Development of anticipatory nausea and vomiting: A prospective analysis

Abstract

Cancer patients scheduled to begin their first chemotherapy treatment were studied to determine whether patients who might be at risk for developing anticipatory nausea and vomiting (ANV) could be identified in advance of any treatment. Patients who developed ANV were compared to those who did not according to demographic and treatment variables and specific personality characteristics: State and trait anxiety, introversion/extraversion, attitudes toward their illness, anger expression and hypnotizability.;Sixty cancer patients scheduled for chemotherapy volunteered to participate in this study. Both inpatients and outpatients were included. Before treatment, subjects completed the baseline questionnaires and were assessed for hypnotizability. On day 1 of each subsequent course of treatment, subjects completed the state anxiety questionnaire and the Morrow Anticipatory Nausea and Emesis questionnaire which assesses side effects of chemotherapy. Patients were followed until their treatments ended or until they developed ANV. Nineteen patients experienced ANV, 25 experienced only post-chemotherapy nausea or vomiting, and 16 never developed post-treatment or anticipatory side effects.;Data were analyzed with Pearson's correlations, t-tests, chi-square tests, and analyses of variance. It was found that nausea following the initial chemotherapy treatment was a significant predictor of those patients who developed ANV. It was discovered that inpatients experienced significantly more severe and longer-lasting ANV than did outpatients. Elevated levels of anxiety were equivalent before treatment one for both the group that developed ANV and the group that did not. Personality characteristics that have been linked to rapid conditioning or have been used to describe cancer patients and their attitudes toward their diagnoses did not predict which patients would develop ANV.;Patients who are at risk for developing ANV could not be identified in advance of their first chemotherapy treatment by the instruments used in this study. However, patients who experienced nausea after treatment one were at risk.;Interventions such as relaxation techniques or hypnosis were known to be effective in controlling nausea and vomiting side effects. One implication of this study is that such interventions could be offered to patients before their second treatment in order to reduce post-treatment side effects and prevent the development of ANV.