by What is Chemotherapy Induced Neutropenia (CIN)?
Chemotherapy Induced Neutropenia (CIN) and Vomiting, commonly known as CINV, refers to the nausea and vomiting experienced by many cancer patients undergoing chemotherapy treatment. Chemotherapy aims to kill fast-growing cancer cells but it cannot differentiate between cancer cells and healthy cells, affecting cells in the stomach and intestine that control nausea and vomiting. This causes CINV in around 70-80% of chemotherapy patients without preventive treatment. CINV can be acute (occurring within 24 hours of chemotherapy) or delayed (occurring more than 24 hours after chemotherapy).
Risk Factors for Chemotherapy Induced Neutropenia (CIN)
Certain chemotherapy drugs and combinations are more emetogenic or likely to cause nausea and vomiting than others. Drugs like cisplatin, doxorubicin, carboplatin and high-dose methotrexate carry a high risk of causing CINV without anti-nausea medications. Female sex, previous experience of nausea and vomiting during chemotherapy cycles, and being younger than 50 years old also increase the risk. Drinking alcohol within 24 hours of chemotherapy can worsen the effects. Failure to manage CINV properly during initial cycles also elevates the risk for subsequent cycles.
Pathophysiology of CINV
Chemotherapy triggers the release of neurotransmitters like substance P and serotonin in the gastrointestinal tract and areas of the brain that control vomiting like the chemoreceptor trigger zone. This results in the vagus nerve signaling nausea and vomiting. Tumor cells themselves can also release serotonin. The areas of the brain involved are the vomiting center in the medulla oblongata and the chemoreceptor trigger zone outside the blood-brain barrier in the brainstem. Cisplatin is believed to directly stimulate serotonin receptors in these areas to cause CINV.
Current Prevention and Treatment Options
Multiple classes of anti-nausea medications are used depending on the risk level and timing of CINV. 5-HT3 receptor antagonists like ondansetron work best for acute CINV while corticosteroids like dexamethasone are good for both acute and delayed phases. Neurokinin-1 receptor antagonists like aprepitant are very effective for preventing delayed CINV from highly emetogenic chemotherapy. Combining different classes of anti-nausea medications gives better results than single agents alone. Non-pharmacological measures like acupressure, ginger, and relaxation techniques may help control milder nausea when used along with medications.
Impact of Uncontrolled CINV
Failure to control CINV can make chemotherapy intolerable for patients and even force them to opt-out of potentially lifesaving treatment. Uncontrolled nausea and vomiting also cause fluid and electrolyte imbalances, dehydration, malnutrition and weight loss. This further weakens the immunity of cancer patients making them more susceptible to infections. CINV also negatively impacts quality of life due to inability to carry on with normal daily activities and social relationships. It imposes an immense physical, mental and financial burden on patients and their caregivers.
Improving CINV Management
To improve CINV management, it is important for oncology teams to do a thorough risk assessment at the beginning of chemotherapy and select the most appropriate anti-nausea regimen based on emetogenicity and patient risk factors. Good counseling of patients regarding expectations, dietary advice and adherence to the prescription are also critical. Breakthrough nausea or unacceptable side-effects from medications should be promptly addressed by dose adjustment or addition of alternate agents. Multi-modal approaches combining preventive medications with non-drug methods can strengthen control of CINV. Better education among patients and medical professionals is needed worldwide to minimize suffering caused by this chemotherapy complication.
In conclusion, Chemotherapy Induced Neutropenia (CIN) poses a major challenge for cancer patients undergoing chemotherapy. With advances in our understanding of its pathophysiology and availability of multiple pharmacological classes targeting different neurobiological pathways, complete prevention of CINV has become an achievable goal when a right multi-drug, multi-modal approach is applied according to the emetogenic potential and individual patient risk factors. However, more awareness is still needed regarding evidence-based practices for optimized CINV management globally so that no patient has to abandon curative treatment due to uncontrolled nausea and vomiting.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
Ravina Pandya, a content writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemicals and materials, etc. With an MBA in E-commerce, she has expertise in SEO-optimized content that resonates with industry professionals.
