Behavioural factors influencing the development and expression of chemotherapy induced side effects

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. Anxiety on the Profile of Mood States (POMS) was not found related (P > .05). It appears that anxiety when measured as a constellation of symptoms (such as is done on the SCL-90 and the STAI) is related to the development of ANV, while anxiety measured as a mood (POMS) is not.