Psychosocial predictors of chemotherapy-induced nausea and vomiting among chemotherapy-naïve cancer patients: a prospective multicenter cohort study.

purposeProspective evidence on the role of pre-chemotherapy psychosocial factors in symptom burden across the first chemotherapy cycle remains limited among patients with cancer. This prospective multicenter observational cohort study aimed to comprehensively evaluate clinical and pre-chemotherapy psychosocial predictors of chemotherapy-induced nausea and vomiting (CINV) across the entire first chemotherapy cycle.

methodsChemotherapy-naive adult cancer patients scheduled to receive their first cycle of highly or moderately emetogenic chemotherapy (HEC or MEC) were enrolled. Pre-chemotherapy psychosocial variables were assessed using the Distress Thermometer (DT), selected Mini-Mental Adjustment to Cancer (Mini-MAC) subscales, and an investigator-developed behavioral/cognitive risk factor questionnaire. CINV was assessed through a 21-day patient diary after chemotherapy. Correlation and multicollinearity diagnostics were performed to assess relationships among psychosocial variables. Univariable and multivariable logistic regression analyses were applied to identify factors associated with CINV across the acute, delayed, and beyond-risk phases. Moderation analyses examined whether clinical variables modified psychosocial effects. A sensitivity analysis restricted to patients receiving guideline-adherent prophylaxis assessed psychosocial associations with CINV using reduced models adjusted for established CINV risk factors.

resultsAmong 1168 patients screened, 1031 chemotherapy-naive individuals were eligible and included in the final analysis. Acute-phase CINV occurred in 72.8% of patients, while delayed-phase CINV was reported by 73.0%. Notably, 25.6% of patients experienced CINV beyond the risk phase, predominantly nausea (25.5%) rather than vomiting (3.8%). Patients who developed CINV had higher levels of pre-treatment psychological distress and maladaptive coping, including helplessness/hopelessness and anxious preoccupation (all P < 0.001). In univariable analyses, clinical factors, including HEC, advanced disease stage, and non-adherence to guideline-recommended prophylaxis, as well as patient-related and psychosocial factors, were associated with CINV. After adjustment, motion sickness history, short sleep duration, and clinically significant distress remained independently associated with CINV across multiple phases. In the beyond-risk phase, multiple psychosocial and behavioral factors, including vomiting expectancy, perceived nausea susceptibility, motion sickness history, short sleep duration, clinically significant distress, helplessness/hopelessness, and anxious preoccupation, remained independently associated with CINV, whereas most clinical determinants lost statistical significance, except chemotherapy emetogenicity. Moderation analyses indicated that these psychosocial associations were not significantly modified by chemotherapy emetogenicity or antiemetic guideline adherence. In sensitivity analyses restricted to patients receiving guideline-adherent prophylaxis, Mini-MAC/H, Mini-MAC/AP, and short sleep duration remained associated with overall CINV.

conclusionsPre-chemotherapy psychosocial and behavioral susceptibility factors were independently associated with CINV throughout the first chemotherapy cycle, with particularly persistent associations beyond the conventional risk window. These findings support integrating routine pre-chemotherapy psychosocial screening into standard antiemetic and survivorship-oriented supportive care. IMPLICATIONS FOR CANCER SURVIVORS: Incorporating psychosocial risk assessment before chemotherapy may help identify patients vulnerable to persistent CINV and inform individualized supportive care across the survivorship continuum.