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

Abstract

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.

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

“…A variety of patient, disease, and treatmentrelated variables have been examined. Consistent with a conditioning model, the presence and severity of PNV has emerged as the major factor in ANV development (7)(8)(9)(10)(11)(12)(13).…”

“…Examination of the psychological, medical, and nursing literature through mid-1989 revealed a total of one dozen reports of empirical research which could illuminate the ANV-anxiety relationship (5,7,8,(12)(13)(14)(15)(31)(32)(33)(34)(35). These studies are summarized in Table 1.…”

“…For example, elevated levels of trait anxiety (13), state anxiety (7,8,12,14,15), and general "distress" (13) have been found to characterize patients who experience ANV. Accordingly, the role of anxiety has been a major focus of empirical investigation as well as theoretical speculation (2,16,17).…”

Chemotherapy-induced Nausea and Vomiting

“…The classical conditioning paradigm does not fully explain the development of ANV, 22,23 and a role for cognitive factors, such as anxiety and response expectancies, in ANV development exists. 7,[24][25][26] Anxiety is known to affect the development of NV at least in part through negative expectancies, 24,[27][28][29] and, reciprocally, negative expectancies are instrumental in the development of anxiety.…”

“…16,34,35 Therefore, anxiety and response expectancies may mediate patients' conditioning towards ANV. Several studies have revealed that response expectancies significantly predict the occurrence of ANV 23,26,[36][37][38] A descriptive study conducted by our research group with 63 female cancer patients with various types of cancer showed that expectancy strongly predicted development of nausea prior to the third chemotherapy (p = 0.001). Expectation of nausea was assessed prior to their first treatment on a five-point semantic rating scale, anchored at one end by "1" = "I am certain I will not have nausea," and at the other end by "5" = "I am certain I will have nausea."…”