Search

Purpose: This study aims to synthesize and analyze the impact of technology-based interventions on chemotherapy-induced nausea, vomiting, and quality of life in pediatric patients., Design and Methods: Seven electronic databases were searched: PubMed, Web of Science, Cochrane, MEDLINE, CINAHL, Scopus, and Google Scholar. The JBI checklist assessed the studies' methodological quality. This study was performed based on the PRISMA checklist., Results: This review incorporated five published studies, exploratory randomized controlled trials, and non-randomized pre and post-test control group studies involving 232 pediatric oncology patients receiving chemotherapy. The meta-analysis revealed a significant impact of technology-based interventions on alleviating chemotherapy-induced nausea and vomiting (Hedge's g = -0.707, Q = 9.61, I 2  = 47.97%, p < 0.001). It was found that a significant effect of technology-based interventions on the patient's quality of life was observed (Hedge's g = -0.745, Q = 5.431, I 2  = 63.74%, p < 0.001)., Conclusions: These findings indicated that technology-based interventions have significant potential in managing chemotherapy-induced nausea and vomiting and quality of life., Practice Implications: Future research endeavors should explore this aspect further, employing a broader range of outcome measures and longer-term follow-up assessments better to understand their impact on pediatric oncology patients' well-being., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Prevalent symptoms that affect children and adolescents throughout the process of cancer diagnosis and treatment include nausea and vomiting, fatigue, pain, mucositis, and anxiety., Aim: To examine the effect of a home-based multimodal symptom-management program for alleviation of nausea and vomiting, fatigue, pain, mucositis, and anxiety in children and adolescents undergoing chemotherapy for hematological malignancies or solid tumors., Methods: In an exploratory pilot randomized study with qualitative interview, patients between 10 and 18 years of age were randomly assigned to either the symptom-management program plus usual care (intervention group) or usual care (control group). The program consisted of multiple nonpharmacological interventional components. The targeted symptoms were measured at baseline (after diagnosis), at the first 2 weeks of each cycle of chemotherapy, and at 6 months after baseline, using the Memorial Symptom Assessment Scale 10-18 and the State Anxiety Scale for Children., Results: Fifty children (31 boys; mean age, 13.7 years) were randomized either to the intervention group or the control group (25 each) and underwent baseline assessment. A comparison between the groups showed that the intervention group had a significant less fatigue over time (P < .05). However, no differences were found with respect to nausea and vomiting, pain, mucositis, and anxiety between groups. Both children and parents reported a positive experience with the symptom-management program., Conclusion: The home-based symptom-management program may have helped to reduce fatigue in children and adolescents undergoing chemotherapy. In addition, qualitative data support the importance of improving children and parents' knowledge, coping skills, and psychological preparation for symptoms associated with chemotherapy., (© 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC.)

Chemotherapy-induced nausea and vomiting (CINV) may be linked to the psychological status of cancer patients. Therefore, the authors aimed to better understand the underlying risk factors for CINV using the Brief Illness Perception Questionnaire. A total of 238 patients were recruited during three cycles of chemotherapy. Patient, disease and treatment characteristics were noted at the onset of chemotherapy. The Brief Illness Perception Questionnaire was administered face-to-face prior to chemotherapy. The relationship between illness perceptions and CINV was analyzed using Spearman's rank correlation. Positive illness perception parameters, including personal and treatment control, were negatively correlated, whereas negative illness perception parameters, including consequences, timeline, identity, concern and emotions, were positively correlated with CINV after adjusting for age, sex and emetogenic potential of chemotherapy (p < 0.001). Illness perception may be an underlying risk factor for CINV.

The significant physical and emotional effects of chemotherapy-induced nausea and vomiting (CINV) are experienced by cancer patients. Severe symptoms decrease the patient's quality of life and potentially deters further treatment. The five main forms of CINV (i.e., acute, delayed, anticipatory, breakthrough, and refractory) require different treatment regimens, which often include 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids. Despite a significant amount of research and development of antiemetic agents, management of CINV remains a great challenge with many needs waiting to be adequately addressed, such as controlling non-acute CINV, developing appropriate CINV treatment protocols for multiple-day chemotherapy patients, and providing options for those prone to CINV despite treatment. Further research is required to optimize CINV management for these patients., (Copyright © 2020. Published by Elsevier Ltd.)

Objective: The purpose was to describe the physical, psychological, social, and spiritual needs of patients with non-cancer serious illness diagnoses compared to those of patients with cancer., Method: We conducted a retrospective chart review of all patients with a non-cancer diagnosis admitted to a tertiary palliative care unit between January 2008 and December 2017 and compared their needs to those of a matched cohort of patients with cancer diagnoses. The prevalence of needs within the following four main concerns was recorded and the data analyzed using descriptive statistics and content analysis: •Physical: pain, dyspnea, fatigue, anorexia, edema, and delirium•Psychological: depression, anxiety, prognosis, and dignity•Social: caregiver burden, isolation, and financial•Spiritual: spiritual distress., Results: The prevalence of the four main concerns was similar among patients with non-cancer and cancer diagnoses. Pain, nausea/vomiting, fatigue, and anorexia were more prevalent among patients with cancer. Dyspnea was more commonly the primary concern in patients with non-cancer diagnoses (39%), who also had a higher prevalence of anxiety and concerns about dignity. Spirituality was addressed more often in patients with cancer., Significance of Results: The majority of patients admitted to tertiary palliative care settings have historically been those with cancer. The tertiary palliative care needs of patients with non-cancer diagnoses have not been well described, despite the increasing prevalence of this population. Our description of the palliative care needs of patients with non-cancer diagnoses will help guide future palliative care for the increasing population of patients with non-cancer serious illness diagnoses.

Purpose: Radiotherapy-induced nausea and vomiting is a common side effect of radiotherapy. It is well-established that nausea and vomiting have a negative impact on quality of life, but the relative influence of each of symptom is infrequently reported. This study aimed to compare the effects of nausea and vomiting on quality of life in cancer patients receiving palliative radiotherapy., Methods: The Functional Living Index-Emesis (FLIE) is a quality of life questionnaire developed in the chemotherapy-induced nausea and vomiting setting. The FLIE consists of 18 questions, half of which address nausea and half of which address vomiting. Three prospective studies on the efficacy of various anti-emetic medications conducted at our center used the FLIE to assess radiotherapy-induced nausea and vomiting at various time points during and after palliative radiotherapy. FLIE data from these three studies were combined for the present analysis. Univariate and multivariate analyses were conducted to assess the relationships between nausea and vomiting, time of FLIE completion, and patient-reported quality of life., Results: Nausea and vomiting scores both decreased patients' quality of life. Multivariate modeling showed that both symptoms significantly influenced patients' ability to enjoy meals. Nausea was also associated with increased hardship for the patient, while vomiting imposed more difficulty on the patients' loved ones., Conclusions: Nausea and vomiting both significantly influence quality of life. Nausea seems to impact the patient more directly, whereas vomiting affects those closest to the patient.

Background: Approved almost 15 years ago for use in the chemotherapy setting, palonosetron, a 2nd generation 5-hydroxtryptamine 3 receptor antagonist (5-HT3 RA), has demonstrated efficacy in preventing chemotherapy-induced nausea and vomiting. However, its utility in the prophylaxis and treatment of radiation-induced nausea and vomiting (RINV) has yet to be evaluated. In this pilot study, we investigated the rates of control in RINV in patients with pre-existing emesis., Methods: Patients with pre-existing emesis undergoing palliative radiotherapy to sites with emetic risk were prescribed palonosetron 0.5 mg before the start of radiation treatment, and every other day until completion of treatment. Patients were followed up in acute (day 1 of treatment to day 1 after treatment) and delayed phases (days 2-10 after treatment). Prophylaxis and rescue (PR) was defined as a decrease in anti-emetic use, or episodes of nausea and/or vomiting from baseline. Complete prophylaxis (CP) was defined as no increase in anti-emetic use, or episodes of nausea and/or vomiting. Secondary endpoints included control of nausea and quality of life (QOL), as assessed with the Functional Living Index-Emesis and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15 Palliative., Results: Fourteen patients were enrolled. Rates of control were higher in the acute phase (n=14) for nausea (PR =42.9%, CP =42.9%) and vomiting (PR =21.4%, CP =71.4%) compared to the delayed phase (n=13) for nausea (PR =42.9%, CP =7.7%) and vomiting (PR =15.4%, CP =53.8%)., Conclusions: Palonosetron appears to be safe and patients with pre-existing emesis receiving palliative radiotherapy. More studies are needed to investigate its efficacy in this patient population.

Objective: To review the evidence for a systematic relationship between cancer patients' pre-treatment expectations (anticipated side effects) and subsequent experience of treatment-related side effects, and to compare this relationship in patients with no prior treatment experience (cognitive expectations) and with some prior treatment experience (conditioned response)., Methods: A total of 12,952 citations were identified through a comprehensive search of the literature published on or before November 2016 and screened against inclusion criteria. Studies were eligible if they included participants undergoing curative treatment for cancer, measured a treatment side effect, examined the relationship between anticipation and experience of side effects, and reported quantitative data., Results: Thirty-one studies were included in the review and meta-analysis (total N = 5069). The side effects examined were nausea (anticipatory and post-treatment), vomiting, fatigue, pain, problems with concentration, and skin reactions. Meta-analyses indicated positive associations between anticipation and subsequent experience for all included side effects in patients with no prior treatment exposure (r = 0.153-0.431). Stronger associations were found for all included side effects in patients with previous treatment experience (r = 0.211-0.476), except for fatigue (r = 0.266) and pain (r = 0.235). No significant differences were found when overall effect sizes for patients with and without prior treatment exposure were compared for each side effect, except for anticipatory nausea (p = 0.012)., Conclusion: These results may have implications for future interventions that target patients' expectations of cancer treatment-related side effects. Future research could explore patient reports of messages received about likely treatment effects both before and during treatment., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The comprehensive assessment of symptoms is the basis for effective, individualised palliative treatment. Established scoring systems provide in-depth information but are often lengthy and hence unsuitable. We introduce the PERS(2) ON score as a short and practically feasible score to evaluate symptom burden. Fifty patients admitted to a Palliative Care Unit rated seven items, i.e. pain, eating (loss of appetite/weight loss), rehabilitation (physical impairment), social situation (possibility for home care), suffering (anxiety/burden of disease/depression), O2 (dyspnoea) and nausea/emesis, on a scale ranging from 0 (absence) to 10 (worst imaginable), resulting in a score ranging from 0 to 70. Assessments were performed at admission, 7 days after admission and at the day of discharge. Symptom intensity scores were calculated, and change over time was evaluated. A significant improvement was observed from the PERS²ON score between admission and 7 days (P < 0.001; paired t-test). Significant improvement from baseline evaluation to evaluation on the day of discharge was observed (P = 0.001; paired t-test). This study provides initial evidence that the PERS²ON score is both feasible and sensitive to changes of the most prominent symptoms in palliative care. It may be useful in clinical practice to direct palliative treatment strategies and provide targeted symptom management., (© 2015 John Wiley & Sons Ltd.)

Background: Docetaxel is a widely used cytotoxic agent. This study evaluates the impact of docetaxel toxicities on patient's health-related quality of life (QoL)., Patients and Methods: We conducted a multicenter, prospective, non-interventional trial, in which the QoL was assessed using the EORTC QLQ-C30 questionnaires at baseline and every 4 weeks up to 40 weeks in patients receiving a docetaxel-based chemotherapy for metastatic disease. Treatment-related adverse events were correlated with the corresponding QoL scores. Uni- and multivariate analyses were applied., Results: From January 2008 to June 2011, a total of 2659 patients were included. The majority of patients (48.1%) had prostate cancer, followed by breast (17.1%) and non-small-cell-lung cancer (15.8%). Patients received a median of 5 docetaxel cycles with the median dose of 75 mg/m(2). The presence of grade 3/4 diarrhea showed the strongest effect on global health status/QoL average scores (50.91 versus 33.06), followed by vomiting (50.91 versus 35.17), dyspnea (50.94 versus 35.81), mucositis/stomatitis (50.88 versus 36.41), nausea (50.91 versus 36.68), infection (50.90 versus 37.14), fatigue (50.90 versus 43.82) and anemia (50.91 versus 41.03), P < 0.05 for all comparisons. Grade 3/4 leukopenia/neutropenia, alopecia, constipation, neurotoxicity and nail disorders had no significant impact on the global health status/QoL or other items., Conclusion: In this large non-interventional trial, docetaxel-associated grade 3 or 4 toxicities were shown to have a strong detrimental effect on patient's QoL. Notably, diarrhea and vomiting had the strongest negative impact on QoL measures. This has to be kept in mind while making therapeutic decisions and providing optimized supportive treatment measures., Clinical Trials Number: This study was registered at Deutsches Krebsstudienregister (DKSR, primary registry in the WHO Registry Network) with the ID 527., (© The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Chemotherapy-induced nausea and vomiting (CINV) in cancer patients are common symptoms most feared by patients. The aim of this study was to analyze the impact of CINV associated to moderate/highly emetogenous chemotherapy regimens on patients' quality of life (QoL)., Patients and Methods: Open, multicenter, prospective observational study was performed. Each patient filled out a patient diary for each cycle from the day before chemotherapy and for the next 5 days that included the number of emetic episodes, the intensity of nausea, and QoL evaluation (functional living index-emesis questionnaire)., Results: Data from 202 consecutive patients from nine university hospitals were collected, but only data from 160 were analyzed (79.2 %). Most of the participants (70 %) were women with a mean age of 50 years (SD 1.2 years). The most frequent cancer site was breast (44 %) followed by lung (16 %) and 76.3 % were receiving highly emetogenous chemotherapy. Despite the use of antiemetic prophylaxis, patients experienced significant nausea and vomiting during 31 % (3.2 % during acute, 15.0 % during delayed phase, and 13.2 % during both phases) and 45.1 % (5.1 % only during the acute phase, 23.5 % only during the delayed phase and 16.5 % during both phases) of the cycles, respectively, having 44.5 % (nausea) and 39.3 % (emesis) of the cycles an impact on patients' QoL., Conclusions: The results of the study confirm the detrimental effect of CINV on patients' QoL despite the use of antiemetic prophylaxis (5HT(3) receptor antagonist, steroids, and dopamine receptor antagonists). It is mandatory to intensify the detection of CINV in order to improve the management of these important, albeit frequent, side effects of cancer treatments.

Background: Chemotherapy-induced nausea and vomiting (CINV) are common adverse effects, but occurrences among pediatric oncology patients are not well documented., Objective: The primary aim was to describe anticipatory, acute, and delayed CINV among children with cancer from the child's, caregiver's, and nurse's perspective. A secondary aim evaluates the correlation of CINV among the child's, caregiver's, and nurse's perspectives., Methods: CINV perspectives were evaluated before, during, and after a single course of highly or moderately emetogenic chemotherapy. CINV were evaluated among 40 pediatric cancer patients using the Adapted Rhodes Index of Nausea and Vomiting for Pediatrics, among their caregivers using the Adapted Rhodes Index of Nausea and Vomiting for Parents, and among their nurses using the National Cancer Institute Nausea and Vomiting Grading Criteria., Results: CINV were reported by the patient, caregiver, and nurse at all times, with the most frequent reports occurring in the delayed period. Patient's mean total nausea and vomiting scores increased significantly over time. Patient reports of anticipatory, acute, and delayed CINV correlated with caregiver and nurse reports except for anticipatory nausea between the nurse and patient., Conclusions: CINV occurred throughout the chemotherapy course, with delayed CINV occurring most frequently and with greater severity and distress. Caregiver CINV reports correlated closely with patient reports., Implications for Practice: Nurses need to be aware of the frequency, severity, and distress of CINV throughout the chemotherapy regimen. CINV can occur before and after chemotherapy treatment and should be assessed so that appropriate interventions can be implemented.

Purpose/objectives: To identify anticipatory, acute, and delayed chemotherapy-induced nausea and vomiting (CINV) frequency and coping strategies used among pediatric patients with cancer., Design: Prospective, cohort design., Setting: A pediatric teaching hospital in the southern United States., Sample: A convenience sample of 40 children aged 7-12 years scheduled to receive either moderately emetic chemotherapy or highly emetic chemotherapy for cancer treatment., Methods: Children completed the Adapted Rhodes Index of Nausea and Vomiting for Pediatrics and the Kidcope-Younger Version., Main Research Variables: CINV and coping strategies., Findings: CINV occurred during the anticipatory, acute, and delayed times, with the highest frequency occurring during the delayed time. The most frequently used coping strategies were distraction and wishful thinking, whereas the most effective strategies were social support and distraction. No statistically significant differences were observed in the frequency or efficacy of coping strategies over time., Conclusions: CINV occurs throughout chemotherapy treatment. The most efficacious coping strategies included active and passive coping, with active coping strategies being more effective., Implications for Nursing: Nurses should recognize that CINV occurs at all points of chemotherapy treatment. Nurses can assist children in developing active coping strategies to manage their CINV.

Background: The reproducibility of symptom clusters (SCs) in different populations would support the validity of the cluster concept. Ideal approaches to cluster identification are unknown. The presence of a sentinel (most prevalent) symptom may reduce the number of symptoms in a comprehensive symptom assessment tool. The primary purpose was to assess consistency of SCs between 2 independent data sets. A secondary aim was to evaluate whether use of a sentinel symptom might abbreviate assessment but retain acceptable accuracy., Methods: An agglomerative hierarchical cluster analysis in 922 patients with advanced cancer identified 7 SCs. We conducted the same analysis on an additional 181 cancer patients to assess cluster consistency. The most prevalent symptom within each cluster was defined as the ''sentinel'' symptom. Positive predictive value (PPV) and negative predictive value (NPV) were calculated to assess ability of the sentinel symptom to predict other symptoms in the cluster., Results: Similar clusters were identified in both data sets, which included nausea/vomiting, neuropsychologic, and aerodigestive clusters. When the sentinel symptom was present, >50% nonsentinel symptoms in a cluster were present; when absent, <50% nonsentinel symptoms were identified. However, the range for PPV and NPV of the sentinel symptom to identify other symptoms in the cluster was 19% to 72% and 41% to 95%, respectively., Conclusions: Consistent SCs were found in 2 separate data sets with the same assessment tool and statistical analysis. These findings support the statistical and clinical validity of the cluster concept through consistency between different populations. The nausea/vomiting, neuropsychologic, and aerodigestive clusters may be reliable for use in assessment. The presence or absence of a sentinel symptom in each cluster did not predict the presence or absence of other symptoms in the cluster. Sentinel symptoms are inadequate to assess symptom burden.

(1) In June 2006 the French National Cancer Institute published the results of a survey of eating difficulties among 1843 patients receiving cancer chemotherapy; (2) More than one-third of patients said they had less appetite than before ("far less" in 13% of cases). About half of patients said they had noticed a change in their sensation of thirst; (3) Half of patients who had been receiving treatment for at least 6 months said they had lost weight; (4) Half of patients found food tasted different. 43% of patients found certain odours unbearable, especially perfumes and tobacco. One-third of patients said the smell of the treatment room made them nauseous. Many patients found mealtimes unpleasant, sometimes even a source of anxiety; (5) In practice, these eating difficulties should be taken into account when assessing the risk-benefit balance of cancer treatments. When a treatment needs to be pursued, patients should be helped to find ways of making food more palatable, the treatment room should be well ventilated, and perfumes should not be used.

Nausea and/or vomiting are aversive gastrointestinal (GI) symptoms. Nausea and vomiting manifest unconditionally after a nauseogenic experience. However, there is correlative, quasiexperimental and experimental evidence that nausea and vomiting can also be learned via classical (Pavlovian) conditioning and might occur in anticipation of the nauseogenic event. Classical conditioning of nausea can develop with chemotherapy in cancer patients. Initially, nausea and vomiting occur during and after the administration of cytotoxic drugs (post-treatment nausea and vomiting) as unconditioned responses (UR). In addition, 20%-30% of cancer patients receiving chemotherapy report these side effects, despite antiemetic medication, when being re-exposed to the stimuli that usually signal the chemotherapy session and its drug infusion. These symptoms are called anticipatory nausea (AN) and/or anticipatory vomiting (ANV) and are explained by classical conditioning. Moreover, there is recent evidence for the assumption that post-chemotherapy nausea is at least partly influenced by learning. After summarizing the relevant assumptions of the conditioning model, revealing that a context can become a conditioned stimulus (CS), the present paper summarizes data that nausea and/or vomiting is acquired by classical conditioning and, consequently, may be alleviated by conditioning techniques. Our own research has focussed on two aspects and is emphasized here. First, a conditioned nausea model was established in healthy humans using body rotation as the nausea-inducing treatment. The validity of this motion-sickness model to examine conditioning mechanisms in the acquisition and alleviation of conditioned nausea and associated endocrine and immunological responses is summarized. Results from the rotation-induced motion sickness model showed that gender is an important moderator variable to be considered in further studies. This paper concludes with a review of the application of the demonstrated conditioning principles as interventions to ameliorate distressing AN/ANV in cancer patients undergoing chemotherapy, which is the second focus of our work.

Unlabelled: The psychosocial strategies used by advanced cancer patients to manage anorexia are poorly described. A greater understanding of them may guide clinicians to provide appropriate interventions to patients and caregivers., Methods: Glaserian Grounded Theory was used to recruit and analyse data from two women and seven men with advanced cancer suffering from anorexia. They were interviewed about the emotional and social impact of appetite loss and the strategies that they used to compensate for reduced food intake., Results: Shifting to conscious control (overeating) was the basic social psychological process employed by participants to manage the emotional and social consequences of declining intake. Although a number of symptoms were found to contribute, nausea or the anticipation of emesis provoked by food was most commonly named as the ultimate barrier to eating., Discussion: Participants retained the motivation and ability to eat without appetite, providing the intake of food did not provoke nausea or the anticipation of emesis. Nutritional interventions must be tailored around patients' eating capabilities. Counselling and education programmes that assist family members in understanding the shift to conscious control over eating are required.

Delayed vomiting is a potentially significant adverse effect of chemotherapy used to treat childhood cancer, but little is known about the experience of delayed vomiting in children and adolescents. An exploratory study was conducted to determine the pattern of delayed vomiting in children and adolescents with cancer after highly emetic chemotherapy and to identify possible risk factors. In a sample of 82 children and adolescents who completed 117 cycles of highly emetic chemotherapy, the overall prevalence of delayed vomiting was 32%. The frequency of delayed vomiting was highest on delayed day 2, with 21% of participants experiencing vomiting. By delayed day 7, only 9% of participants still reported vomiting. The severity of vomiting was moderate to severe in 11% to 12% of subjects. Age and gender had no significant effect on delayed vomiting. The emetic potential of the agent, incomplete protection from acute vomiting, and treatment regimens that lasted 6 or more days significantly affected delayed vomiting. In addition, a history of motion sickness, lack of acute control, and 6 or more days of chemotherapy were predictive of delayed vomiting.

This study was designed to determine the effect of a progressive muscle relaxation intervention on nausea and vomiting associated with anticancer chemotherapy. Subjects were 30 hematology patients who were hospitalized and received chemotherapy treatment at a large hospital in the interior of São Paulo, Brazil. The results indicated that progressive muscle relaxation lead to statistically significant changes in physiological and muscle conditions and in nausea and vomiting levels. Therefore, this relaxation technique may be an effective nursing intervention method to allay or alleviate nausea and vomiting in patients receiving chemotherapy. For future studies, we suggest using a control group, a homogeneous sample in terms of antiemetic and chemotherapy type and dosage, and the longitudinal following of subjects during chemotherapy.

Nausea and vomiting are common and well-studied symptoms in cancer care. Most previous studies have focused on the frequency and management of these symptoms. The aim of the study was to acquire a deeper understanding of cancer patients' symptom experiences with a focus on nausea and vomiting during chemotherapy treatment, and the consequences these have on their daily lives. Nine women with different types of cancer and chemotherapy treatments were admitted for chemotherapy treatment and participated in the study. Semi-structured interviews were conducted and analysed using content analysis inspired by Kvale's methods of clarifying and developing new meaning. Five main categories were identified as "before cancer diagnosis", "being ill--consequences on daily life", "going through chemotherapy treatment", "coping with treatment" and "after treatment--looking forward to a normal life". The present findings suggest that the individual experiences of nausea and vomiting during chemotherapy treatment may have a profound effect on how treatment is perceived and may influence future decisions concerning further treatment.

This study aimed at developing a shortened version of the EORTC QLQ-C30, one of the most widely used health-related quality of life questionnaires in oncology, for palliative care research. The study included interviews with 41 patients and 66 health care professionals in palliative care to determine the appropriateness, relevance and importance of the various domains of the QLQ-C30. Item response theory methods were used to shorten scales. Patients and health care professionals rated pain, physical function, emotional function, fatigue, global health status/quality of life, nausea/vomiting, appetite, dyspnoea, constipation, and sleep as most important. Therefore, these scales/items were retained in the questionnaire. Four scales were shortened without reducing measurement precision. Important dimensions not covered by the questionnaire were identified. The resulting 15-item EORTC QLQ-C15-PAL is a 'core questionnaire' for palliative care. Depending on the research questions, it may be supplemented by additional items, modules or questionnaires.

Objective: It is a current hypothesis that chemotherapy-induced nausea and vomiting (CINV) may ultimately impede the clinical success of cancer treatments by hindering patients' adherence to the optimal treatment schedule. The aim of this study is to examine clinical trial data retrospectively for possible evidence of such a detrimental impact of CINV., Patients and Methods: Data from three recent European Organization for Research and Treatment of Cancer (EORTC) trials of highly emetogenic cisplatin-based chemotherapy in diverse patient populations were analyzed retrospectively for incidence and possible impact of CINV. Data on the incidence of emesis are presented as simple descriptive analyses, while the hypothetical impact of CINV on clinical outcomes and on the patients' length of hospital stays is analyzed by means of multivariate regression analysis techniques to control for confounding variables., Main Results: Between 42 and 59% of the patients in the trials experienced at least one episode of nausea of NCIC grade 2 or worse, while the incidence of vomiting of similar grade was between 31 and 58%. Only in one of the trials could the determinants of the adherence to protocol therapy be assessed, statistically significant variables were the severity of emesis (p < 0.0001) and other toxicities combined (p < 0.019). In turn, a Cox regression showed adherence to protocol therapy and other toxicities as the only statistically significant determinants of overall survival., Conclusions: This study has shown a discernible detrimental impact of CINV on patients' adherence to protocol therapy and, indirectly, on survival in one of the three trials examined. Further studies are required to substantiate this finding.

Despite the introduction of new effective antiemetics, nausea and vomiting (emesis) remain troublesome side effects of chemotherapy in cancer patients. These side effects not only affect patients' quality of life adversely, but also reduce patient adherence to the chemotherapy treatment and may ultimately negatively affect disease progression. Since, there is no single antiemetic agent that is effective all the time, there is a need for better understanding of the biological nature of nausea and emesis in order to enhance pharmacological interventions, as well as a need for better psychological understanding so that effective behavioral interventions may also be developed. This review focuses on both physiological and psychological origins of nausea and vomiting as side effects of chemotherapy.

Cost-utility analysis is appropriate for supportive care interventions, since both quality of life and duration of survival are taken into account. However, utility scores, which reflect quality of life, have not been objectively defined for parameters such as emesis. The Standard Gamble technique identifies utility by determining patient preference for retaining a fixed intermediate health state or taking a gamble with perfect health and death as possible outcomes (the odds of the two gamble outcomes can be varied). If death is not a reasonable negative anchor (for example, with transient symptoms of treatment), then a surrogate negative anchor that is itself defined according to a perfect health/death gamble may be used. We explored use of the Standard Gamble to define a reasonable surrogate negative anchor for evaluation of the impact of emesis. Ten normal volunteers performed a Standard Gamble exercise in which the fixed health state was a year of chemotherapy followed by survival in good health and the gamble had possible outcomes of perfect health or immediate death. The amount of nausea/vomiting during chemotherapy (continuous or none) and the duration of overall survival (6 years or 2 years) were varied to produce four unique health states. All subjects completed the exercise and demonstrated construct validity. Mean utility scores ranged from 0.89 for 6-year survival/no emesis to 0.46 for 2-year survival/continuous emesis. Presence of emesis significantly affected utility (0.565 vs 0.88), while shorter survival had a lesser effect (0.67 vs 0.78). The Standard Gamble technique can be used to evaluate nausea and vomiting. The fixed health state of 1 year of chemotherapy with continuous nausea and vomiting followed by 1 year of good health defines a utility score of 0.46. This is a reasonable negative surrogate anchor and is being used in a current Cancer and Leukemia Group B (CALGB) study.

The use of increasingly aggressive methods of cancer treatment during the last 20 years has brought clinical attention to the need for more effective management of pain, nausea, and other aversive side effects of state-of-the-art cancer therapy. One of the most promising approaches to effective management is nonpharmacologic intervention based on behavioral research and theory. The purpose of this review is to examine the effectiveness of behavioral intervention methods in the control of aversive side effects of cancer treatments. Fifty-four published studies using a variety of research designs were identified for review. Results indicated the following: 1) Behavioral intervention can effectively control anticipatory nausea and vomiting in adult and pediatric cancer patients undergoing chemotherapy; however, the evidence for the efficacy of behavioral intervention to control post-chemotherapy nausea and vomiting is less clear. 2) Behavioral intervention integrating several behavioral methods can ameliorate anxiety and distress associated with invasive medical treatments. 3) Although a variety of behavioral methods have been shown to reduce acute treatment-related pain, there is increasing evidence that these methods are not equally effective. Hypnotic-like methods, involving relaxation, suggestion, and distracting imagery, hold the greatest promise for pain management. Unfortunately, research is scant on the use of behavioral intervention to control prolonged pain associated with invasive medical procedures. It is clear that the application of behavioral theory and methods has an important place in the care of patients undergoing invasive cancer treatments.

We examined the relationship between patients' pretreatment expectations for nausea and vomiting and their subsequent development in a homogeneous group of 29 female cancer patients receiving platinum-containing chemotherapy as inpatients (Study 1) and in 81 subjects with any of a variety of cancer diagnoses treated largely as outpatients (Study 2). Each study found a significant relationship between patients' expectations for nausea development measured prior to their first treatment and their mean postchemotherapy nausea severity (both, p < 0.05). Patients' expectations accounted for unique variance in nausea severity in each study even after controlling for known pharmacological and physiological predictors of nausea (Study 1: delta R2 = .18, p < .04; Study 2: delta R2 = .05, p < .03). By contrast, we found no significant relationships between expectations for vomiting and subsequent vomiting. Our results support the view that patients' expectations for nausea affect its subsequent development, indicating the presence of a significant psychological component in treatment-related nausea. Implications of this are discussed.

The purpose of this study was to identify the relationship between parents and children in measuring children's acute and delayed nausea and vomiting induced by cancer chemotherapy. Twenty parent-child dyads participated in the study. Both instruments: Adapted Rhodes Index of Nausea and Vomiting by parent and by child (8-18 years old) were used every 12 h. The reliability and validity of these instruments have been established. There were significantly moderate to strong associations between parents and children in measuring these symptoms from Day 1 to Day 3 (total scores: r = 0.85-0.93; nausea scores: r = 0.67-0.93; and vomiting scores: r = 0.91-0.99, all P < 0.01). Therefore, parents' observation of their children's symptoms was strongly associated with their child's self-report of symptoms. Parents were able to assess their children's acute and delayed nausea and vomiting because in this sample almost all parents accompanied their children all day long.

Background: Modern cancer treatments can cure or prolong patients' lives. However, the associated physical and psychosocial problems can detrimentally affect patients' compliance with treatment and, ultimately, their outcomes. Therefore, oncologists need to recognize the problems experienced by their patients and, when possible, help resolve these problems., Methods: The authors conducted a cross-sectional survey of physical symptoms, anxiety, depression, and perceived needs among 204 consenting patients visiting an outpatient medical oncology department. Immediately following consultations with consenting patients, medical oncologists and registrars also completed a survey in which they indicated their perception of each patient's level of each problem. These two data sets were then compared., Results: Five oncologists' perceptions of patients' levels of the major physical symptoms cited in the survey (fatigue, nausea, vomiting, and hair loss) demonstrated the highest levels of awareness, with sensitivity rates up to 80%. Although sensitivity was less than 50% for all other physical symptoms, specificity was greater than 78% for all symptoms except fatigue. Only 17% of patients classified as clinically anxious and 6% of those classified as clinically depressed were perceived as such by their oncologists. However, the oncologists perceived much higher levels of perceived needs than patients reported, resulting in high sensitivity but low specificity rates. Oncologists' knowledge of and rapport with their patients and the pressure of their workloads were associated with their awareness of their patients' reported problems., Conclusions: Medical oncologists' perceptions may not accurately reflect their patients' reported physical and psychosocial experiences. Further interventions should be developed to assist oncologists in detecting such problems, especially psychosocial ones.

The purpose was to measure the effects of postchemotherapy nausea and vomiting (PCNV) on health-related quality of life (HQL) in patients receiving either moderately or highly emetogenic chemotherapy. The study sample consisted of 832 chemotherapy-naive patients with cancer who received either moderately or highly emetogenic chemotherapy as part of multicenter trials of new antiemetics. The patients completed the self-report European Organization for Research and Cancer (EORTC) core Quality of Life Questionnaire (QLQ-C30) before chemotherapy (baseline) and 1 week (day 8) and 2-4 weeks after chemotherapy. They also completed a self-report nausea and vomiting (NV) diary for 5-7 days after chemotherapy. To determine the effects of PCNV on HQL, the change in scores between the baseline and day 8 HQL assessments was calculated for each domain and symptom in the QLQ-C30 and compared in four subgroups of patients: those with both nausea and vomiting, those with nausea but no vomiting, those with no nausea but with vomiting, and those with neither nausea nor vomiting. The group with both nausea and vomiting showed statistically significantly worse physical, cognitive and social functioning, global quality of life, fatigue, anorexia, insomnia and dyspnea as compared to the group with neither nausea nor vomiting (0.0001 < P < 0.05). Patients with only nausea but no vomiting tended to have less worsening in functioning and symptoms than those having both nausea and vomiting. Increased severity of vomiting (> 2 episodes) was associated with worsening of only global quality of life and anorexia as compared with 1-2 episodes of vomiting (0.0001 < P < 0.01). By 2-4 weeks after chemotherapy all HQL scores had either returned to their baseline levels or were better than baseline. PCNV adversely affects several quality-of-life domains, but patients with only nausea experience less disruption than do those with both nausea and vomiting. Patients with 1-2 episodes of vomiting experience almost the same degree of disruption of HQL as do patients with more than 2 episodes of vomiting.

We investigated the preference and perceived efficacy of coping strategies used to manage chemotherapy-induced nausea and emesis in 57 pediatric oncology patients. Over 85% of children preferred "Wishful Thinking," "Emotional Regulation," and "Distraction" to cope with nausea, and "Emotional Regulation" to manage emesis. Stepwise logistic regression analyses revealed that the coping strategy used and its perceived efficacy depended upon patient age and gender, severity of symptom distress, time elapsed from last chemotherapy, experience, and whether nausea or emesis was the identified problem. Successful copers, defined as those reporting high coping efficacy and minimal distress, composed only 25% of the sample. These children most often used "Problem Solving" combined with "Social Support" for symptom management. Successful coping was also associated with lower emetogenic potential of chemotherapy. The significance of these results is discussed for identifying high-risk children who may benefit from coping interventions.

This is a review of the systematic studies conducted since 1980 in the area of hypnotic interventions for anxiety, pain, and emesis control in child and adolescent cancer patients. The focus of the present paper is on how the problems encountered in studying the use of hypnosis with this population influence the results. The review is divided between studies focused on controlling anxiety and pain and those focused on controlling nausea and vomiting. Consistent findings are identified, and suggestions for future research are made.

There have been significant improvements in the diagnosis and treatment of malignant tumours. However, recent advances in cytostatic therapy are associated with several adverse side-effects which can impair the patient's well-being and may result in refusal or delay of treatment. Nausea and vomiting are perceived to be the most unpleasant of these side-effects. This paper addresses some of the issues involved in the improvement of these two distressing symptoms.

Sixty cancer patients who were receiving chemotherapy at an outpatient Oncology Centre were surveyed for their views on a list of treatment-related toxicities. The severity of each toxicity was assessed using a visual analogue scale. Sixty percent of patients felt that the overall toxicity was acceptable. Ten percent felt like giving up. Problem with venous access was named the worst toxicity by 37% of patients, followed by nausea and vomiting (19%), and long waiting time (11%). Male patients tended to tolerate chemotherapy better. The female patients were significantly more affected by hair loss than their male counterpart. Better understanding of the toxicities of chemotherapy as perceived by the patients themselves allows them to take appropriate measures in improving their quality of life.

Aversive side effects are commonly associated with potentially curative chemotherapy treatments. Despite the advances in the development and testing of antiemetic medication, nausea and vomiting remain prevalent and troublesome side effects of chemotherapy. Four studies (from 1978-1990) of 2,499 consecutive cancer patients being treated with a variety of chemotherapy agents showed that 62-72% were experiencing posttreatment nausea/vomiting despite the use of available antiemetic medication. In addition to occurring during, or up until days following, treatment with cytotoxic drugs, nausea and vomiting may begin to occur in anticipation of chemotherapy treatments. This phenomenon is called anticipatory nausea and vomiting (ANV) and it occurs in at least one in four patients. Randomised clinical trials have shown that antiemetic drugs do not control ANV once it has developed. No single clinical or patient variable has been found to be as significantly associated with the development of ANV as several in concert. We have examined the predictive value of eight clinical characteristics in a series of three clinical trials. The first of these trials was developmental; the other two have been longitudinal prospective trials. The eight clinical characteristics appear stronger in predicting those patients who will not subsequently develop ANV rather than those who will. Anxiety has been proposed as a mechanism in the development and expression of anticipatory side effects. Here we show an association (P < .05) between patient self-report of anxiety on the State-Trait Anxiety Inventory (STAI) and the Symptom Checklist-90 (SCL-90) assessed at the first chemotherapy treatment, and subsequent development of anticipatory side effects within the first five treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

It is evident from the data presented above that nausea and vomiting are frequent side effects which are often persistent and distressing to patients. Evidence suggests, and intuitively it appears that avoidance of nausea and vomiting is important to the patients' ability to maintain their quality of life during the treatment period. It is of particular interest to note that in the literature reviewed in this paper standard antiemetic prescribing and practice were followed. It would, therefore, appear that available antiemetic agents are not always effective or may not be adequately employed. The toxicities associated with dopamine receptor antagonists, the current standard of antiemetic regimens, limit their usefulness in the clinical setting. In fact, the contribution of antiemetic therapy toxicities to the incidence of anxiety, fatigue, and restlessness which were commonly reported by patients in the studies reviewed should be considered. Additional effort to characterise the impact of nausea and vomiting on cancer patients' quality of life is needed. Clearly, the data available suggest that these symptoms should be included as part of the physical domain component of quality of life instruments used in cancer patients. Ideally, the instrument used should contain separate items for nausea and vomiting. Major side effects of antiemetic therapy should also be assessed since these may be as debilitating as the effects of nausea and vomiting. Increased awareness of total patient impact of emesis and antiemetic therapy will serve as an impetus for improvements in antiemetic therapy strategies and practices.

Fifty adult oncology outpatients receiving chemotherapy were surveyed to assess their experiences with chemotherapy-associated nausea and vomiting. Of patients who noted post-chemotherapy nausea with or without vomiting, 46% reported anticipatory nausea. The anticipatory symptoms developed after the onset of post-chemotherapy neausea. Patients experiencing anticipatory symptoms had received chemotherapy over a significantly longer period of time than had the patients with post-treatment nausea only. Of these patients who had noted post-chemotherapy nausea with or without vomiting for two or more months, 50% reported pre-treatment nausea with or without vomiting. There was no tendency toward anticipatory symptoms according to age, sex, race, educational level, disease, or type of chemotherapy. Thoughts of chemotherapy, sights, specific odors and tastes evoked anticipatory symptoms. Pre-treatment or anticipatory nausea and vomiting are probably a manifestation of classical (Pavlovian) conditioning.

A pilot investigation of nine cancer patients receiving chemotherapy on an outpatient basis at the University of Florida's Shands Teaching Hospital is reported. The focus of the study was comparing patients with anticipatory vomiting symptoms with patients who did not exhibit prechemotherapy vomiting on measures of affect and coping style. The data indicated that patients exhibiting prechemotherapy vomiting, compared with the other patients, were more anxious and depressed; additionally, they exhibited a coping style which was inhibitive rather than facilitative in nature. A theoretical context for defining and treating prechemotherapy vomiting is offered.

Forty-seven of 225 (21%) consecutive cancer patients were found to experience nausea and/or vomiting prior to a chemotherapy treatment. Multivariate examination of demographic and clinical characteristics showed patients with anticipatory side effects to report more severe posttreatment emesis, to report their most severe posttreatment nausea as occurring later after treatment, and to be more likely to be taking cisplatin than patients without anticipatory side effects. Seventy percent of the patients with anticipatory nausea and/or vomiting attributed the side effects to a psychologic etiology.

During the course of cancer treatment behavioural symptoms such as gagging, coughing and vomiting often develop in the absence of apparent tissue damage. Moreover, symptoms whose onsets are clearly related to disease processes often continue after the disease has been eliminated. The reported research incorporated time-series analyses of patients' behavioural symptoms and assessments of behavioural interventions involving the modification of nurse--patient and family--patient interactions. Results showed that: (1) inadvertent social reinforcement by hospital staff and family members fosters the development of behavioural symptoms; (2) personnel associated with treatment can become discriminative stimuli for social attention and thereby evoke symptom behaviours; and (3) by modifying the social reinforcement contingencies associated with treatment protocols, the frequency of psychosomatic symptoms can be reduced without changing the quality of medical/nursing care and social interaction.

One hundred cancer chemotherapy patients rated the severity of pre- and posttreatment nausea and emesis and completed the State-Trait Anxiety Inventory. In addition, scores on the Millon Behavioral Health Inventory were obtained for 59 of those patients. Thirty-three percent of the patients reported having experienced anticipatory nausea and 11% reported having experienced anticipatory vomiting. Patients who experienced anticipatory nausea had more posttreatment nausea and vomiting, were more depressed, and were characteristically more anxious than other patients. A personality profile including the future despair, social alienation, and inhibited style (from the Millon Behavioral Health Inventory) identified patients with anticipatory nausea.

The purpose of this study was to determine the prevalence and correlates of anticipatory nausea and vomiting in a sample of pediatric patients with cancer who were receiving outpatient chemotherapy. Forty male and female patients representing a broad range of diagnoses were interviewed with their parents concerning nausea and vomiting before and after chemotherapy. Anticipatory nausea was reported by 28.8% of the sample; anticipatory vomiting was present in 20% of the sample. An additional 9% had experienced anticipatory nausea and vomiting in the past but not currently. Anticipatory nausea and vomiting was positively correlated with the emetic potential of chemotherapeutic regimens and the severity of nausea and vomiting after chemotherapy; anticipatory nausea and vomiting most often developed within the first 4 months of treatment. Onset of anticipatory nausea and vomiting usually occurred two to four hours before treatment and was most severe at the actual time of drug administration. Considerable interpatient variability was observed, with treatment-related factors accounting for only 22% of the variance in the occurrence of anticipatory nausea and vomiting. These findings are considered within a behavioral framework for understanding conditioned aversions in pediatric patients with cancer. Implications for patient education, future research on the prediction of children at risk, and intervention are discussed.

Eight adolescents (10-17 years, mean 12.1) with cancer received behavioral intervention for chemotherapy-related nausea and vomiting. Within 3-5 days after the administration of each course of chemotherapy, patients rated (1-10 scale; 1 = none, 10 = maximum) their nausea and vomiting and the extent to which chemotherapy bothered them and disrupted their daily routine. After a baseline (preintervention) assessment of 2-3 courses of chemotherapy, patients received intervention during another 2-3 courses. While no significant reduction of symptoms were found prior to intervention, with intervention there were reductions in nausea (Z = 2.37, p less than 0.02), vomiting (Z = 2.52, p less than 0.01), bother (Z = 2.24, p less than 0.02), and disruption of activities (Z = 2.38, p less than 0.02). This preliminary study suggests that chemotherapy side effects in adolescents can be reduced with behavioral intervention.