Predictive patient characteristics for chemotherapy-induced nausea and vomiting in solid organ cancers: an observational study from a tertiary care setting

Abstract

Chemotherapy-induced nausea and vomiting (CINV) persists in a substantial proportion of patients despite guideline-based antiemetic prophylaxis. Current preventive strategies largely emphasize chemotherapy-related risk, with limited consideration of patient-specific factors. This study aimed to identify patient-related predictors of CINV. This single-center longitudinal observational study was conducted at a tertiary care center in North India. Adult patients (≥ 18 years) with solid organ malignancy treated with carboplatin–paclitaxel and uniform antiemetic prophylaxis were enrolled. Demographic, clinical, biochemical, lifestyle, psychological, and disease-related variables were assessed. Multivariate logistic regression analysis was performed to identify independent predictors of CINV defined as CTCAE grade 3 nausea and/or grade ≥ 2 vomiting. A total of 192 patients were included (mean age 53.7 ± 12.0 years), of whom 71.4% were female and 45.8% had metastatic disease. Gynecological cancers were the most common (45.8%), followed by lung (23.4%), breast (14.6%), and gastrointestinal malignancies (11.4%). The overall incidence of composite primary endpoint CINV was 46.8%. Univariate analysis demonstrated higher CINV risk in patients aged < 60 years (OR 2.03), females (OR 2.28), those with higher BMI (OR 1.05) and creatinine clearance (OR 1.01), and those with gynecological cancers (OR 2.91), while alcohol use (OR 0.59) and smoking (OR 0.66) were associated with lower risk. On multivariate analysis, female sex was the only independent predictor of CINV (OR 2.12). Nearly half of patients experienced CINV despite standardized prophylaxis. Female sex emerged as the strongest independent risk factor, underscoring the importance of incorporating patient-specific characteristics into individualized antiemetic decision-making to improve symptom control and treatment outcomes.