What occurs in the other 20% of cancer patients with chemotherapy-induced nausea and vomiting (CINV)? A single-institution qualitative study

Purpose: Despite recent advances in prophylaxis and management, 20% of patients who receive moderately to severely emetogenic chemotherapy continue to experience nausea and vomiting. Relying on patients’ own words, this study sought to capture and characterize the lived experience with chemotherapy-induced nausea and vomiting (CINV) for this important subgroup of patients. Methods: Solid tumor patients with a history of poorly controlled CINV provided informed consent and participated in a semi-structured interview, which was audio-recorded and transcribed. After data saturation, enrollment ceased, and inductive, qualitative analytic methods were employed. Results: The median age of the 20 enrolled patients was 56 years (range 27–83) with an equal gender split; half had gastrointestinal cancers. Two themes emerged. First, CINV is severe and multidimensional: “It’s like shredding your muscles… It’s doing it over and over again.” This symptom complex has psychosocial implications: “Isolation is a big thing.” Financial toxicity is also implicated: “I use [an antiemetic] when I feel like it is absolutely necessary because it is so expensive I cannot afford it anyway.” The second theme is underreporting of symptoms. Patients seemed to accept N/V as part of treatment and were therefore less forthcoming: “God, if you’re pumping poison in your system, you gotta expect some side effects.” Conclusions: These vivid data should motivate investigators to continue conducting clinical trials CINV and should remind healthcare providers about the importance of patient education on the availability of therapy for breakthrough symptomatology.