Prevalence and risk factors for nausea and vomiting in breast cancer patients undergoing chemotherapy
DOI:
https://doi.org/10.2340/1651-226X.2026.44933Keywords:
breast cancer, chemotherapy, nausea and vomiting, risk factors, meta-analysisAbstract
Background and purpose: Chemotherapy-induced nausea and vomiting (CINV) is a common and severe adverse effect of breast cancer (BC) treatment that compromises treatment adherence and quality of life. This meta-analysis aims to assess the prevalence and risk factors of CINV in BC patients, thereby providing clinical insights for its prevention and improvement.
Patient/material and methods: Relevant literature was identified through an extensive search of electronic databases from their inception up to July 10, 2025: PubMed, Web of Science, Embase, Cochrane, CNKI, Wanfang, and VIP databases on prevalence rates, odds ratios (OR), and corresponding 95% confidence intervals (CI) were extracted for analysis.
Results: The screening process identified 12 eligible studies. The meta-analysis showed that the overall prevalence of CINV in BC patients was 48% (95% CI = 0.37–0.58). Univariate analysis identified the following risk factors: age ≤ 45 years (OR = 3.21, 95% CI = 1.44–7.17) and a history of motion sickness
(OR = 4.85, 95% CI = 1.65–14.30). Multivariate analysis showed that age ≤ 45 years (OR = 2.36, 95% CI =
1.78–3.14), history of motion sickness (OR = 2.05, 95% CI = 1.42–2.98), and chemotherapy cycles ≥ 3 (OR = 2.27,
95% CI = 1.28–4.04) were risk factors. In contrast, anxiety (OR = 2.74, 95% CI = 0.66–11.29) and comorbidities (OR = 1.04, 95% CI = 0.72–1.49) were not significantly associated with CINV in BC patients.
Interpretation: This meta-analysis shows that the prevalence of CINV in BC patients is high. It focused on the Asian population and indicated that younger age, history of motion sickness, and more chemotherapy cycles (≥ 3) were risk factors for CINV. Targeting these risk factors may help prevent CINV in BC patients.
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References
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–63.
https://doi.org/10.3322/caac.21834 DOI: https://doi.org/10.3322/caac.21834
Giaquinto AN, Sung H, Newman LA, Freedman RA, Smith RA, Star J, et al. Breast cancer statistics 2024. CA Cancer J Clin. 2024;74(6):477–95.
https://doi.org/10.3322/caac.21863 DOI: https://doi.org/10.3322/caac.21863
Loibl S, Poortmans P, Morrow M, Denkert C, Curigliano G. Breast cancer. Lancet (London, England). 2021;397(10286):1750–69.
https://doi.org/10.1016/S0140-6736(20)32381-3 DOI: https://doi.org/10.1016/S0140-6736(20)32381-3
EEscala-Garcia M, Morra A, Canisius S, Chang-Claude J, Kar S, Zheng W, et al. Breast cancer risk factors and their effects on survival: a Mendelian randomisation study. BMC medicine. 2020;18(1):327.
https://doi.org/10.1186/s12916-020-01797-2 DOI: https://doi.org/10.1186/s12916-020-01797-2
Sun Y-S, Zhao Z, Yang Z-N, Xu F, Lu H-J, Zhu Z-Y, et al. Risk factors and preventions of breast cancer. Int J Biol Sci. 2017;13(11):1387–97.
https://doi.org/10.7150/ijbs.21635 DOI: https://doi.org/10.7150/ijbs.21635
McDonald ES, Clark AS, Tchou J, Zhang P, Freedman GM. Clinical diagnosis and management of breast cancer. J Nucl Med. 2016;57 Suppl 1:9s–16s.
https://doi.org/10.2967/jnumed.115.157834 DOI: https://doi.org/10.2967/jnumed.115.157834
Nigdelis MP, Karamouzis MV, Kontos M, Alexandrou A, Goulis DG, Lambrinoudaki I. Updates on the treatment of invasive breast cancer: Quo Vadimus? Maturitas. 2021;145:64–72.
https://doi.org/10.1016/j.maturitas.2020.11.006 DOI: https://doi.org/10.1016/j.maturitas.2020.11.006
Cantini L, Trapani D, Guidi L, Boscolo Bielo L, Scafetta R, Koziej M, et al. Neoadjuvant therapy in hormone Receptor-Positive/HER2-Negative breast cancer. Cancer Treat Rev. 2024;123:102669.
https://doi.org/10.1016/j.ctrv.2023.102669 DOI: https://doi.org/10.1016/j.ctrv.2023.102669
Sikov WM, Berry DA, Perou CM, Singh B, Cirrincione CT, Tolaney SM, et al. Impact of the addition of carboplatin and/or Bevacizumab to Neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage II to III triple-negative breast cancer: CALGB 40603 (Alliance). J Clin Oncol. 2015;33(1):13–21.
https://doi.org/10.1200/JCO.2014.57.0572 DOI: https://doi.org/10.1200/JCO.2014.57.0572
Loibl S, O’Shaughnessy J, Untch M, Sikov WM, Rugo HS, McKee MD, et al. Addition of the PARP inhibitor veliparib plus carboplatin or carboplatin alone to standard neoadjuvant chemotherapy in triple-negative breast cancer (BrighTNess): a randomised, phase 3 trial. Lancet Oncol. 2018;19(4):497–509.
https://doi.org/10.1016/S1470-2045(18)30111-6 DOI: https://doi.org/10.1016/S1470-2045(18)30111-6
Oostendorp LJM, Stalmeier PFM, Donders ART, van der Graaf WTA, Ottevanger PB. Efficacy and safety of palliative chemotherapy for patients with advanced breast cancer pretreated with anthracyclines and taxanes: a systematic review. Lancet Oncol. 2011;12(11):1053–61.
https://doi.org/10.1016/S1470-2045(11)70045-6 DOI: https://doi.org/10.1016/S1470-2045(11)70045-6
Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med. 2008;358(23):2482–94.
https://doi.org/10.1056/NEJMra0706547 DOI: https://doi.org/10.1056/NEJMra0706547
Simpson D, Plosker GL. Paclitaxel: as adjuvant or neoadjuvant therapy in early breast cancer. Drugs. 2004;64(16):1839–47.
https://doi.org/10.2165/00003495-200464160-00008 DOI: https://doi.org/10.2165/00003495-200464160-00008
Gupta K, Walton R, Kataria SP. Chemotherapy-Induced Nausea and Vomiting: Pathogenesis, Recommendations, and New Trends. Cancer Treat Res Commun. 2021;26:100278.
https://doi.org/10.1016/j.ctarc.2020.100278 DOI: https://doi.org/10.1016/j.ctarc.2020.100278
Ballatori E, Roila F. Impact of nausea and vomiting on quality of life in cancer patients during chemotherapy. Health Qual Life Outcomes. 2003;1:46. DOI: https://doi.org/10.1186/1477-7525-1-46
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71
https://doi.org/10.1186/s13643-021-01626-4 DOI: https://doi.org/10.1186/s13643-021-01626-4
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.
https://doi.org/10.1016/j.jclinepi.2009.06.005 DOI: https://doi.org/10.1016/j.jclinepi.2009.06.005
Zeng X, Liu H, Chen X, Leng W. Meta-analysis series IV: a quality assessment tool for observational studies. Chinese J Evid Based Cardiovasc Med. 2012;4(4):297–9.
Roscoe JA, Morrow GR, Colagiuri B, Heckler CE, Pudlo BD, Colman L, et al. Insight in the prediction of chemotherapy-induced nausea. Support Care Cancer. 2010;18(7):869–76.
https://doi.org/10.1007/s00520-009-0723-2 DOI: https://doi.org/10.1007/s00520-009-0723-2
Singh KP, Kober KM, Ernst B, Sachdev J, Brewer M, Zhu Q, et al. Multiple gastrointestinal symptoms are associated with chemotherapy-induced nausea in patients with breast cancer. Cancer Nurs. 2022;45(3):181–9. DOI: https://doi.org/10.1097/NCC.0000000000000976
Nawa-Nishigaki M, Kobayashi R, Suzuki A, Hirose C, Matsuoka R, Mori R, et al. Control of nausea and vomiting in patients receiving anthracycline/cyclophosphamide chemotherapy for breast cancer. Anticancer Res. 2018;38(2):877–84.
https://doi.org/10.21873/anticanres.12297 DOI: https://doi.org/10.21873/anticanres.12297
Jiang T, Wang X, Zheng L, Ren T, Li Y, Li J. Risk factors of nausea and vomiting in patients with breast cancer undergoing chemotherapy: a retrospective study. Medicine (United States). 2025;104(3):e41067.
https://doi.org/10.1097/MD.0000000000041067 DOI: https://doi.org/10.1097/MD.0000000000041067
Booth CM, Clemons M, Dranitsaris G, Joy A, Young S, Callaghan W, et al. Chemotherapy-induced nausea and vomiting in breast cancer patients: a prospective observational study. J Support Oncol. 2007;5(8):374–80.
Xiaocen W. Analysis on the occurrence of vomiting during chemotherapy and its influencing factors in patients with breast cancer. Med Innov China. 2024;21(6):142–5.
Xiangyuan L, Zhaochun L, Jianwei Z. Establishment and evaluation of a risk prediction model for nausea and vomiting caused by chemotherapy for breast cancer Jilin Med J. 2023;44(10):2807–10.
Wei Y, Yuhe L, Yuhe L, Xin Z, Baosheng W. Risk factors of chemotherapy – induced nausea and vomiting in breast cancer: a retro-spective study. Mod Oncol. 2017;25(12):1911–4.
Shuping Q, Wang L. Influencing factors and nursing intervention methods of anticipatory vomiting in breast cancer patients undergoing chemotherapy. Chin Sci Technol J Database (Abstract Edition) – Med Health. 2018(12):68–9.
Ng B, Astari YK, Adrian Wiranata J, Leo B, Hutajulu SH, Hardianti MS, et al. Chemotherapy-induced nausea and vomiting in patients with breast cancer: risk factor and predictive model using classification and regression tree (CART). Cureus. 2023;15(8):e44438.
https://doi.org/10.7759/cureus.44438 DOI: https://doi.org/10.7759/cureus.44438
Huang X, Li X, Li J, Luo L, Chen H, Tan Y, et al. Chemotherapy-induced nausea and vomiting in breast cancer patients: a multicenter prospective observational study. Asia-Pac J Oncol Nurs. 2021;8(4):433–7.
https://doi.org/10.4103/apjon.apjon-2120 DOI: https://doi.org/10.4103/apjon.apjon-2120
Hailin Y. Analysis of the current Situation and influencing factors of nausea and vomiting in Breast Cancer Patients undergoing chemotherapy. Contemp Med. 2022;28(9):147–9.
Zung WWK. A rating instrument for anxiety disorders. Psychosomatics. 1971;12(6):371–9.
https://doi.org/10.1016/S0033-3182(71)71479-0 DOI: https://doi.org/10.1016/S0033-3182(71)71479-0
Wang Y, Zheng R, Wu Y, Liu T, Hao L, Liu J, et al. Risk prediction model for chemotherapy-induced nausea and vomiting in cancer patients: a systematic review. Int J Nurs Stud. 2025;168:105094. DOI: https://doi.org/10.1016/j.ijnurstu.2025.105094
Navari RM. Palonosetron: a second-generation 5-hydroxytryptamine receptor antagonist. Fut Oncol. 2006;2(5):591–602.
https://doi.org/10.2217/14796694.2.5.591 DOI: https://doi.org/10.2217/14796694.2.5.591
Hilarius DL, Kloeg PH, van der Wall E, van den Heuvel JJG, Gundy CM, Aaronson NK. Chemotherapy-induced nausea and vomiting in daily clinical practice: a community hospital-based study. Supportive Care in Cancer. 2011;20(1):107-17. DOI: https://doi.org/10.1007/s00520-010-1073-9
Simino GPR, Reis IA, Acurcio FdA, Andrade EIG, Brazil NML, Cherchiglia ML. Fatores de risco associados a náuseas e vômitos induzidos por quimioterapia antineoplásica. Rev Saúde Pública. 2020;54.
https://doi.org/10.11606/s1518-8787.2020054002178 DOI: https://doi.org/10.11606/s1518-8787.2020054002178
Warr DG, Street JC, Carides AD. Evaluation of risk factors predictive of nausea and vomiting with current standard-of-care antiemetic treatment: analysis of phase 3 trial of aprepitant in patients receiving adriamycin–cyclophosphamide-based chemotherapy. Support Care Cancer. 2010;19(6):807–13.
https://doi.org/10.1007/s00520-010-0899-5 DOI: https://doi.org/10.1007/s00520-010-0899-5
Rha SY, Park Y, Song SK, Lee CE, Lee J. Controlling chemotherapy-induced nausea requires further improvement: symptom experience and risk factors among Korean patients. Support Care Cancer. 2016;24(8):3379–89.
https://doi.org/10.1007/s00520-016-3146-x DOI: https://doi.org/10.1007/s00520-016-3146-x
Mosa ASM, Hossain AM, Lavoie BJ, Yoo I. Patient-Related Risk Factors for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review. Front Pharmacol. 2020;11:329.
https://doi.org/10.3389/fphar.2020.00329 DOI: https://doi.org/10.3389/fphar.2020.00329
Koch A, Cascorbi I, Westhofen M, Dafotakis M, Klapa S, Kuhtz-Buschbeck JP. The Neurophysiology and Treatment of Motion Sickness. Dtsch Arztebl Int. 2018;115(41):687-96.
https://doi.org/10.3238/arztebl.2018.0687 DOI: https://doi.org/10.3238/arztebl.2018.0687
Kohl RL, Homick JL. Motion sickness: a modulatory role for the central cholinergic nervous system. Neurosci Biobehav Rev. 1983;7(1): 73–85.
https://doi.org/10.1016/0149-7634(83)90008-8
Horn CC, Richardson EJ, Andrews PLR, Friedman MI. Differential effects on gastrointestinal and hepatic vagal afferent fibers in the rat by the anti-cancer agent cisplatin. Auton Neurosci. 2004;115 (1–2):74–81. DOI: https://doi.org/10.1016/j.autneu.2004.08.011
https://doi.org/10.1016/0149-7634(83)90008-8 DOI: https://doi.org/10.1016/0149-7634(83)90008-8
Rapoport BL. Delayed Chemotherapy-Induced Nausea and Vomiting: Pathogenesis, Incidence, and Current Management. Front Pharmacol. 2017;8:19.
https://doi.org/10.3389/fphar.2017.00019 DOI: https://doi.org/10.3389/fphar.2017.00019
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Copyright (c) 2026 Yuhui Feng, Liushan Wei, Qinhong Zou, Xiaoyong Lei, Xiaoyan Yang
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