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
PURPOSE/OBJECTIVES: To address the concept of anticipatory nausea within the theoretical framework of classical conditioning. DATA SOURCES: Published articles, book chapters. DATA SYNTHESIS: Although classical conditioning explains much in the development of anticipatory nausea, other factors also are at work. Preventing this phenomenon is necessary because it is difficult to treat and control once it develops. CONCLUSIONS: Nurses are in a position to identify patients at highest risk for developing anticipatory nausea and implement interventional strategies to prevent/minimize it. IMPLICATIONS FOR NURSING PRACTICE: Many aspects of anticipatory nausea have not yet been researched well. Nurses must study how anticipatory nausea develops and interventions that can be used to reduce its prevalence.