***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: CONTEXT AND OBJECTIVE Nausea and vomiting are major inconveniences for patients undergoing chemotherapy . Despite st and ard preventive treatment , chemotherapy-induced nausea and vomiting ( CINV ) still occurs in approximately 50 % of these patients . In an attempt to optimize this treatment , we evaluated the possible effects of carbamazepine for prevention of CINV . DESIGN AND LOCATION Prospect i ve nonr and omized open-label phase II study carried out at a Brazilian public oncology service . METHODS Patients allocated for their first cycle of highly emetogenic chemotherapy were continuously recruited . In addition to st and ard antiemetic protocol that was made available , they received carbamazepine orally , with staggered doses , from the third day before until the fifth day after chemotherapy . Considering the sparseness of evidence about the efficacy of anticonvulsants for CINV prevention , we used Simon 's two-stage design , in which 43 patients should be included unless overall complete prevention was not achieved in 9 out of the first 15 entries . The Functional Living Index-Emesis question naire was used to measure the impact on quality of life . RESULTS None of the ten patients ( 0 % ) presented overall complete prevention . In three cases , carbamazepine therapy was withdrawn because of somnolence and vomiting before chemotherapy . Seven were able to take the medication for the entire period and none were responsive , so the study was closed . There was no impact on the patients ' quality of life . CONCLUSION Carbamazepine was not effective for prevention of CINV and also had a deleterious side-effect profile in this population BACKGROUND Delayed chemotherapy-induced nausea and vomiting ( CINV ) remains a major adverse effect of cancer chemotherapy . We assessed , under current practice patterns , the occurrence and impact on healthcare re source utilization of CINV in patients receiving emetogenic chemotherapy .  An additional aim of this study was to estimate costs imputable to CINV in the German healthcare environment . MATERIAL S AND METHODS This prospect i ve , multi-center , cross-sectional cost-of-illness study was conducted in three hospitals and in three office-based facilities in Germany . Consecutive patients undergoing emetogenic chemotherapy ( levels 4 or 5 according to Hesketh classification of emetogenicity ) were enrolled . Data were obtained from preplanned chart review s and from self-administered patient question naires . Analysis of direct costs was performed from the perspectives of third party payer ( statutory sick fund ) , provider ( hospital ) and patients . Indirect costs were assessed on the basis of paid workdays lost . RESULTS During the 5-day observation period , 134 of 208 chemotherapy cycles observed ( 64.4 % ) were associated with at least one episode of nausea or vomiting . More patients experienced delayed than acute CINV ( 60.7 % versus 32.8 % ) , and more patients reported nausea than vomiting ( 62.5 % versus 26.0 % ) . A total of 68 patients ( 32.6 % ) utilized healthcare re sources due to CINV . The most frequently used re sources were rescue medications and outpatient hospital and office physician visits . Only one patient required hospitalization and only three patients lost workdays due to CINV . Average costs imputable to CINV per patient ( with or without CINV ) per treatment cycle incurred by third party payers and hospital providers were Euro 49 and Euro 48 , respectively . Patient or treatment characteristics that were associated with high costs imputable to CINV were as follows : cisplatin-containing regimen ; experience of emesis ; and presence of delayed CINV . CONCLUSIONS A substantial proportion of patients continue to experience CINV . This entails not only clinical but also economic consequences , and highlights a continuing need for improved utilization of existing antiemetic agents and for new , more efficacious treatments . The greatest improvements in patient care and potential for cost offset may be realized by preventing delayed CINV INTRODUCTION Chemotherapy-induced nausea and vomiting ( CINV ) is one of the most important worries of cancer patients . Although not life-threatening , it has a great negative impact on quality of life ( QOL ) . OBJECTIVE The aim of this study was to determine the impact of CINV ( i.e. , acute and delayed ) on breast cancer patients QOL and to discern opinions related with antiemetic guidelines used dependent on the three main races in Malaysia ( Malay , Chinese , Indian ) . METHODS In this longitudinal prospect i ve observational study , 158 breast cancer patients treated with chemotherapy  were interviewed and valid question naires ( MANE and ONEM ) were used to report the impact of CINV on their QOL within the first 24 hours and after 3 to 5 days of chemotherapy treatment . RESULTS The main result was that delayed CINV has an impact on QOL greater than acute CINV . The impact of nausea was reportedly higher than that of vomiting . Also differences in race i.e. , genetic polymorphisms ( pharmacogenomics ) influenced the utility of antiemetic treatments and patients opinions . CONCLUSION Based on the results of our study a new guideline for antiemetic treatment should be used to reduce the impact of CINV on QOL , taking into account variation in genetic polymorphisms among the three races in Malaysia This study compared the efficacy and tolerability of oral ondansetron ( 8 mg twice daily [ BID ] for up to 3 days ) with those of phenothiazine prochlorperazine ( 10 mg BID for up to 3 days ) in 133 cancer patients receiving cyclophosphamide-based chemotherapy .  In addition , the study evaluated the impact of these treatments on patients ' health-related quality of life , measured with both the Functional Living Index -- Cancer and the Functional Living Index -- Emesis question naires . The first dose of study drug was administered 30 minutes before initiation of chemotherapy . Patients received a rescue antiemetic at their request or if the investigator deemed it necessary . There was a statistically significant difference in the number of patients with no emetic episodes over the 3-day study period : 60 % in the ondansetron group compared with 21 % in the prochlorperazine group . Twenty-five percent of ondansetron-treated patients compared with 68 % of prochlorperazine-treated patients experienced three or more emetic episodes , rescue medication use , or withdrawal from the study due to adverse events or lack of efficacy of the study drug . Among patients with at least one emetic episode , the mean time to emesis was significantly longer ( 13 hours and 37 minutes ) in the ondansetron group compared with the prochlorperazine group ( 9 hours and 30 minutes ) . Nausea and appetite scores did not differ significantly between groups . The score on the vomiting subscale of the Functional Living Index -- Emesis was significantly more favorable in the ondansetron group compared with the prochlorperazine group , indicating better maintenance of health-related quality of life in ondansetron-treated patients . Both treatments were well tolerated . The most common potentially drug-related adverse event was headache , which occurred in significantly more ( 16 % ) ondansetron-treated patients compared with prochlorperazine-treated patients ( 3 % ) . The results of this study demonstrate that oral ondansetron 8 mg BID for up to 3 days is more effective than prochlorperazine 10 mg BID for up to 3 days in the prevention of emesis associated with moderately emetogenic chemotherapy Objectives Chemotherapy-induced nausea and vomiting ( CINV ) remains a major adverse effect of cancer chemotherapy which may increase morbidity , reduce quality of life and threaten the success of cancer therapy . Aprepitant is effective in preventing CINV , achieving higher complete response ( no emesis and no rescue therapy ) compared to st and ard prevention , in patients receiving either highly ( HEC ) or moderately emetogenic chemotherapy ( MEC ; absolute reduction = 11 and 13 % , respectively ) . We assessed the cost effectiveness of aprepitant-based vs st and ard prevention in these indications in Belgium . Material s and methods A decision analytical model was developed in MS Excel ( Fig. 1 ) . To estimate re source use , two approaches were used . The first is based on the preventive regimens applied in r and omized controlled trials comparing aprepitant-based CINV prevention ( for HEC : aprepitant days 1–3 , ondansetron 32 mg i.v . day 1 , oral placebo twice daily days 2–4 , oral dexamethasone days 1–4 ; for MEC : aprepitant days 1–3 , ondansetron 16 mg p.o . day 1 , placebo on days 2–3 , oral dexamethasone day 1 ) , vs a st and ard regimen ( for HEC : oral placebo days 1–3 , ondansetron 32 mg i.v . day 1 and 16 mg p.o . days 2–4 , oral dexamethasone days 1–4 ; for MEC : oral placebo , ondansetron 16 mg p.o . days 1–3 , dexamethasone day 1 ) The second analysis is based on current real-world re source use in the Belgian setting in the prevention of CINV using a longitudinal Hospital Data base . CINV-specific utility values were used to calculate quality -adjusted life years ( QALYs ) . Drug costs were obtained from official reimbursement listings . Treatment costs for CINV were obtained from a German study and adapted to Belgium . Results The aprepitant-based regimen is associated with 0.003 and 0.014 more QALYs in HEC and MEC , respectively and with per patient savings of € 66.84 ( trial based ) and € 74.62 ( real-life based ) for HEC and € 17.95 ( trial based ) and € 21.70 ( real-life based ) for MEC . Hence , aprepitant is both more effective and less expensive ( = dominant ) . One-way sensitivity analyses were performed on treatment cost of emesis , the clinical benefit of  aprepitant and the cost of ondansetron  and showed that the results were robust on the first two parameters but sensitive on the decrease in cost of ondansetron for the moderately emetogenic chemotherapy regimens . Conclusions In both approaches , the aprepitant-based strategy is more effective and less expensive compared to st and ard care Purpose Nausea is a troublesome and distressing symptom for patients receiving chemotherapy .  While vomiting is well controlled with current antiemetics , nausea is a more difficult symptom to manage . The aim of this study was to assess the impact of nausea on nutritional status , quality of life and psychological distress . Methods This was a prospect i ve observational study over two cycles of chemotherapy . Patients completed the Multinational Association of Supportive Care in Cancer Antiemesis Tool , a measure of nutritional status ( Patient-Generated Subjective Global Assessment ) , the Functional Assessment of Cancer Therapy-General ( FACT-G ) quality of life scale and the Hospital Anxiety and Depression Scale at the end of each chemotherapy cycle ( around day 10 post-chemotherapy ) . Results The sample consisted of 104 patients , primarily female , receiving anthracycline-based chemotherapy .  While vomiting was minimal ( 5.2–14.6 % of the patients ) , high levels of nausea were observed ( 55.2–72.9 % ) , and severe nausea ( > 6 on a 0–10 scale ) was reported by 20.5–29.2 % of the participants . Severe nausea had a borderline significant impact in relation to physical functioning ( p = 0.025 ) and a significant impact on nutritional status ( severe acute nausea , p = 0.003 ; severe delayed nausea , p = 0.017 ) . Clinical ly meaningful changes were observed in relation to the FACT-G total score . Conclusion Chemotherapy-induced nausea does have an impact on nutritional status and physical functioning and can impair anxiety and quality of life . As a key symptom associated with other symptoms , it is imperative that greater attention is given to managing treatment-related nausea through innovative non-pharmacological and nutritional interventions Purpose Addition of rolapitant to st and ard antiemetic therapy improved protection against chemotherapy-induced nausea and vomiting ( CINV ) in phase 3 trials of patients receiving highly emetogenic chemotherapy ( HEC ) or moderately emetogenic chemotherapy ( MEC ) . Here , we assessed the impact of CINV on the daily lives of patients receiving HEC or MEC using the Functional Living Index-Emesis ( FLIE ) . Methods In three double-blind phase 3 studies , patients receiving HEC or MEC were r and omized 1:1 to receive oral rolapitant 180 mg or placebo prior to chemotherapy plus 5-hydroxytryptamine type 3 receptor antagonist and dexamethasone therapy . Patients completed the FLIE question naire on day 6 of cycle 1 . Endpoints included FLIE total score , nausea and vomiting domain scores , and the proportion of patients with no impact on daily life ( total score > 108 [ range 18–126 ] ) . We performed a prespecified analysis of the MEC/anthracycline-cyclophosphamide ( AC ) study and a post hoc analysis of two pooled cisplatin-based HEC studies . Results In the pooled HEC studies , rolapitant significantly improved the FLIE total score ( 114.5 vs 109.3 , p < 0.001 ) , nausea score ( 55.3 vs 53.5 , p < 0.05 ) , and vomiting score ( 59.2 
    Output:
    
Despite the availability of numerous treatment options , CINV was found to have a strong impact on HRQoL of patients .
Direct costs are particularly affected , but this result could be due to scarcity of studies assessing indirect costs .
Evidence supports the notion that CINV continues to have a negative impact on HRQoL of patients , even for those receiving moderately emetic chemotherapy .