Differences in nausea, vomiting, and retching between younger and older outpatients receiving cancer chemotherapy

Individual Factors Contributing to Nausea in First-Time Chemotherapy Patients: A Prospective Cohort Study

Objective

The expectation of developing side effects can enhance the likelihood to develop them – a phenomenon referred to as nocebo effect. Whether nocebo effects can be reduced by lowering negative expectancies, is not clear. The aim of this prospective study was to learn more about the factors contributing to nausea expectancy and their potential role in actual occurrence of nausea in patients undergoing chemotherapy for the first time in their life.

Methods

Patients scheduled for moderately emetogenic chemotherapeutic regimens filled in questionnaires to assess state anxiety and quality of life and to rate the expectancy of nausea as a side effect of chemotherapy. Patient diaries were used to monitor the severity of post-chemotherapy nausea in the 4 days following chemotherapy administration. Bivariate analyses complemented by multiple regression analyses were performed to identify the relationship between nausea expectation and nausea occurrence.

Results

121 female patients (mean age 53 years) with completed questionnaires were included in the analyses. The majority of the patients had a diagnosis of breast cancer (86%). The two main sources for nausea expectancy were positive history of nausea in other situations and state anxiety. Patients with high expectancy levels (first quartile) experienced greater nausea than those with lower expectancy levels. Bivariate analyses revealed a weak but non-significant association between nausea expectation and post-chemotherapy nausea. When controlling for age, type of cancer, history of nausea, state and trait anxiety, and global quality of life, positive history of nausea (OR = 2.592; 95% CI, 1.0 to 6.67; p < 0.05), younger age (OR = 0.95; 95% CI, 0.92 to 0.99; p < 0.05), and a lower quality of life (OR = 0.97; 95% CI, 0.94 to 1.0; p < 0.05), but not nausea expectancy (OR = 1.014; 95% CI, 0.51 to 2.02; p = 0.969), predicted the occurrence of post-chemotherapy nausea.

Conclusion

In this female cohort, younger patients with lower initial quality of life and a positive history of nausea were at higher risk to develop nausea after first time chemotherapy. These patients may benefit from psychological co-interventions that aim to enhance quality of life.

Examining Oral Intake Temperature in Cardiac Surgery Patients

The effect of restricting the temperature of cardiac surgery patients' oral intake to room temperature or warmer, over the first 3 postoperative days, on gastrointestinal (GI) symptoms was examined. In all, 57 patients were randomly assigned to receive the intervention or usual care. GI symptoms were measured daily over the first 5 postoperative days. Following hospital discharge, GI symptoms and return to function data were collected over 4 postoperative weeks. On Postoperative Day 1, 41% of patients reported having GI symptoms, and they were significantly associated with higher cross-clamp time. Symptoms dissipated over time. There were no differences between the study groups in GI symptoms or return to function. Nearly 70% of patients who withdrew from the study were randomized to the intervention group. Difficulty associated with adhering to the study protocol was their primary reason for withdrawing. Given these findings, a large-scale clinical trial may not be warranted.

Review of acupressure studies for chemotherapy-induced nausea and vomiting control

The purpose of this review was to evaluate the effects of a noninvasive intervention, acupressure, when combined with antiemetics for the control of chemotherapy-induced nausea and vomiting (CINV). Ten controlled acupressure studies were included in this review. The review evaluated one quasi-experimental and nine randomized clinical trials, which included two specific acupressure modalities, that is, acupressure band and finger acupressure. The effects of the acupressure modalities were compared study by study. Four of seven acupressure band trials supported the positive effects of acupressure, whereas three acupressure band trials yielded negative results regarding the possible effects of acupressure; however, all the studies with negative results had methodological issues. In contrast, one quasi-experimental and two randomized finger acupressure trials all supported the positive effects of acupressure on CINV control. The reported effects of the two acupressure modalities in each phase of CINV produced variable results. Acupressure bands were effective in controlling acute nausea, whereas finger acupressure controlled delayed nausea and vomiting. The overall effect of acupressure was strongly suggestive but not conclusive. Differences in the acupressure modality, the emetic potential of chemotherapeutic agents, antiemetic use, and sample characteristics of each study made study-to-study comparisons difficult. Suggestive effects of acupressure, cost-effectiveness, and the noninvasiveness of the interventions encourage researchers to further investigate the efficacy of this modality. Acupressure should be strongly recommended as an effective, nonpharmacologic adjuvant intervention for CINV control if its positive effects are reproduced in future acupressure clinical trials.

Evolving roles of oncology pharmacists in Singapore: a survey on prescribing patterns of antiemetics for chemotherapy induced nausea and vomiting (CINV) at a cancer centre

BACKGROUND

National Cancer Centre (NCC) is currently the largest ambulatory oncology treatment centre in Singapore that treats mainly solid tumors and lymphomas. Oncology pharmacists at NCC play an active role in the management of CINV. In order to improve the clinical services delivered by pharmacy, particularly in the utilization of antiemetics, pharmacy department conducted a survey that aimed to understand the prescribing patterns of antiemetics for CINV.

OBJECTIVES

ves. The primary aim of this study was to describe medical oncologists' perceptions of factors that can influence prescribing of antiemetics for acute and delayed nausea and vomiting associated with chemotherapy. A secondary aim was to assess medical oncologists' perception of antiemetic counseling by oncology pharmacists.

METHODS

This was a single-centered, non-randomized survey conducted at NCC in Singapore. Twenty-seven oncologists in the Department of Medical Oncology (DMO) were invited to participate in this survey. Survey forms were distributed to the medical oncologists at weekly DMO and tumor board meetings in November 2006.

RESULTS

Twenty oncologists returned surveys during the study period. Most oncologists closely adhered to the institution guideline on antiemetics utilization; however, results showed a trend of overprescribing acute antiemetics for low emetogenic chemotherapy regimens. Oncologists have identified anxiety, age and gender as the top three patient risk factors taken into consideration when they prescribe antiemetics. Majority of oncologists found pharmacists' counseling on antiemetics to be effective.

CONCLUSIONS

Through this survey, oncology pharmacists at NCC were able to identify areas of antiemetics utilization that needed refinement. Results from this survey provide opportunities for oncology pharmacists to collaborate with medical oncologists to further improve the management of chemotherapy induced nausea and vomiting.

Chemotherapy in the Geriatric Population

The population in America is aging, and the number of older adults who develop cancer continues to grow. Gerontologic considerations in the delivery of health care become increasingly more important as a result of these population trends. Factors such as physiologic age-related changes, comorbid conditions, and the incidence of polypharmacy contribute to the challenges of administering chemotherapy to older patients with cancer. Age-related physiologic changes, including alterations in the gastrointestinal system, renal system, body composition, and hematopoiesis, impact patients' ability to tolerate standard doses of chemotherapy. In addition, these changes increase the likelihood of developing severe toxicities. Comorbid conditions confound the side effects of chemotherapy, and the use of multiple medications places older patients with cancer at increased risk for developing drug interactions. Older patients with cancer may be more susceptible to developing toxicities from chemotherapy, and these toxicities may be more severe. When healthcare professionals follow age-appropriate standards of oncology care, chemotherapy can be safely and effectively administered to older patients with cancer. Oncology nurses play a crucial role in assessing for potential complications and managing toxicities. Incorporating geriatric care into oncology nurses' daily practice ensures quality care for older patients with cancer.

Massage Relieves Nausea in Women with Breast Cancer Who Are Undergoing Chemotherapy

OBJECTIVES

The aim of the present study was to examine the effect of massage on nausea, anxiety, and depression in patients with breast cancer undergoing chemotherapy.

DESIGN

This work was a single-center, prospective, randomized, controlled trial.

SETTINGS/LOCATION

This study was conducted in an oncology clinic, in a hospital in southwestern Sweden.

SUBJECTS

Thirty-nine (39) women (mean age = 51.8) with breast cancer undergoing chemotherapy were enrolled.

INTERVENTIONS

The patients were randomly assigned to a massage therapy group (20 minutes of massage on five occasions) or a control group (five 20-minute visits).

OUTCOME MEASURES

All patients recorded nausea and anxiety on the Visual Analogue Scale before and after each intervention. They also completed the Hospital Anxiety and Depression Scale.

RESULTS

Massage treatment significantly reduced nausea compared with control treatment (p = 0.025) when improvement was measured as a percentage of the five treatment periods. Differences in anxiety and depression between the two treatment regimes could not be statistically demonstrated.

CONCLUSIONS

This study complements previous studies on the effect of massage and supports the conclusion that massage reduces nausea in these patients.

Virtual reality: a distraction intervention for chemotherapy

PURPOSE/OBJECTIVES

To explore virtual reality (VR) as a distraction intervention to relieve symptom distress in adults receiving chemotherapy treatments for breast, colon, and lung cancer.

DESIGN

Crossover design in which participants served as their own control.

SETTING

Outpatient clinic at a comprehensive cancer center in the southeastern United States.

SAMPLE

123 adults receiving initial chemotherapy treatments.

METHODS

Participants were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and then received no intervention (control) during an alternate matched chemotherapy treatment. The Adapted Symptom Distress Scale-2, Revised Piper Fatigue Scale, and State Anxiety Inventory were used to measure symptom distress. The Presence Questionnaire and an open-ended questionnaire were used to evaluate the subjects' VR experience. The influence of type of cancer, age, and gender on symptom outcomes was explored. Mixed models were used to test for differences in levels of symptom distress.

MAIN RESEARCH VARIABLES

Virtual reality and symptom distress.

FINDINGS

Patients had an altered perception of time (p < 0.001) when using VR, which validates the distracting capacity of the intervention. Evaluation of the intervention indicated that patients believed the head-mounted device was easy to use, they experienced no cyber-sickness, and 82% would use VR again. However, analysis demonstrated no significant differences in symptom distress immediately or two days following chemotherapy treatments.

CONCLUSIONS

Patients stated that using VR made the treatment seem shorter and that chemotherapy treatments with VR were better than treatments without the distraction intervention. However, positive experiences did not result in a decrease in symptom distress. The findings support the idea that using VR can help to make chemotherapy treatments more tolerable, but clinicians should not assume that use of VR will improve chemotherapy-related symptoms.

IMPLICATIONS FOR NURSING

Patients found using VR during chemotherapy treatments to be enjoyable. VR is a feasible and cost-effective distraction intervention to implement in the clinical setting.

Chemotherapy-related nausea and vomiting - past reflections, present practice and future management

Although much progress has occurred in the last decade regarding the management of chemotherapy-induced nausea and vomiting, these remain among the most intolerable side-effects of treatment and patients continue to report the negative impact such symptoms have on their ability to enjoy life. Inadequate control of nausea and vomiting reduces patients' quality of life and functional status and jeopardizes the delivery of optimal treatment, so making its management a priority for oncology health care workers. This article will reflect on past and present evidence regarding the management of chemotherapy-induced nausea and vomiting while highlighting some of the most recent scientific advances before drawing conclusions about the future management of this troublesome symptom for patients receiving chemotherapy.

Telephone-linked care for cancer symptom monitoring: a pilot study

PURPOSE

The purpose of this pilot project was to explore the feasibility of using a telephone-based computerized system to monitor postchemotherapy symptoms and to test the mechanism of generating alert communications to healthcare providers about symptoms that are poorly controlled.

DESCRIPTION OF STUDY

Twenty-seven patients with cancer participated in the study by calling the telephone-linked care (TLC) system daily during a single cycle of chemotherapy and reporting on seven common chemotherapy-related symptoms. Using selected symptom data, symptoms that met a preset threshold for severity generated a fax notification of the patient's symptom pattern to the physician. Patients then were interviewed about their satisfaction with TLC and about suggestions for improvement.

RESULTS

The study demonstrated that TLC is easy to learn and use and that it captures daily symptom information from patients in their homes. A majority of patients experienced symptoms that were severe enough to generate symptom-alert faxes. Patient satisfaction with TLC was high. The technique, TLC voice, and the duration of the calls were acceptable to patients. There were few technical problems.

CLINICAL IMPLICATIONS

The TLC system has the potential to improve dramatically symptom monitoring and symptom care of patients with cancer at home. Further testing is needed, but the TLC chemotherapy monitoring application shows promise for improving supportive-care service delivery for cancer patients. In its initial test, the TLC chemotherapy monitoring application has been shown to be highly acceptable to patients, able to generate useful symptom data, and able to generate faxed alerts to healthcare providers, thus improving communication about poorly controlled symptoms.

The Chinese translation of the Index of Nausea, Vomiting, and Retching

The purpose of this study was to determine reliability and validity of the Chinese version of the Index of Nausea, Vomiting, and Retching (INVR) and the Index of Nausea and Vomiting Form 2 (INV-2) to provide a reliable and valid measure of nausea, vomiting, and retching for Chinese nurses and other healthcare providers. An integrative translation method was used in the study. The reliability and validity of the Chinese versions of the INVR and the INV-2 was evaluated using test-retest, parallel forms, and crossover design. A convenience sample of 177 Chinese-speaking participants was accrued from a large teaching cancer institute and a teaching obstetric hospital in Beijing, Peoples Republic of China. The integrative translation method was proven to be an effective method for translating instruments from the source to the target language. The Chinese versions of both the INV-2 and INVR were found to have high Cronbach's alpha scores and high agreement rates. The responses to the Chinese version of INVR were more frequently consistent than the responses to the INV-2. The majority of the patients voiced preference for the INVR. The findings suggest the significance of the Chinese versions of INVR and INV-2 in terms of nursing practice. The findings also support the cross-cultural method for future study at international level.

Chemotherapy-induced nausea and vomiting

Nausea and vomiting (N&V) is among the most distressing side effects of chemotherapy, despite the development of more efficacious antiemetic agents. As many as 60% of patients who receive cancer chemotherapy experience some degree of N&V. However, the actual incidence is difficult to determine with accuracy because of the variety of drugs, doses, and health conditions of the patients who receive cancer treatments. This article examines the state of the science related to chemotherapy-induced nausea and vomiting and reviews both pharmacologic and behavioral strategies that have demonstrated efficacy in managing these distressing symptoms.

Hospice patients' and nurses' perceptions of self-care deficits based on symptom experience

Although the relief and/or control of physically, emotionally, and spiritually distressing symptoms are the hallmarks of hospice care, accurate assessment of the individual's unique and often rapidly changing symptom experience is lacking. The purpose of this descriptive, correlational study was to assess and quantify hospice patients' perceptions of their symptom experiences and those of the hospice nurse assessing them. A convenience sample of 53 hospice patients (32 males, 21 females), with a mean age of 69 years, from a large midwestern home-based hospice completed the Adapted Symptom Distress Scale Form 2 (ASDS-2) at admission, and at 2 and 4 weeks after admission. The Hospice Admission Intake was completed at admission. Individual hospice nurses completed the ASDS-2 within 24 hours of their hands-on assessment, in addition to the demographic characteristics profile. Findings indicated an improvement in symptom experience, distress, and occurrence scores from admission to week 2, and in the symptom experience and distress scores from admission to week 4. Hospice nurses tended to give higher symptom experience scores than the patients gave to themselves. These findings demonstrate the importance of obtaining information about symptom experience from the patient as well as the nurse.