CONDITIONED AVERSIONS IN PEDIATRIC CANCER PATIENTS RECEIVING CHEMOTHERAPY

Abstract

The purpose of this study was to investigate the prevalence and determinants of conditioned aversions in pediatric cancer patients receiving chemotherapy. In the first phase of the study, 80 children and adolescents were interviewed along with their parents concerning pre-treatment reactions in the form of anticipatory nausea and vomiting (ANV). Anticipatory nausea was reported by 28.8% of the sample and anticipatory vomiting was present in one out of five patients. ANV was correlated positively with the emetic potential for the chemotherapy regimens and the severity of post-chemotherapy nausea and vomiting, and most often developed within the first four months of treatment. Considerable inter-patient variability in pre-treatment symptoms was noted, with treatment-related variables accounting for less than one-fourth of the variance in ANV.;In the second phase, standardized psychological measures were administered to a group of patients manifesting ANV and to a matched control group of patients without ANV, and their parents. Patients with ANV were found to be higher on trait anxiety and lower on stimulus screening than patients without ANV, suggesting that personality and information processing variables may promote conditioning in some patients but not in others. Patterns of parental management of children in stressful situations also distinguished between the research and control groups, with punishment more commonly used in the former group and modeling/reassurance more commonly used in the latter, pointing to the contribution of operant factors to the development and maintenance of conditioned aversions.;In the third phase of the study, patients in both groups were experimentally tested for their susceptibility to conditioned taste aversions (CTAs) associated with chemotherapy. A higher rate of CTAs was found for patients with ANV than for control patients, suggesting that these patients may be generally more conditionable and possibly at greater risk for gastrointestinal symptomatology.;These findings are discussed in terms of their implications for early screening and identification of high-risk patients and for corrective and prophylactic behavioral intervention strategies. Major methodological issues and directions for future research are outlined.