Fifty cancer patients receiving chemotherapy, 25 by push injection and 25 by drip infusion, were assigned to one of three conditions for their chemotherapy treatments: (a) progressive muscle-relaxation training plus guided-relaxation imagery; (b) therapist control, in which a therapist was present to provide support and encouragement but did not provide systematic relaxation training; and (c) no-treatment control. Patients participated in one pretraining, three training, and one follow-up session. Results indicated that during the training sessions, patients who received relaxation training, relative to patients in either of the other two conditions, (a) reported feeling significantly less anxious and nauseated during chemotherapy, (b) showed significantly less physiological arousal (as measured by pulse rate and systolic blood pressure) and reported less anxiety and depression immediately after chemotherapy, and (c) reported significantly less severe and less protracted nausea at home following chemotherapy. The attending nurses' observations during chemotherapy confirmed patient reports. In general, patients in the therapist control condition and the no-treatment control condition did not differ significantly from each other. The differences amorig conditions generally remained significant during the follow-up session. The data suggest that relaxation training may be an effective procedure for helping cancer patients cope with the adverse effects of their chemotherapy.The chemotherapeutic treatment of can-fore I make a plea to all co-operative chemotherapeutic cer is a debilitating, aversive, and often e rou P s to ******* a se ?; oh to f efifectiye antiemetic dreaded experience for millions of cancer ^of che!=^p atients. Whltehead (1975, p. 200), ma tially the quality of life during such therapy. moving plea to his fellow physicians, de-, scribes the situation:The aversiveness of cancer chemotherapy is caused in large part by the fact that the After one or more courses [of chemotherapy], patients drugs administered during chemotherapy may begin to vomit on the morning of their treatment, . °.or upon arrival at the physician's office, in anticipation treatments affect virtually every cell in the of the injection, attesting to the abhorrence with which body, not just the cancer cells. As a result they regard the treatment. They confess to feeling ill of its effects on normal tissues, even a *'SUCfor three weeks or more out of every four and may ce s s f u l" course of chemotherapy can probecome deeply depressed and even suicidal.. . .Thereduce a variety of unpleasan t si de effects, in-This research was supported-in part by Department eluding decreased immunity to Other disof Health, Education, and Welfare Research Grant No. eases, change in liver enzymes, hair loss, loss 'CA 25516 from the National Cancer Institute and a of appetite, stomatitis, nausea, vomiting, Biomedical Research Support Grant through Vander-temporary or permanent frigidity or impobiit University . tence, and negative aifects such as anxiety...

Cancer patients receiving chemotherapy often experience nausea and vomiting that develop as a result of classical conditioning. In order to determine whether this nausea and vomiting could be delayed or prevented, 24 cancer patients were randomized either to a group that received progressive muscle relaxation training (PMRT) plus guided imagery (GI), or to a no-treatment control group. Relaxation training sessions were held before the initiation of chemotherapy and during the first three chemotherapy treatments. Results indicated that patients receiving PMRT and GI had significantly less nausea and vomiting and significantly lower blood pressures, pulse rates, and dysphoria, especially anxiety, than did control patients. Nurse observations corroborated patient reports. These data suggest that early training in PMRT and GI can reduce and perhaps prevent the development of conditioned nausea and vomiting, and can alleviate high anxiety levels, in cancer patients who receive emetogenic chemotherapy.The side effects of cancer chemotherapy can be so aversive and debilitating that some patients regard them as worse than the cancer itself. Such patients often are noncompliant with their treatment, and a few reject further treatment altogether (Wikox, Petting, Nettesheim, & Abeloff, 1982). Among the most dreaded of the side effects are the conditioned nausea and vomiting (CNV) experienced by approximately 25%-30% of all patients. Evidence suggests that CNV develop through a classical conditioning process; that is, through their association with pharmacologically induced side effects, various stimuli (e.g., smells, thoughts, tastes) become capable of eliciting nausea, vomiting, and intense emotional reactions (see Burish & Carey, 1986). Conditioned side effects can occur before the chemotherapy treatment begins, in which case they are referred to as anticipatory side effects, or they can occur during or after the treatment, in which case they appear with and are often indistinguishable from pharmacologically induced side effects. In all cases, once CNV have developed, they are highly resistant to antiemetic drugs. The prevalence of CNV, as well as their resistance to pharmacological control, has produced considerable concern and research in recent years. Several investigators have studied the effectiveness of behavioral treatments such as progressive muscle relaxation training (e.g., Lyles, Burish, Krozely, & Oldham, 1982), systematic desensitization (e.g., Morrow & Morrell, This project was partly supported by Grant CA25516 from the National Cancer Institute.We thank Dean Brenner and David Holmes for their helpful comments on the manuscript, Denise Matt for her help with the statistical analysis, and the entire staff of the

To further investigate the antineoplastic efficacy and safety of somatostatin analogues, 2 trials were performed. Octreotide, SMS 201-995 (Sandostatin), was escalated in doses ranging from 1,500 micrograms to 6,000 micrograms daily in 14 patients with carcinoid. Somatuline, (BIM 23014C, Angiopeptin, Lanreotide) was given in doses ranging from 2,250 micrograms to 9,000 micrograms daily to 13 neuroendocrine patients (6 carcinoid, 2 atypical carcinoid, 3 pancreatic islet cell and 2 small cell lung cancer patients). All patients successfully completed dose escalations without significant adverse effects and were evaluable for toxicity. The dose limiting side-effect of octreotide was the injection volume. No dose limiting adverse effects have been observed with somatuline. Carcinoid syndrome symptoms were better controlled with higher octreotide doses. Thirteen patients were evaluable for octreotide's antitumor efficacy with a partial response observed in 4 (31%), stable disease in 2 and progressive disease in 7 patients. Radiographic changes of increased tumor necrosis occurred in 5 patients and was independent of response. Somatuline resulted in a partial response in 4 patients (2 carcinoids, 1 gastrinoma and 1 small cell lung cancer) (31%), stable disease in 1 atypical carcinoid, and progressive disease in 8 (4 carcinoid, 1 atypical carcinoid, 2 islet cell and 1 multi-drug resistant small cell lung cancer). Six of the 8 carcinoid patients had radiographic changes of increased necrosis. Dose escalation of somatostatin analogues is well tolerated and may be associated with antitumor activity in some neuroendocrine neoplasms.

Bioavailability of a 100-mg oral etoposide dose is greater than suggested in the package insert from Bristol Laboratories (Evansville, IN). Comparable oral etoposide doses are not uniformly twice that of an IV dose, as suggested by the package insert, but will depend on the final oral dose administered. Bioavailability is better at lower oral etoposide doses. This study confirms the wide interpatient and intrapatient variability in oral etoposide bioavailability.

In a study of the antiemetic effectiveness of high-dose oral metoclopramide, 66 previously untreated patients receiving 60 mg/m2 cisplatin were entered into a double-blind randomized trial. Patients were stratified according to age and tumor type, then randomized to receive either oral or intravenous (IV) high-dose metoclopramide. Patients were evaluated for antiemetic protection, toxicity, affect (anxiety, hostility, and depression), and autonomic arousal (pulse rate and blood pressure) at three-hour intervals on the day of their chemotherapy. Metoclopramide serum levels were measured by high-performance liquid chromatography. Results indicated no significant differences between the oral and IV groups on any measurement of antiemetic protection, affect, or autonomic arousal. There were also no significant differences in side effects except for frequency of stools; patients who received oral metoclopramide had significantly more stools than patients who received IV metoclopramide. The mean (+/- SD) serum metoclopramide level at four hours achieved orally was 1,171 +/- 660 ng/mL; the mean (+/- SD) level achieved IV was 1,030 +/- 392 ng/mL (P = .498). We conclude that high-dose oral and IV regimens of metoclopramide as administered in this study have equivalent antiemetic efficacy in previously untreated patients receiving 60 mg/m2 cisplatin.