Anticipatory nausea and vomiting in cancer patients undergoing chemotherapy treatment: Prevalence, etiology, and behavioral interventions

Abstract

Nausea and vomiting are common side effects that occur after chemotherapeutic drugs are given to treat cancer. Recent attention has been focused on the occurrence of nausea and vomiting in anticipation of a treatment. Prevalence data from a variety of studies show that approximately 25% of patients receiving chemotherapy treatments for cancer develop anticipatory nausea and vomiting (ANV) by the time of their fourth treatment. A review of studies examining models and variables associated with potential etiology indicates that no single demographic, clinical, or psychologic characteristic appears to be as related to the development of anticipatory side effects as are several characteristics in concert. Specifically, patients under 50 years of age who are treated with potentially emetic chemotherapy and who experience distressing nausea and vomiting after treatment appear to be at risk for the development of anticipatory nausea and vomiting. The development of anticipatory side effects appears to follow a classically conditioned model; no compelling data contradict a view that anticipatory side effects are learned. A review of both case and controlled studies on the biobehavioral treatment of ANV indicates that: (a) while studies on Hypnosis have been methodologically weak, they provide support for continued controlled investigations in children; (b) Progressive Relaxation Training appears effective in controlling posttreatment nausea and vomiting; and (c) Systematic Desensitization appears effective in controlling both anticipatory and posttreatment nausea and vomiting. The review concludes with a brief consideration of several methodologic and practical issues that point to promising directions for future research in the area.