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Purpose: Despite significant antiemetic advances, almost 50 % of treated cancer patients still experience nausea and vomiting (N&V). The goal of antiemetic therapy - complete prevention of treatment-induced nausea and/or vomiting (TIN+/-V) - remains elusive for several reasons. Potentially, N&V may be part of a symptom cluster where co-occurring symptoms negatively affect antiemetic management. Consequently, we examined TIN+/-V incidence and the impact of nausea, vomiting and symptom cluster(s) containing them, respectively, on patients' quality of life (QoL) and psychological adjustment across treatment. Methods: A longitudinal secondary analysis was performed on data from a prospective, observational QoL study involving 200 newly diagnosed cancer patients who underwent combined modality treatment. QoL, psychological adjustment and patient/clinical characteristics were examined at pretreatment, on-treatment (8 weeks) and post-treatment. Results: Overall, 62 % of patients experienced TIN+/-V, with TIN (60 %) doubling TIV incidence (27 %). Exploratory factor analyses of QoL scores at each treatment time point identified a recurrent gastrointestinal symptom cluster comprising nausea, vomiting and appetite loss. Approximately two thirds of patients reported co-occurrence of all three symptoms, which exerted synergistic effects of multiplicative proportions on overall QoL. Patients who reported co-occurrence of these symptoms during treatment experienced significantly greater QoL impairment (physical, role and social functioning, fatigue, N&V, appetite loss, overall physical health, overall QOL) and psychological distress (cancer distress, premorbid neuroticism) than those unaffected (0.001 > p ≤ 0.05). Moreover, nausea was more pervasive than vomiting or appetite loss across treatment and had a greater impact on overall QoL. While antiemetic therapy was effective for vomiting and helped prevent/relieve associated appetite loss, the benefits for appetite loss were seemi

Despite significant advances in antiemetic management, almost 50% of cancer patients still experience nausea and vomiting during treatment. The goal of antiemetic therapy is complete prevention of treatment-induced nausea and/or vomiting (TINV); however, realisation of this goal remains elusive, thus supplementary strategies identifying patients at high risk must be employed in the interim. Consequently, we examined TINV incidence and its risk factors, including patient, clinical and pretreatment quality of life (QOL)/psychological factors. Two hundred newly diagnosed cancer patients beginning combined treatment participated in this prospective, longitudinal, observational study. QOL (including TINV), psychological adjustment, and patient/clinical characteristics were examined at pretreatment, on-treatment (8 weeks ± 1 week) and post-treatment. Overall, 62% of patients experienced TINV, with TIN incidence (60%) doubling that of TIV (27%). Eight independent risk factors predicted 73% of TIN incidence: high premorbid/anticipatory NV, moderately/highly emetogenic chemotherapy (M/HEC), longer treatment (>3 months), female gender, surgery prior to adjuvant chemotherapy ± radiotherapy, private health insurance and low emotional functioning (pretreatment). Six independent risk factors predicted 77% of TIV incidence: premorbid/anticipatory vomiting, M/HEC, female gender, cancer resection and low role functioning (pretreatment). TINV still represents a very major concern for patients. Several pretreatment risk factors for the development of TIN and TIV, respectively, were identified. Patients about to undergo cancer treatment, particularly combined treatment involving emetogenic chemotherapy and surgery, should be screened for these factors with a view to modifying standard pretreatment/maintenance antiemetic therapy. Furthermore, and consistent with recent research, it is recommended that more comprehensive interventions combining antiemetics with other effective pharmacolo

Despite the paucity of controlled trials and possible interference with conventional treatments, complementary and alternative therapy (CAT) use is becoming increasingly popular and many patients do not discuss it with their physicians. Consequently, we examined the incidence and type of CAT use, perceived benefits of use, and the relationship between demographic, clinical or psychological factors and use in Western Australian patients. Two hundred newly diagnosed cancer patients beginning conventional multi-modal treatment participated. Health-related quality of life (HQOL), psychological adjustment and CAT use were assessed longitudinally at pretreatment, in treatment (at 8 weeks) and post-treatment. Overall, 30% of patients reported CAT use in the course of treatment. CAT users were predominantly younger (P = 0.004), tertiary educated (P = 0.016), possessed comorbid conditions (P = 0.023), and underwent lengthy treatment (P = 0.004). Patients who underwent lengthy treatment (>6 months) were three times more likely to use CAT than those who did not. Overall, 64% of CAT users perceived benefit from their use, primarily citing enhanced physical and emotional well-being. CAT users, however, did not score significantly better than non-users on any measure of HQOL, physical health or psychological function. CAT users generally reported greater psychosocial distress than non-users across treatment, especially at pretreatment (baseline). However, with ongoing/new CAT use they significantly reduced their distress levels to that of non-users by 8 weeks in treatment (P = 0.042). Complementary and alternative therapies enhanced cancer patients' psychological well-being during the early stages of conventional treatment only. Use of CAT by cancer patients may be a clinical marker for psychosocial distress, and should trigger clinicians to inquire about physical symptoms, and concomitant anxiety and depression.

Fatigue is highly prevalent amongst cancer patients. It is probably the most common unrelieved symptom of cancer, and can reduce physical, psychological and social functioning and cause distress in patients. A longitudinal study is currently in progress at RPH investigating patients’ quality of life (QOL) including fatigue and psychosocial morbidity. Standardised measures were administered to a consecutive series of 198 chemotherapy patients at: (a) pretreatment, (b) on-treatment (8 weeks), (c) post-treatment and (d) 6 months follow-up. The demographic profile of the cohort included 47% male, 53% female and mean age 56 years (SD = 13). Initial results showed that 20% of patients described fatigue as the single most important recent problem. Fatigue was elevated at on- and post-treatment compared to other times (p < .05), and more so in women than men (p < .01). Consistent correlates of fatigue across time were physically-orientated included physical functioning, muscle bulk and weight loss and patients’ perceived physical health (all p < .01; r = 0.4-0.6). Psychological correlates of fatigue were generally weak (r < 0.4) except for depression. Results suggest that physical variables are more important in explaining fatigue. Firmer conclusions about the relative contributions of physical and psychological variables will be made once more mature data becomes available for analyses. Some clinical options geared towards alleviating dysfunctional levels of fatigue amongst cancer patients will be discussed.

Audit has been defined as ‘the systematic, quantifiable comparison of specific clinical practices against explicit current standards in order to identify opportunities to improve the quality of patient care’. Translated this means evaluating the care a patient receives including procedures for diagnosis and treatment and reviewing the outcome from the patient’s perspective. Clinical audit’s main objective is to review the quality of care rather than the cost of providing it, and unlike research which aims to identify the best treatment, audit puts research into practice by measuring the gap between actual practice and evidence based practice. The assessment and then the improvement of quality are widely regarded as forming a cycle of activity which together produce continuing improvements in quality. Many cancer patients experience problems which are psychological in nature. To date most clinical audit efforts in cancer have focused almost exclusively on medical aspects of care. Current care provision is based primarily on the biomedical model with medical interventions offered to address psychosocial issues such as distress, fatigue etc. Most research conducted on psychosocia1 aspects of cancer care is cross-sectional multiple time series questionnaire administration. The primary emphasis here being multivariate statistical analyses in between group designs. The authors report findings from a psychosocial care clinical audit model where 198 cancer patient notes were reviewed extensively by hand in an attempt to add value to quality of life data already collected by self-report questionnaire over time.