancer patients receiving anthracycline-based chemotherapies. Conclusions: This study has successfully demonstrated that anxiety symptoms vary among patients who experience different cancers. They may experience different efficacy outcomes with their antiemetics. The PV approach is able to identify 7 anxiety-associated symptoms that can be clinically-relevant when assessing CINV risks among cancer patients.

Integration of pharmacoinformatics as part of onco-culture: predicting chemotherapy-induced nausea and vomiting from patients' anxiety symptoms

Objectives: A pharmacoinformatics tool was employed in this prospective, cohort study to determine its utility in identifying risk factors that are useful as predictors of chemotherapy-induced nausea and vomiting (CINV). Methods: Asian patients on a variety of chemotherapy regimens and appropriate antiemetic treatment were recruited from January 2007–July 2010. CINV events were recorded using a CINV diary. Pharmacoinformatics analysis involved principal component analysis of 12 risk factors to differentiate patients with and without complete response (CR), complete protection (CP) and complete control (CC). Results: 710 patients were recruited. Mean age was 52.9±10.3 years. Majority were females (67%) and Chinese (84%). Patient proportions that achieved CR, CP and CC were 58%, 42% and 27% respectively. Five risk factors were identified as potential predictors of these endpoints. Period of alcohol drinking and history of CIV were predictive in cisplatin-based regimens, while drinking frequency and history of CIN were predictive in anthracycline-based and oxaliplain-based regimens. Fatigue interference was a better predictor than severity generally Conclusions: This study has successfully utilized a pharmacoinformatics tool to pinpoint 5 clinical predictors in patients whose CINV are not well managed. Future research should further optimize antiemetic therapies in these populations.S Support Care Cancer (2011) 19 (Suppl 2):S67–S370 DOI 10.1007/s00520-011-1184-yObjectives: Patients with and without CINV report different anxiety symptoms. This study utilized a novel pharmacoinformatics approach to identify anxiety symptoms that could predict chemotherapy-induced nausea and vomiting (CINV) based on a 21-item objective assessment tool (Beck Anxiety Inventory). Methods: Asian patients on a variety of chemotherapy regimens and appropriate antiemetic treatment were recruited from January 2007–July 2010. CINV events were recorded in a CINV diary. The principal variable (PV) approach was used for pharmacoinformatic analysis of 21 anxiety symptoms to differentiate patients with and without complete response (CR), complete protection (CP) and complete control (CC). Results: 710 patients were recruited. Mean age was 52.9±10.3 years. Majority were females (67%) and Chinese (84%). Patient proportions that achieved CR, CP and CC were 58%, 42% and 27% respectively. Seven items (33%) were identified as clinical predictors of the CINV endpoints. ‘Fear of dying’ was a predictor for CINV in head-and-neck and gastrointestinal cancer patients receiving platinum-based chemotherapies. In addition, ‘hot/cold sweats’ was associated with head-and-neck cancer patients, while ‘nervousness’ and ‘faintness’ were mainly observed in gastrointestinal cancer patients. On the other hand, ‘fear of the worst’, ‘numbness’ and ‘unable to relax’ predicted for poor CINV control in breast cancer patients receiving anthracycline-based chemotherapies. Conclusions: This study has successfully demonstrated that anxiety symptoms vary among patients who experience different cancers. They may experience different efficacy outcomes with their antiemetics. The PV approach is able to identify 7 anxiety-associated symptoms that can be clinically-relevant when assessing CINV risks among cancer patients.

Identification of anxiety symptoms in patientswith chemotherapy-induced nausea and vomitingundergoing moderately-emetogenic chemotherapy

Objectives: State anxiety is a risk factor for chemotherapy-induced nausea (N) and vomiting (V). However, objective assessments are not routinely performed to assess patients’ anxiety statuses. This study identifies anxiety characteristics that distinguish patients with and without CINV based on the Beck Anxiety Inventory (BAI), an objective assessment tool. Methods: NV events were collated from 127 cancer patients undergoing moderately-emetogenic chemotherapy (MEC) consisting of intravenous oxaliplatin (130mg/m2 on day 1, every 21 days) and oral capecitabine (2000mg/m2/day, days 1–14) (XELOX). These events were correlated with 21 anxiety characteristics belonging to the subjective, neuro physiological, autonomic and panic domains of the BAI. Principal Components (PCs) analysis, a mathematical projection method used for investigating relationships among multiple correlated variables and explaining causes of variation in datasets, was used for analysis. An 80% cut-off was used to determine the number of PCs retained. Statistical analysis was performed using the Student’s t-test. Results: Majority of patients were Chinese (90%) and over 50 years old (87%). Approximately half were males (56%). Higher proportions of patients suffered from delayed than acute NV. Females were significantly more anxious than males (BAI scores: 12.1±9.4 versus 6.7±6.5, p=0.001). Over a third of the variation in anxiety experienced by patients with and without NV was explained by subjective characteristics, including ‘being scared’ (40.1–48.5%) and ‘helplessness’ (34.7–41.4%). ‘Nervousness’ was experienced solely by patients who experienced N. In addition, two neuro-physiological symptoms could be used to distinguish between patients who suffered from acute NV (‘dizziness’, 7.9–8.3% variation in non-sufferers) and delayed NV (‘unsteady gait’, 6.8–11.5% variation in sufferers). Conclusions: Patients with and without chemotherapy-induced NV while on XELOX therapy report different types of anxiety symptoms. These symptoms are useful as potential measures of state anxiety for clinicians to assess a patient’s CINV risk in their daily practice.