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To determine the incidence of anticipatory vomiting (AV) and postchemotherapy nausea and vomiting (PCNV) in women receiving cyclophosphamide, methotrexate, and 5-FU (CMF) adjuvant chemotherapy for breast carcinoma, we studied 52 women randomized to two regimens (standard-dose and low-dose) of CMF. Charts were reviewed for the cycle of onset of AV and PCNV, the severity of PCNV, and relationships of these syndromes to CMF dose and protocol compliance. Among the 52 patients, AV occurred in 17 (33%), while PCNV was experienced by 46 (88%). Severe PCNV (defined as uncontrolled nausea and/or vomiting interfering with performance of daily activities) occurred in 22 of 52 (42%) women. Eighteen of 23 (78%) women receiving standard-dose CMF experienced severe PCNV, and 13 of these had AV. Patients in whom severe PCNV began before cycle 4 were more likely to develop AV than women in whom PCNV began later (P less than 0.01). Ten of 52 (19%) patients discontinued CMF adjuvant chemotherapy because of nausea and vomiting; seven of the ten (70%) were receiving standard-dose CMF and seven had experienced AV. This study demonstrates that both AV an PCNV are significant toxic effects that not only affect the quality of life of a woman receiving CMF chemotherapy for breast cancer but also limit the ability of the clinician to provide maximum therapy to woman at high risk of recurrence of breast carcinoma.

We studied the prevalence of anticipatory nausea (AN) and anticipatory nausea and vomiting (ANV) in an ambulatory medical oncology population by self-report questionnaire over 7 weeks. Thirty-eight of 123 (31%) patients receiving parenteral chemotherapy reported anticipatory symptoms (AN or ANV). Twenty-one (17%) patients reported ANV and 17 (14%) reported AN only. Patients receiving parenteral chemotherapy (N = 123) with anticipatory symptoms (N = 38) were younger (45.1 +/- SE 1.9 vs 55.5 +/- 1.45, P less than 0.001) and more likely to be female (82% vs 61%, P = 0.04), unmarried (47% vs 26%, P = 0.03), and receiving adjuvant chemotherapy for breast cancer (42% vs 7% P less than 0.001) than patients without anticipatory symptoms (N = 85). A greater proportion of patients with both postchemotherapy nausea and vomiting and anticipatory symptoms reported greater than 12 hours of postchemotherapy nausea (65% vs 39%, P = 0.01) and postchemotherapy nausea and vomiting (37% vs 12%, P = 0.01) after their most recent cycle of chemotherapy than did patients with postchemotherapy symptoms only. In structured interviews with 23 patients with anticipatory symptoms, 16 identified specific stimuli associated with AN or ANV, taste being the most frequently mentioned (ten of 16 patients) sensory modality. In our clinic, patients receiving adjuvant chemotherapy for breast cancer develop anticipatory symptoms frequently and represent a relatively homogenous sample for further studies.