Abstract
BackgroundPatients undergoing chemotherapy are highly burdened by side effects. These may be caused by the pharmacodynamics of the drug or be driven by psychological factors such as negative expectations or pre-conditioning, which reflect nocebo effects. As such, negative pre-treatment expectations or prior experiences might exacerbate the burden of chemotherapy side effects. Educating patients about this nocebo effect has been put forward as a potential strategy to optimize patients’ pre-treatment expectations. In this study, we evaluate whether a briefing about the nocebo effect is efficacious in reducing side effects.MethodsIn this exploratory study, a total number of n = 100 outpatients with newly diagnosed gastrointestinal cancers are randomized 1:1 to an information session about the nocebo effect (nocebo-education) or an attention control group (ACG) with matching interaction time. Assessments take place before the intervention (T1 pre), post-intervention (T1 post), and 10 days (T2) and 12 weeks (T3) after the initial chemotherapy. The primary outcomes are the patient-rated number and intensity of side effects at 10-days and at 12-weeks follow-up. Secondary outcomes include coping with side effects, tendency to misattribute symptoms, compliance intention, attitude towards the chemotherapy, co-medication to treat side effects and the clinician-rated severity of toxicity. Further analyses are conducted to investigate whether a potential beneficial effect is mediated by a change of expectations before and after the intervention.DiscussionInforming patients about the nocebo effect might be an innovative and feasible intervention to reduce the burden of side effects and strengthen patients’ perceived control over adverse symptoms.Trial registrationThe trial is registered at the German Clinical Trials Register (ID: DRKS00009501; retrospectively registered on March 27, 2018). The first patient was enrolled on September 29, 2015.
Highlights
Patients undergoing chemotherapy are highly burdened by side effects
No interim analyses will be conducted. This is the first study to evaluate whether a nocebo-education can have beneficial effects considering side effects of the chemotherapy when compared to an attention control group
No study has evaluated whether informing patients about the nocebo effect would be useful to optimize expectations and decrease side effect load in clinical practice
Summary
Patients undergoing chemotherapy are highly burdened by side effects These may be caused by the pharmacodynamics of the drug or be driven by psychological factors such as negative expectations or pre-conditioning, which reflect nocebo effects. Negative pre-treatment expectations or prior experiences might exacerbate the burden of chemotherapy side effects. Gastrointestinal tumors, including cancer of the esophagus, stomach, colon, rectum, anus, pancreas, gallbladder and bile duct, constitute the largest group of cancer for men, and the second largest group of cancer for women [1] They are characterized by high mortality rates [1]. Side effects are not fully defined by the pharmacodynamics of a given drug, but can be caused by psychological factors These so-called nocebo effects are best known as the counterparts of placebo effects [7]. Studies which investigated adverse events after placebo intake [10, 11], as well as studies which used verbal suggestions to manipulate treatment expectations prior to medication intake, demonstrated the existence of nocebo effects [12,13,14]
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