Impact of radiation-induced nausea and vomiting on quality of life
Bo Angela Wan
Received: 14 December 2017 /Accepted: 21 May 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose Radiotherapy-induced nausea and vomiting is a common side effect of radiotherapy. It is well-established that nausea
and vomiting have a negative impact on quality of life, but the relative influence of each of symptom is infrequently reported.
This study aimed to compare the effects of nausea and vomiting on quality of life in cancer patients receiving palliative
Methods The Functional Living Index-Emesis (FLIE) is a quality of life questionnaire developed in the
chemotherapy-induced nausea and vomiting setting. The FLIE consists of 18 questions, half of which address nausea
and half of which address vomiting. Three prospective studies on the efficacy of various anti-emetic medications
conducted at our center used the FLIE to assess radiotherapy-induced nausea and vomiting at various time points
during and after palliative radiotherapy. FLIE data from these three studies were combined for the present analysis.
Univariate and multivariate analyses were conducted to assess the relationships between nausea and vomiting, time
of FLIE completion, and patient-reported quality of life.
Results Nausea and vomiting scores both decreased patients’ quality of life. Multivariate modeling showed that both symptoms
significantly influenced patients’ ability to enjoy meals. Nausea was also associated with increased hardship for the patient, while
vomiting imposed more difficulty on the patients’ loved ones.
Conclusions Nausea and vomiting both significantly influence quality of life. Nausea seems to impact the patient more directly,
whereas vomiting affects those closest to the patient.
Quality of life
Vo m i ti n g
Radiotherapy-induced nausea and vomiting (RINV) is a
common side effect of radiotherapy [1–4]. The patho-
physiology of RINV remains unclear but has been re-
ported to affect up to 80% of cancer patients receiving
radiotherapy [2, 3, 5]. Radiotherapy factors such as lo-
cation, field size, dose, and fractionation as well as
other characteristics including chemotherapy, age, anxi-
ety, and alcohol consumption are believed to contribute
to the incidence and severity of RINV [1, 2]. Despite
its prevalence, there is very little research on RINV
when compared to chemotherapy-induced nausea and
vomiting (CINV), and current treatment strategies for
RINV are not always sufficient for management of pa-
tients’ symptoms [1, 4].
The Functional Living Index-Emesis (FLIE) is a val-
idated measurement tool modeled after the Functional
Living Index-Cancer, but with additional emphasis on
the impact of nausea and vomiting on the patient’s
physical activity, social and emotional functioning, and
ability to enjoy meals . The FLIE was originally
designed to measure the impact of CINV on the quality
of life (QoL) of cancer patients receiving chemotherapy
. In the absence of an RINV-specific QoL tool, the
FLIE has also been effectively used to assess changes in
QoL due to RINV [1, 3, 7].
Several studies have reported a relationship between eme-
sis and QoL [1, 2, 5, 6, 8]. Whether nausea or vomiting has a
* Edward Chow
Department of Radiation Oncology, Odette Cancer Centre,
Sunnybrook Health Sciences Centre, University of Toronto, 2075
Bayview Avenue, Toronto, ON M4N 3M5, Canada
Leslie Dan Faculty of Pharmacy, University of Toronto,
Supportive Care in Cancer