Etiology and treatment of the psychological side effects associated with cancer chemotherapy: A critical review and discussion.

Abstract

Cancer patients receiving chemotherapeutic treatments routinely experience a wide range of distressing side effects, including nausea, vomiting, and dysphoria. Such symptoms often compromise patients 1 quality of life and may lead to the decision to postpone or even reject future, potentially life-saving, treatments. In this article, we discuss the hypotheses that have been offered to explain the development of such symptoms. We also review, in greater detail, the research evidence for the efficacy of five treatments for such symptoms: hypnosis, progressive muscle relaxation training with guided imagery, systematic desensitization, attentional diversion or redirection, and biofeedback. We discuss the implications of this treatment research, paying particular attention to factors associated with treatment outcome, mechanisms of treatment effectiveness, and issues associated with clinical application. Chemotherapy is the treatment of choice for hundreds of thousands of cancer patients diagnosed each year in the UnitedStates (Silverberg & Lubera, 1986). Its frequent use with cancer patients is the result of recent advances in antineoplastic medication; new and more effective medications have increased the life expectancy for many patients and, in some cases, have resulted in remission and cure. Unfortunately, such long-term gain can come at considerable short-term cost to the cancer patient in the form of aversive and debilitating side effects. Among the more common drug-induced side effects are alopecia, stomatitis, immunosuppression, anorexia, nausea, and vomiting.In addition to these pharmacological side effects, chemotherapy patients also experience psychological side effects.Psychological side effects, which should not necessarily be regarded as abnormal or indicative of psychopathology, are those that cannot be attributed directly to the antineoplastic medications; instead, such symptoms are believed to result from psychological processes (e.g., learning) that occur in the chemotherapy context. These symptoms can occur before chemotherapy (in which case they are referred to as anticipatory side effects) as well as during and after the actual chemotherapy infusion. When they occur after chemotherapy has been administered (and while the drugs remain pharmacologically active within the system), it is practically impossible to distinguishWe wish to thank Kate B. Carey and the anonymous reviewers for their many helpful suggestions on an earlier draft of this review.

Pretreatment factors predicting the development of postchemotherapy nausea and vomiting in Chinese breast cancer patients

“…Younger age and later stage of the disease were predictors of acute NV, whereas high fatigue levels were predictive of some of the variance in acute vomiting. Thus, besides the pharmacological properties of the chemotherapy, nonpharmacological factors are involved in the development of postchemotherapy NV, confirming previous reports in the literature [5,7,8,10,24]. Further, frequency, duration and intensity of NV, although they have some common pretreatment predictors, are largely explained by the combined effects of different variables [10,11,21], and in terms of nonpharmacological factors they may constitute different clinical phenomena.…”

“…This suggests that patients' psychological status may play an important part in the development of NV after the acute NV period has elapsed, as the latter period is strongly related to the emetogenic potential of the drugs used in chemotherapy. Carey and Burish [24] suggest that anxiety speeds up associative learning (which predominantly leads to the development of anticipatory NV) and that this may be why psychological variables have been identified as predictors mainly in relation to delayed NV. Heightened anxiety or stress levels may also increase noradrenergic activity, thus also contributing to the development of anticipatory symptoms [24].…”

“…Carey and Burish [24] suggest that anxiety speeds up associative learning (which predominantly leads to the development of anticipatory NV) and that this may be why psychological variables have been identified as predictors mainly in relation to delayed NV. Heightened anxiety or stress levels may also increase noradrenergic activity, thus also contributing to the development of anticipatory symptoms [24]. As the subjects in the present study were chemotherapynaive, anticipatory NV could not have developed, but it is not unlikely that conditioned stimuli might have developed in these over-anxious patients.…”

Chemotherapy-Induced Nausea, Vomiting, and Fatigue – the Role of Individual Differences Related to Sensory Perception and Autonomic Reactivity

“…We therefore find it possible that high absorption is associated with increased ANS reactivity following chemotherapy. Absorption has also been shown to be related to increased reports of distress [30, 31], and pretreatment distress in the form of anxiety and depression has generally been shown to be a significant predictor of reported symptoms, including nausea and vomiting [8, 12,48,49,50], and fatigue [51, 52] in cancer patients. It is therefore possible that associations between absorption and side effects are explained by higher levels of distress in high-absorption women.…”

The effect of disgust-related side-effects on symptoms of depression and anxiety in people treated for cancer: a moderated mediation model

“…One prominent, yet under-researched, emotion relevant to the experience of cancer is disgust. Individuals with cancer potentially have to DISGUST SIDE-EFFECTS AND MENTAL HEALTH IN CANCER confront a range of disgust-inducing stimuli, including, but not being limited to, becoming a "diseased" or "contaminating" object (Neal et al, 2007), sickness and nausea (e.g., Carey & Burish, 1988), bowel and bladder problems (e.g., Bauer, Bastian, Gozzi, & Stief, 2009), changes to an idealised body envelope (e.g., Bredin, 1999), and the salience of their own mortality and death (e.g., Goldenberg, Arndt, Hart, & Routledge, 2008). Moreover, the majority of these may not be caused by the cancer itself, but as side-effects of the treatments patients receive.…”