الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 83 |  |  |
| | | from | 83 | | |
Abstract
Chemotherapy-induced nausea and vomiting (CINV) remains a significant side effect after chemotherapy that affects patients’ nutritional status, psychology and quality of life. Many risk factors have been recognized for development of CINV including emetogenicity of chemotherapy and individual risk factors. Several lines of antiemetics have been proposed to manage this important side effect of chemotherapy with continuous updates. This work aimed at investigating the possible role of Helicobacter pylori infection as a risk factor for CINV.
The present work included 60 patients diagnosed with breast cancer; 30 patients infected with Helicobacter pylori detected by fecal antigen test and 30 patients free from H. pylori infection. These patients were chosen according to certain inclusion criteria (age 18 -75 years at the time of inclusion, WHO performance status 0-1, adequate bone marrow function, adequate liver, adequate renal functions, naive to chemotherapy, and scheduled to receive their first course of anthracycline-based chemotherapy) and exclusion criteria (Previous history of chemotherapy, pregnancy and lactation, any cardiac diseases and refusal of treatment).
All patients were subjected to pretreatment evaluation regarding clinical history, physical examination, laboratory investigations (full blood count, serum renal function tests, serum liver function tests and Fecal antigen test for Helicobacter pylori) and radiological examination (chest X-ray/CT, US abdomen and pelvis/CT, bone scan if indicated and Echocardiogram). Treatment was then initiated in the form of anthracycline-based chemotherapy with assessment of chemotherapy induced nausea and vomiting after the first cycle where patients recorded episodes of nausea, vomiting, and use of antiemetics in a diary during the first 24 hours and during days 2–5 following chemotherapy. The grade of nausea and vomiting (grade 0–4) was defined using the National Cancer Institute–Common Toxicity Criteria (NCI–CTC, version 4.0).
The patient characteristics were homogenous between the two study groups with no statistically significant difference, expect for menopausal status. As regards the tumor characteristics, the two groups were comparable without any statistically significant difference.
In the present work, acute nausea developed in 60% and 50% of patients in the H. pylori positive and negative groups respectively. Acute vomiting was reported in 60% and 46.7% of patients in the two groups respectively. Delayed nausea was seen in 86.7% and 73.3% of the two groups respectively whereas delayed vomiting was encountered in 76.6% and 73.3% of patients in the two groups respectively. Although incidence of both acute and delayed CINV was higher in patients with positive H. pylori, the difference was not statistically significant.
In this work, many variables have been studied in relation to CINV in both the Helicobacter positive and negative groups. These variables included age, menopausal status, concomitant medical co-morbidities, history of motion sickness/morning sickness of pregnancy, stage of the disease and hormonal receptor status.
Regarding the age, younger age has been significantly associated with acute CINV and delayed vomiting in the Helicobacter pylori positive group and delayed nausea in the Helicobacter pylori negative group. Also, Helicobacter pylori infection has been significantly associated with acute vomiting in the younger age group.
In this work, menopausal status has been related to CINV in a pattern similar to that of the age variable.
The next evaluated variable was concomitant medical co-morbidities. Absence of concomitant co-morbidities was significantly associated with both acute and delayed chemotherapy induced vomiting (CIV) but not nausea.
Motion sickness was only significantly associated with acute vomiting in the Helicobacter pylori negative group.
History of morning sickness in prior pregnancies, stage of the breast cancer disease and hormonal receptor status didn’t show any significant relation to chemotherapy-induced nausea and vomiting in both groups.