Tracking Nausea/Vomiting in Diary Helped Health Care Team Reduce Symptoms

Asking patients to track their nausea and vomiting after a course of chemotherapy helped the health care team to adjust medications and achieve better control of symptoms, according to the results of a small single center study.

“The use of a simple diary in the current study allowed the clinical staff to make adjustments to patients’ antiemetic therapy,” wrote researchers led by Frida Barak, MD, of Barzilai Medical Center Ashkelon, Israel. “That involvement gave the staff a sense of caring, showing them that they had successfully taken care of their patients.”

The goal of the study was to evaluate whether the use of a diary was an effective tool to ensure nursing staffs’ effective communication with patients, to adjust antiemetic therapy, and to involve patients in the process.

The study included any new woman with operable breast cancer who was treated with doxorubicin-containing adjuvant chemotherapy. All women were asked to detail any past nausea and vomiting they experienced during pregnancy or during other experiences. For this study, the patients were asked to rank their nausea/vomiting on a scale from 1 (none) to 4 (severe) each day after their chemotherapy regimen began. Based on information in the diary, the healthcare team would adjust the patient’s antiemetic treatment. Forty-seven women completed the study. The mean age of patients was 57 years.

Overall, antiemetic therapy was successful after the first treatment, with 57% of patients not experiencing any nausea or vomiting.

The researchers found that “most patients responded favorably to the opportunity to express their fears and anxieties in diary format and were appreciative of the individual attention.”

Three patients ranked their nausea/vomiting as severe after the first treatment. After consultation with the health care team, one patient continued to experience severe nausea/vomiting, but the other two patients reduced theirs to light or no nausea/vomiting.

In addition, 16 patients ranked their nausea/vomiting as moderate. After review of the diaries, only 4 patients continued at the moderate ranking and 12 had reduced symptoms to light or no nausea/vomiting.

The researchers also looked to see if there was any relationship between nausea and vomiting experienced during pregnancy and that experienced during chemotherapy. Nine women reported having nausea/vomiting during pregnancy and 55% of those also experience moderate-to-severe nausea/vomiting during chemotherapy.

“The results of the current study suggest a propensity (1.5 times higher) for women who experienced nausea/vomiting during pregnancy to experience chemotherapy induced nausea/vomiting,” the researchers wrote. “The knowledge of patient nausea/vomiting during pregnancy, motion sickness related nausea/vomiting, or past personal experience or exposure to nausea/vomiting in others are of major importance for nurses and other clinical staff because they possibly identify patients who could experience nausea/vomiting during chemotherapy.”