Clinical Characteristics and Distribution of Chemotherapy-Induced Nausea and Vomiting Severity in Breast Cancer Patients Undergoing Chemotherapy
Keywords:
Breast Cancer, Chemotherapy, CINV, CTCAE, Nausea, VomitingAbstract
Background: Chemotherapy-Induced Nausea and Vomiting (CINV) is one of the most common and distressing side effects of chemotherapy in breast cancer patients, negatively impacting quality of life and treatment adherence. Understanding the clinical characteristics and severity distribution of CINV across different phases is essential for optimizing antiemetic management.
Objective: This study aimed to describe the clinical characteristics and distribution of CINV severity across acute, delayed, and anticipatory phases in breast cancer patients undergoing chemotherapy at a referral hospital in Bandung.
Methods: This prospective cohort study was conducted at the chemotherapy unit of a tertiary referral hospital in Bandung, West Java, Indonesia, from April to May 2026. A total of 144 breast cancer patients receiving outpatient chemotherapy were enrolled using consecutive sampling. Clinical characteristics including age, cancer stage, molecular subtype, ER/PR/HER2 status, chemotherapy regimen, and antiemetic regimen were obtained from medical records. CINV severity was assessed using a validated PRO-CTCAE questionnaire, with responses converted to CTCAE version 5.0 grades (0-4). Data were analyzed descriptively using frequencies and percentages.
Results: The majority of patients were female (99%), aged 40-59 years (61%), diagnosed at stage III (81%), with Luminal B subtype (79%) and HER2 positive status (64%). The most common chemotherapy regimen was AC (Doxorubicin + Cyclophosphamide) at 34%. Dual antiemetic regimen (ondansetron + dexamethasone) was used by 56.9% of patients, while 41.0% received triple regimen (ondansetron + dexamethasone + diphenhydramine). Regarding CINV severity, the acute phase showed the highest failure rate (27%), with Grade 1 being most prevalent (40%). The delayed phase demonstrated better control (14% failure, 53% Grade 0), while the anticipatory phase showed excellent control (2% failure, 83% Grade 0).
Conclusions: CINV severity varies across phases, with the acute phase being the most challenging to control. The majority of breast cancer patients in this study were female, diagnosed at advanced stages, with Luminal B subtype and HER2 positivity. These findings highlight the importance of phase-specific antiemetic strategies, particularly during the acute phase.
References
F. Bray et al., “Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries,” CA. Cancer J. Clin., vol. 74, no. 3, pp. 229–263, 2024, doi: 10.3322/caac.21834.
A. Burguin, C. Diorio, and F. Durocher, “Breast cancer treatments: Updates and new challenges,” J. Pers. Med., vol. 11, no. 8, Aug. 2021, doi: 10.3390/jpm11080808.
K. Gupta, R. Walton, and S. P. Kataria, “Chemotherapy-Induced Nausea and Vomiting: Pathogenesis, Recommendations, and New Trends,” Cancer Treat. Res. Commun., vol. 26, no. December 2020, p. 100278, 2021, doi: 10.1016/j.ctarc.2020.100278.
M. Putri Ekasari, N. Munif Yasin, S. Ari Kristina, and Z. Ikawati, “Effectiveness of Antiemetic Treatment Among Breast Cancer Patients in Inpatient Unit Sardjito General Hospital,” KnE Life Sci., vol. 4, no. 11, p. 8, Mar. 2019, doi: 10.18502/kls.v4i11.3847.
C. C. Horn, “The physiology of vomiting,” in Nausea and Vomiting: Diagnosis and Treatment, Springer International Publishing, 2016, pp. 15–25. doi: 10.1007/978-3-319-34076-0_2.
S. R. Nindya and S. Bakti, “TERAPI MUAL MUNTAH PASCA KEMOTERAPI,” J. Kedokt. Brawijaya, vol. Vol.9, No., 2016.
J. Herrstedt et al., “2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting,” ESMO Open, vol. 9, no. 2, Feb. 2024, doi: 10.1016/j.esmoop.2023.102195.
A. F. Ariyani, A. Purnamayanti, and A. Kirtishanti, “Efektivitas Ondansetron ebagai Profilaksis Mual dan Muntah pada Pasien Kanker Payudara Stadium 3 Pasca Kemoterapi,” vol. 7, no. 1, pp. 41–45, doi: 10.18860/jip.v7i1.16697.
I. Dzikriyani and D. Setiawan, “Cost-effectiveness analysis of antiemetics therapy in breast cancer patients with moderate emetogenic chemotherapy in Prof. Dr. Margono Soekarjo Hospital, Indonesia,” Pharmaciana, vol. 11, no. 3, p. 330, 2021, doi: 10.12928/pharmaciana.v11i3.17650.
A. C. Dueck et al., “Validity and reliability of the us national cancer institute’s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE),” JAMA Oncol., vol. 1, no. 8, pp. 1051–1059, Nov. 2015, doi: 10.1001/jamaoncol.2015.2639.
N. Cancer Institute, “Common Terminology Criteria for Adverse Events (CTCAE) Common Terminology Criteria for Adverse Events (CTCAE) v5.0,” 2017. [Online]. Available: https://www.meddra.org/
J. Kim et al., “Global patterns and trends in breast cancer incidence and mortality across 185 countries,” Nat. Med., vol. 31, no. 4, pp. 1154–1162, Apr. 2025, doi: 10.1038/s41591-025-03502-3.
M. Radak, A. Sharifi, D. Richard, and H. Fallahi, “Breast Cancer and Aging: Understanding the Complex Relationship and Implications for Prevention and Screening,” Dec. 01, 2025, John Wiley and Sons Inc. doi: 10.1002/aac2.70009.
I. B. Setyawan et al., “Sociodemographic disparities associated with advanced stages and distant metastatic breast cancers at diagnosis in Indonesia: a cross-sectional study,” Ann. Med. Surg., vol. 85, no. 9, pp. 4211–4217, Sep. 2023, doi: 10.1097/ms9.0000000000001030.
Y. W. Prajoko et al., “High frequency of the PIK3CA H1047L mutation in Indonesian breast cancer across molecular subtypes,” PLoS One, vol. 20, no. 5 May, May 2025, doi: 10.1371/journal.pone.0322154.
I. Irianiwati, T. C. Gurky, S. L. Anwar, R. G. Bawono, and E. K. Dwianingsih, “Correlation between BRCA1 expression and the advanced stage of triple-negative breast cancer,” Mol. Clin. Oncol., vol. 22, no. 4, Apr. 2025, doi: 10.3892/mco.2025.2827.
T. F. Fonseca, V. S. Pessoa, D. J. Miranda, D. P. Martins, N. A. Costa, and H. R. Lima, “Heart protective effects of cardioactive drugs associated with antineoplastic treatment against breast cancer,” 2022, Termedia Publishing House Ltd. doi: 10.5114/wo.2022.120639.
“Early and locally advanced breast cancer: diagnosis and management NICE guideline,” 2018. [Online]. Available: www.nice.org.uk/guidance/ng101
F. M. Schnell, “Chemotherapy-Induced Nausea and Vomiting: The Importance of Acute Antiemetic Control,” Oncologist, vol. 8, no. 2, pp. 187–198, Apr. 2003, doi: 10.1634/theoncologist.8-2-187.
D. S. Ettinger et al., “NCCN Guidelines Version 2.2023 Antiemesis Continue,” 2023. [Online]. Available: https://www.nccn.
J. A. Roscoe, G. R. Morrow, M. S. Aapro, A. Molassiotis, and I. Olver, “Anticipatory nausea and vomiting,” Oct. 2011. doi: 10.1007/s00520-010-0980-0.
Fauziah Hasdin, Dinda Monika, and Bambang Subakti, “Review Article: Mechanisms and Efficacy of Using Diphenhydramine as a Chemotherapy Premedication,” J. Pharm. Negat. Results, pp. 2268–2276, Oct. 2022, doi: 10.47750/pnr.2022.13.s06.295.
