High-Dose Rate Brachytherapy in Prostate Cancer Patients – A Study On Nausea and Vomiting

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High-dose rate brachytherapy (HDRB) is one of many treatments for prostate cancer. Despite a reported 80% to 90% success rate in terms of cure rates, nausea and vomiting have been noted as a significant problem. At St. Vincent's Private Hospital, an incidence of nausea and vomiting was estimated at 67% of patients undergoing HDRB. This study examines the possible causes and risk factors of post-operative nausea and vomiting with this treatment option.IntroductionHigh-dose rate brachytherapy (HDRB) is one of many treatments for prostate cancer. Despite a reported high cure rate, incidence of post-operative nausea and vomiting is significant in this patient population undergoing HDRB at St. Vincent's Private Hospital.PurposeTo examine possible causes and identify risk factors for the increased incidence of nausea and vomiting in patients with prostate cancer being treated with HDRB.MethodsA retrospective audit review of patient hospital medical and transport records was performed from January 2003 to December 2005. The sample consisted of 264 consecutive male patients undergoing HDRB treatment for prostate cancer. The sample was divided into one of three groups: 1) asymptomatic, 2) nausea, and 3) nausea and vomiting. Independent variables examined were 1) anesthetics, 2) morphine, 3) method of transport, 4) pain, 5) age, and 6) obesity.Data AnalysisDescriptive statistics, including mean, median, mode, standard deviation, and range using Microsoft Excel, were applied to all variable individually. Statistical significance was established using Chi square test for independence or a one-way analysis of variance (ANOVA).ResultsOf the six variables examined, age, transport, and pain were either statistically significant or an association was found between nausea and vomiting and each of these variables. Anesthetics, morphine, and weight were not significant.ConclusionRisk factors involved in post-operative nausea and vomiting (PONV) for HDRB patients are complex. Factors, such as amount of movement/transport, obesity, age, and morphine use, may place these patients at increased risk. With the identification of age, pain, and transport as being associated with PONV, development of a patient profile for nausea and vomiting may be possible. With a more complete assessment of these patients prior to HDRB treatment, clinicians may be able to target and minimize these risk factors. Development of specific interventions or protocols to minimize PONV in this population could be a next step in reducing this complication.Level of Evidence – Level VI(Melnyk & Fineout-Overholt, 2005)

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