Survey Finds Nausea Often Persists During Cancer Therapy Despite Widespread Antiemetic Use

Many patients receiving anticancer therapy continue to experience nausea even when antiemetic drugs are prescribed, according to a cross-sectional survey published in Supportive Care in Cancer. Researchers analyzed 624 anonymized physician-completed questionnaire records to characterize how antiemetics are prescribed in real-world practice, how well nausea and vomiting are actually controlled, and where implementation gaps remain in supportive care. The study mapped each anticancer regimen to the emetic-risk categories of the NCCN Antiemesis guideline, Version 2.2023, applying the highest-risk principle when a regimen contained multiple agents.

The risk distribution was heavily skewed toward the most emetogenic treatments. High-emetic-risk regimens accounted for 389 of 624 records, or 62.3 percent, while moderate-emetic-risk regimens accounted for 150 records, or 24.0 percent. Against this backdrop, nausea proved far more common than vomiting. Acute nausea was reported in 330 of 624 records, or 52.9 percent, and delayed nausea in 238 records, or 38.1 percent. Even after antiemetic treatment, residual nausea persisted in 143 of 624 records, or 22.9 percent, underscoring that the symptom most often incompletely controlled was not vomiting but nausea itself, particularly in its delayed and lingering forms.

Initial antiemetic regimens were predominantly built on 5-HT3 receptor antagonists, which appeared in 555 of 624 records, or 88.9 percent. Guideline implementation, however, could only be assessed with prespecified medication-class proxies based on the first antiemetic regimen, because dose, agent, timing, and delayed-phase continuation were not uniformly captured in the survey records. Among records classifiable as high or moderate emetic risk, the core class-level concordance with the guideline was met in only 188 of 539 records, or 34.9 percent. The picture was starker for high-emetic-risk therapy: the four-class documentation proxy, which reflects the multidrug prophylaxis recommended for the most emetogenic regimens, was observed in just 8 of 389 records, or 2.1 percent.

The statistical analysis added a notable nuance. In multivariable modeling, meeting the core class-level proxy was not significantly associated with fewer residual symptoms, with an adjusted odds ratio of 1.40 and a 95 percent confidence interval of 0.88 to 2.23, meaning the observed association could be compatible with no effect. By contrast, a prior history of chemotherapy-induced nausea and vomiting, known as CINV, was independently associated with residual symptoms, with an adjusted odds ratio of 2.53 and a 95 percent confidence interval of 1.53 to 4.18. As a cross-sectional survey, the study identifies associations rather than causal effects, and the proxy-based assessment of guideline adherence means the concordance figures reflect documented medication classes rather than a complete picture of what patients received.

The authors concluded that antiemetic use was common, yet nausea, particularly delayed and residual nausea, remained frequent, and risk-adapted multidrug prophylaxis for high-risk therapy was incompletely implemented. They argued that improving care will require separately assessing nausea rather than relying on vomiting as the primary endpoint, providing appropriate prophylaxis throughout the entire emetic-risk window rather than only the acute phase, and reassessing control across treatment cycles with attention to prior CINV, tolerability, adherence, and affordability. For a survey population in which highly emetogenic regimens make up the majority of records, the findings suggest that the gap between documented practice and guideline-recommended multidrug prophylaxis remains wide, and that a patient’s history of nausea may be one of the most informative signals for identifying who will continue to struggle despite treatment.

Subject of Research: Real-world antiemetic prescribing and nausea and vomiting control during anticancer therapy

Article Title: Real-world nausea/vomiting control during anticancer therapy: a cross-sectional survey

Article References: Peng, W., Wang, H., & He, C. (2026). Real-world nausea/vomiting control during anticancer therapy: a cross-sectional survey. Supportive Care in Cancer, 34(11), Article 1151. https://doi.org/10.1007/s00520-026-11374-7

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11374-7

Keywords: chemotherapy-induced nausea and vomiting, antiemetic guidelines, NCCN Antiemesis, emetic risk, supportive care, cross-sectional survey, 5-HT3 receptor antagonists, delayed nausea, residual nausea, multidrug prophylaxis, anticancer therapy, guideline adherence