Anticipatory Nausea Research Articles

Anticipatory nausea development in cancer patients: Replication and extension of a learning model

Approximately one in four cancer patients during the course of repeated treatments begins to experience nausea in anticipation of chemotherapy treatments. The following characteristics have been associated with the development of this anticipatory nausea: (1) patient age; (2) the experience of nausea/vomiting after first treatment; (3) the severity of nausea after chemotherapy treatment; (4) the severity of vomiting after chemotherapy treatment; (5) feeling warm or hot all over after treatment; (6) a susceptibility to motion sickness; (7) sweating following treatment; (8) feeling of generalized weakness following treatment. The purpose of this study was to replicate and extend previous research linking these characteristics to anticipatory nausea (AN), with special attention to the potential contribution made by interactions of the characteristics. Logistic analyses demonstrated significant contributions to anticipatory nausea aetiology from the learning-based characteristics of nausea and vomiting presence and their severity; individual difference measures of age and susceptibility to motion sickness were also found to contribute significantly to AN development. Results support a learning theory-based model of anticipatory side-effect development as well as the potential contribution of individual difference measures of AN susceptibility.

Anticipatory nausea and vomiting in cancer patients.

The present study reports on a mediating mechanism for anticipatory nausea and vomiting (ANV) in cancer chemotherapy. ANV is usually explained as a classically conditioned response. However, conditioning models have failed to explain individual variation in ANV susceptibility. On the basis of the positive correlation between degree of autonomic reactivity (AR) and conditionability, it is proposed that individual AR is predictive of ANV development. Of the 31 patients who participated in the study, 74% experienced postinfusion nausea and vomiting (PNV). Of the 23 patients who experienced PNV, 52% developed ANV. AR was recorded in a habituation paradigm before chemotherapy treatment was initiated. The patients in the ANV group showed significantly increased sympathetic reactivity as compared with the no-ANV group, implying that AR is a mediator of ANV development.

Anticipatory nausea and vomiting in cancer patients.

Anticipatory nausea and vomiting in cancer patients.

Effects of coping style and relaxation on cancer chemotherapy side effects and emotional responses

This study was designed to determine (a) the relationship of coping style to cancer chemotherapy side effects and (b) whether coping style moderated the impact of a relaxation intervention on anxiety, depression, and nausea associated with chemotherapy. Forty-eight cancer patients were assigned randomly to receive either progressive muscle relaxation training before chemotherapy (experimental group) or standard care (control group). Spearman correlations indicated that a "blunting" or distraction-oriented coping style was associated with less anticipatory anxiety, less depression, and less nausea during and after chemotherapy. Spearman correlations also indicated that a "monitoring" or information-gathering coping style was associated with more anticipatory anxiety, and more nausea before and during chemotherapy. Although there was a significant effect of the relaxation intervention on posttreatment nausea, there were no other between-group differences. The results did suggest, however, that relaxation was effective in reducing anticipatory anxiety among "blunters," but not "monitors," perhaps because relaxation is a distraction strategy and therefore is consistent with a blunting coping style. The effects of coping and relaxation on pretreatment anxiety may have important implications, because anxiety is a key factor in classic conditioning models of anticipatory nausea and vomiting.

Treatment-related anxieties in children and adolescents with cancer

Abstract Side-effects of anti-cancer treatment like nausea and vomiting and frightening medical procedures are relevant sources of anxiety in children and adolescents with cancer. Anticipatory nausea and vomiting can be described in terms of respondent conditioning. Hypnosis, systematic desensitization, relaxation training and employment of video-games are effective in mitigating these unpleasant concomitants of chemotherapy. Venipunctures, bone marrow aspirations, and lumbar punctures are repetitive painful procedures. Responses of pain and anxiety are ubiquitous, but still difficult to differentiate by psychological assessment. Rating scales and checklists have been developed to evaluate various intervention programs. Hypnotherapeutic approaches and comprehensive cognitive-behavioral treatment packages have been employed successfully to reduce anxiety reactions. In the future, it might be promising to match specific intervention programs with the coping behaviors spontaneously shown by the child; for in...

The role of anxiety in the development of anticipatory nausea in cancer chemotherapy: a review and synthesis.

The role of state anxiety in the development of anticipatory nausea and vomiting (ANV) in cancer chemotherapy has been the focus of considerable empirical investigation and theoretical speculation. However, while some relationship between state anxiety and ANV is presumed to exist, determination of its precise nature has proven elusive. Specific hypotheses linking state anxiety to ANV are described and evaluated in light of the empirical evidence. These hypotheses include (a) ANV is a symptomatic concomitant of state anxiety; (b) state anxiety directly facilitates the classical conditioning of ANV; (c) state anxiety exacerbates the magnitude of post-treatment nausea and vomiting experienced, thus increasing the risk of ANV; (d) ANV causes infusion-related state anxiety; and (e) the observed relationship between ANV and state anxiety is a result of methodological artifact. It is concluded that state anxiety can play a causal role in the development of ANV in some patients. In particular, the hypothesis that state anxiety exacerbates post-treatment nausea and vomiting and thus increases the risk for ANV appears best supported by the data. Finally, the clinical implications of the relationship between ANV and state anxiety for the treatment and prevention of ANV are discussed.

Management of chemotherapy-induced nausea and vomiting.

Cancer chemotherapy is associated with numerous toxicities such as nausea and vomiting (emesis). The frequency, onset, and duration of emesis depend largely on the emetogenic potential of specific agents. An exact mechanism for chemotherapy-induced emesis (CIE) is not known but is thought to occur through several noxious actions and numerous neuronal pathways. The three types of CIE are acute, delayed, and anticipatory. Nonchemotherapy causes of emesis should be considered before diagnosing CIE. Once the diagnosis is established, antiemetic regimens should be recommended based on characteristics of the patients and the agents. Phenothiazines, butyrophenones, cannabinoids, metoclopramide, corticosteroids, and benzodiazepines have been successful in preventing and treating CIE. Combinations of these drugs have also been successful and are still being investigated for improved emetic protection with fewer adverse reactions. Investigational agents such as serotonin antagonists may prove to be effective with few toxic effects. Despite the minimal information available on delayed and anticipatory nausea and vomiting, attempts should be made to treat them. Suggested guidelines for the management of CIE have been developed.

Cancer therapy, vomiting, and antiemetics

Both radiotherapy and chemotherapy for cancer are capable of causing nausea and vomiting. With both treatment modalities, the nausea and vomiting is thought to be a second-order process rather than being due to direct stimulation of neuromechanisms that control vomiting. Both a peripheral (gastrointestinal tract) and central (chemoreceptor trigger zone) effect may be operating with both radiotherapy- and chemotherapy-induced vomiting. With radiotherapy, gastrointestinal toxicity is affected by the type of radiation, radiation dose and field size, fractionation schedule, individual patient factors, and the part of the patient that is radiated. Many different factors also influence the frequency and severity of nausea and vomiting following chemotherapy. With both radiotherapy and chemotherapy, the frequency and severity of nausea and vomiting is probably mediated by a reduction in breakdown of various neurotransmitters. It is presumed that as the levels of neurotransmitters increase, nausea and vomiting develop. Antagonists of these neurotransmitters may afford some antiemetic protection. Nausea and vomiting may be so severe in patients with cancer that they may refuse potentially curative therapy because of it. Anticipatory nausea and vomiting may develop in patients who have become quite sick after receiving treatment. Exposure to stimuli associated with the emetogenic agent is then sufficient to trigger nausea and vomiting. Standard antiemetics do not help anticipatory nausea and vomiting, although behavioural training may. A variety of different drugs have proven useful as antiemetics, including dopamine antagonists such as phenothiazines, metoclopramide, corticosteroids (dexamethasone and methylprednisolone), cannabinoids, and benzodiazapines. Antihistamines and anticholinergics are of value in some situations. New serotonin antagonists appear to be very promising and are currently undergoing clinical studies. Multiagent antiemetic regimens appear to be more effective than single agent regimens in some situations.

Anticipatory Nausea and Vomiting: A Form of Chemotherapy Phobia?

This paper proposes that the phenomenon of anticipatory nausea and/or vomiting is a component of a phobic response to chemotherapy. Two cases are presented to highlight the clinical aspects of chemotherapy phobia. The evidence confirming such a diagnosis is put forth as it relates to anticipatory anxiety, phobic response, avoidance behaviour and treatment.

Anticipatory immune suppression and nausea in women receiving cyclic chemotherapy for ovarian cancer.

Nausea and immune function were assessed in 20 cancer patients in the hospital prior to chemotherapy and compared with assessments conducted at home. Proliferative responses to T-cell mitogens were lower for cells isolated from hospital blood samples than for home samples obtained several days earlier. Patients also experienced increased nausea in the hospital. Hierarchical multiple regression analyses indicated that decreased immune function in the hospital was not related to increased anxiety. The observed anticipatory immune suppression is consistent with the hypothesis that chemotherapy patients may develop conditioned immune suppression as well as conditioned nausea after repeated pairings of hospital stimuli with the emetic and immunosuppressive effects of chemotherapy.

Anticipatory immune suppression and nausea in women receiving cyclic chemotherapy for ovarian cancer.

Anticipatory immune suppression and nausea in women receiving cyclic chemotherapy for ovarian cancer.

Comparison of Antiemetic Activity of Chloropromazine and High Doses of Metoclopramide in Cisplatin-Based Chemotherapy

High dose metoclopramide and different phenothiazines are widely used antiemetics in cancer patients receiving chemotherapy. In a prospective randomized study we compared the antiemetic efficacy of high dose metoclopramide (M) and chloropromazine (C). We also tested the role of dexamethasone (D) when combined with either of these drugs. A total of 165 patients were randomly allocated to 5 groups with 33 patients in each group. Group A received only M, group B: M + D, group C: C + D, group D: M + D + C and group E: M + C. All patients received combination chemotherapy with cisplatin for the first time and were evaluated only once in order to exclude anticipatory nausea and vomiting. Patients in group C had less antiemetic protection than the other groups (p less than 0.001). Groups A, B, D, E, had more or less equal antiemetic efficacy, although the efficacy in group B was somewhat better; this difference was not statistically significant. Side-effects were minimal. Chloropromazine seemed to protect patients who received metoclopramide from extrapyramidal manifestations. In conclusion the results suggest that high dose metoclopramide has a better antiemetic effect than chloropromazine, dexamethasone is a helpful adjuvant drug when used in combination with an effective antiemetic agent, and chloropromazine and dexamethasone may prevent the extrapyramidal side-effects that can occur when metoclopramide is used as single antiemetic drug.

Advances in the management of nausea and vomiting induced by non-cisplatin containing chemotherapeutic regimens

Nausea and vomiting are the most feared toxicities of chemotherapy. Afferent impulses from the chemoreceptor trigger zone, peripheral sites, the cerebral cortex, or the vestibular center can initiate the emetic reflex. Antiemetic protection therefore requires interruption of appropriate emetogenic pathways. Since the chemoreceptor trigger zone contains numerous dopaminergic neurons, antidopaminergic agents including phenothiazines and metoclopramide have gained importance as antiemetics. However standard dose phenothiazines have limited efficacy while high dose metoclopramide may have excessive toxicity in the non-cisplatin setting. Recent advances have therefore centered on development of new classes of antiemetics. Corticosteroids have excellent activity alone or in combination with other antiemetic agents. Cannabinoids have recently been introduced into commercial use as antiemetics with particular activity against non-cisplatin chemotherapy. Benzodiazepines are active against anticipatory nausea and vomiting and are also used in combination antiemetic regimens. Although the vestibular center seems to have a lesser influence on chemotherapy-induced nausea and vomiting, vestibular blocking agents such as scopolamine may have a potential role as adjunctive antiemetics. Finally, appreciation of the role of serotonin (5-HT3) receptors in both peripheral and central emetic pathways may lead to a new class of antiserotonergic antiemetic agents.

Incidence and duration of chemotherapy-induced nausea and vomiting in the outpatient oncology population.

Nausea and vomiting are commonly recognized side effects of chemotherapy. However, the incidence and duration of these effects have not been systematically studied in a large outpatient oncology population. This survey was conducted over two consecutive 6-week periods in the adult oncology clinics of two university teaching hospitals. The objectives were: (1) to document the incidence and duration of chemotherapy-induced nausea and vomiting; (2) to identify variables that influence nausea and vomiting; and (3) to describe patterns of antiemetic prescribing and compliance. One hundred thirty-eight completed patient-maintained diaries were returned (70% response rate). Anticipatory nausea and vomiting were reported by 9.4% and 6.5% of patients, respectively. Fifty percent and 27% of patients reported nausea and vomiting, respectively, on the day chemotherapy was administered (day 1: acute nausea and vomiting phase). Percentages fell to 22% and 11% by day three and 14% and 2.5% on day 5. Of patients who reported nausea and vomiting during the five-day period, 52% and 33% experienced nausea and vomiting, respectively, during the delayed period only (days 2 through 5: delayed emesis phase). Emetogenicity of chemotherapy significantly influenced incidence and duration of those symptoms. Sixty-seven percent of patients reported taking antiemetics on one or more days during the survey period. Of patients who reported antiemetic use, 92% reported antiemetics on day 1, 51% on day 3, and 31% on day 5. At-home antiemetic use was related to the emetogenicity of chemotherapy received. Patients who receive moderate to strong emetogens as defined in this report should receive antiemetic therapy for a minimum of three days. Increasing the dose of antiemetic prescribed both in the clinic and at home may be of benefit.

Chemotherapy-Related Nausea and Vomiting: Etiology and Management

Chemotherapy-Related Nausea and Vomiting: Etiology and Management

Anticipatory nausea and vomiting: prevalence and predictors in chemotherapy patients.

One hundred and seventy-five patients selected at random were prospectively studied. All patients were assessed at least after the first cycle of treatment by a self-report questionnaire which covered the occurrence of nausea and vomiting 24 before chemotherapy, as well as information regarding 22 clinical parameters. Forty-six (26%) patients developed anticipatory nausea. 'Intolerable' posttreatment vomiting and age under 45 were statistically significant parameters (p less than 0.05) in the multivariate analysis. Twenty-one (12%) of the 175 patients experienced anticipatory vomiting. Three variables, age under 45, 'intolerable' posttreatment vomiting and more than three cycles of treatment were found to be significant (p less than 0.05). The relative risk of developing anticipatory nausea and vomiting according to combination of significant clinical predictors in the multivariate analysis is proposed. Therefore recognition of these clinical predictors may serve as a marker for patients with high risk of presenting anticipatory nausea and vomiting, who may benefit from prophylactic behavioral approaches.

Nausea and Vomiting Induced by Cytostatic Agents

The current knowledge on treatment of emesis induced by cytostatic therapy is reviewed. A description of the multiple causative mechanisms shows the rationality of combining antiemetic agents in the prophylaxis of nausea and vomiting, especially when induced by highly emetogenic chemotherapeutic agents as cisplatin. The need for prevention instead of treatment is demonstrated by explaining the syndrome of anticipatory nausea and vomiting. Promising efficacy and lack of serious side effects are reported for newly developed 5-hydroxytryptamine3 antagonists.

Prevalence, predictors, and course of anticipatory nausea in women receiving adjuvant chemotherapy for breast cancer.

Factors related to the prevalence, prediction, and course of anticipatory nausea (AN) in women (n = 77) receiving adjuvant chemotherapy for breast cancer were examined. Using a prospective longitudinal research design, patients were interviewed both before and after each chemotherapy infusion. Fifty-seven percent of the patients developed AN. These patients were characterized by more severe gastrointestinal side effects following the initial infusion and greater expectations for experiencing chemotherapy-related nausea. A more rapid development of AN was related to a history of experiencing nausea across a greater variety of situations, higher IV drug doses, and less infusion-related anxiety at the initial infusion. Although AN occurred intermittently across treatment sessions, severity was constant. Results provided strong support for the hypothesis that classical conditioning processes are instrumental in AN acquisition. The role of anxiety in the development of AN is considered as are clinical implications for the prevention of AN and recommendations for future research.

Anticipatory nausea and vomiting: does it remain a significant clinical problem?

A study performed 5 years ago in our clinic revealed a prevalence rate of 31% for anticipatory symptoms. This finding is consistent with other investigations. It was hypothesized that more effective management of postchemotherapy nausea and vomiting and briefer chemotherapy regimens since the previous study would decrease the prevalence of anticipatory symptoms. The study reported in this article assessed the prevalence of anticipatory symptoms in 121 patients receiving parenteral chemotherapy over a 7-week period. The overall prevalence rate of 33% for anticipatory symptoms was not significantly different from the previous study or other investigations. Length of postchemotherapy nausea was significantly related to the report of anticipatory symptoms. However, the severity of symptoms reported in the investigation was mild. The prevalence in patients on adjuvant therapy for breast cancer was also significantly reduced from the previous investigation. It is concluded that although anticipatory symptoms commonly occur they are only rarely clinically significant.

Test-retest reliability and concurrent validity of the Morrow Assessment of Nausea and Emesis (MANE) for the assessment of cancer chemotherapy-related nausea and vomiting

The present study evaluated the concurrent validity of two assessment approaches for the measurement of cancer chemotherapy-related nausea and vomiting. The results indicated that the concurrent validity between the Morrow Assessment of Nausea and Emesis (MANE; Morrow, 1984b) and continuous self-monitoring and the reliability on the MANE were moderate. The heterotrait-monomethod and heterotrait-heteromethod matrices demonstrated moderate correlations among the frequency, severity, and duration of anticipatory nausea and vomiting as well as high correlations among the frequency, severity, and duration of posttreatment nausea and vomiting. Additionally, the heterotrait-monomethod matrices show a number of correlations above chance between anticipatory and posttreatment symptoms. The results are discussed in light of future research endeavors.