ABSTRACT
PURPOSE: Chemotherapy side effects diminish quality of life and can lead to treatment delay. Nausea and vomiting can occur prior to chemotherapy because of classical conditioning. We studied the effects of 20-minute behavioral interventions, administered by oncology nurses, of higher intensity (mindfulness relaxation-MR) or lower intensity (relaxing music-RM), on anticipatory nausea and vomiting (ANV). PATIENTS AND METHODS: Patients undergoing chemotherapy for solid tumors were randomized to MR (N = 160), RM (N = 159), or standard care SC (N = 155). Subjects were mostly female (91.8%) and white (86.1%) with breast cancer (85%). Most patients had early stage disease (Stage I: 26%; II: 52.9%; III: 19%; IV: 0.1%). Anticipatory nausea and vomiting were assessed at the midpoint and end of the chemotherapy course using the Morrow Assessment of Nausea and Emesis (MANE). RESULTS: Compared to SC, there was reduced anticipatory nausea at the midpoint of chemotherapy in those receiving MR (OR 0.44, 95% CI 0.20-0.93) and RM (OR 0.40, 95% CI 0.20-0.93), controlling for age, sex, cancer stage, and emetogenic level of chemotherapy. There was no difference between treatment groups in anticipatory nausea at the end of chemotherapy or in anticipatory vomiting and postchemotherapy nausea and vomiting at either time point. CONCLUSION: A brief nurse-delivered behavioral intervention can reduce midpoint ANV associated with chemotherapy.
Subject(s)
Antineoplastic Agents/adverse effects , Mindfulness/methods , Nausea/prevention & control , Neoplasms/drug therapy , Nursing Care/methods , Vomiting, Anticipatory/prevention & control , Adult , Conditioning, Classical , Female , Humans , Male , Middle Aged , Nausea/epidemiology , Nausea/psychology , Neoplasm Staging , Neoplasms/diagnosis , Neoplasms/psychology , Quality of Life , Treatment Outcome , Vomiting, Anticipatory/epidemiology , Vomiting, Anticipatory/psychology , Young AdultABSTRACT
INTRODUCTION: Reproductive health problems, including sexual dysfunction and impaired fertility, are distressing and persistent after cancer treatment. However, recent reports suggest that reproductive health remains neglected in oncology settings. AIMS: We conducted a survey to ascertain the prevalence of reproductive health problems in men and women treated in a comprehensive cancer center, and to estimate potential usage of clinical services to preserve fertility or to treat postcancer infertility and sexual dysfunction. METHODS: We mailed 800 questionnaires to men and women treated for cancer at our institution 1 to 5 years previously. Cancer sites and ages were chosen to maximize the risk of reproductive problems. We stratified the sample by living distance from our institution, to see if travel affected service utlilization. To provide a self-selected sample for comparison, another 200 questionnaires were made available in outpatient areas. MAIN OUTCOME MEASURES: Self-report questionnaire. RESULTS: The return rate for the combined surveys was 29% for men and 26% for women. Cancer sites for self-selected respondents were almost identical to those in the postal cohort. Prevalence and types of sexual dysfunction were typical for surveys of cancer survivors, with 49% of men reporting new erection problems after cancer treatment and 45% of women noting loss of desire for sex and vaginal dryness. About a third of patients aged less than 50 years would have liked a fertility consultation before cancer treatment. Twenty to thirty percent wanted more information about premature ovarian failure or health risks for their children. Twenty-four percent of men and 21% of women would definitely want to visit a reproductive health clinic in the next year. Factors associated with wanting an appointment included self-selection to complete the survey and, for men, having less education. CONCLUSION: It should be feasible to establish a multidisciplinary reproductive health center in a comprehensive cancer center.