Fifty cancer patients receiving chemotherapy, 25 by push injection and 25 by drip infusion, were assigned to one of three conditions for their chemotherapy treatments: (a) progressive muscle-relaxation training plus guided-relaxation imagery; (b) therapist control, in which a therapist was present to provide support and encouragement but did not provide systematic relaxation training; and (c) no-treatment control. Patients participated in one pretraining, three training, and one follow-up session. Results indicated that during the training sessions, patients who received relaxation training, relative to patients in either of the other two conditions, (a) reported feeling significantly less anxious and nauseated during chemotherapy, (b) showed significantly less physiological arousal (as measured by pulse rate and systolic blood pressure) and reported less anxiety and depression immediately after chemotherapy, and (c) reported significantly less severe and less protracted nausea at home following chemotherapy. The attending nurses' observations during chemotherapy confirmed patient reports. In general, patients in the therapist control condition and the no-treatment control condition did not differ significantly from each other. The differences amorig conditions generally remained significant during the follow-up session. The data suggest that relaxation training may be an effective procedure for helping cancer patients cope with the adverse effects of their chemotherapy.The chemotherapeutic treatment of can-fore I make a plea to all co-operative chemotherapeutic cer is a debilitating, aversive, and often e rou P s to ******* a se ?; oh to f efifectiye antiemetic dreaded experience for millions of cancer ^of che!=^p atients. Whltehead (1975, p. 200), ma tially the quality of life during such therapy. moving plea to his fellow physicians, de-, scribes the situation:The aversiveness of cancer chemotherapy is caused in large part by the fact that the After one or more courses [of chemotherapy], patients drugs administered during chemotherapy may begin to vomit on the morning of their treatment, . °.or upon arrival at the physician's office, in anticipation treatments affect virtually every cell in the of the injection, attesting to the abhorrence with which body, not just the cancer cells. As a result they regard the treatment. They confess to feeling ill of its effects on normal tissues, even a *'SUCfor three weeks or more out of every four and may ce s s f u l" course of chemotherapy can probecome deeply depressed and even suicidal.. . .Thereduce a variety of unpleasan t si de effects, in-This research was supported-in part by Department eluding decreased immunity to Other disof Health, Education, and Welfare Research Grant No. eases, change in liver enzymes, hair loss, loss 'CA 25516 from the National Cancer Institute and a of appetite, stomatitis, nausea, vomiting, Biomedical Research Support Grant through Vander-temporary or permanent frigidity or impobiit University . tence, and negative aifects such as anxiety...

Cancer patients receiving chemotherapeutic treatments routinely experience a wide range of distressing side effects, including nausea, vomiting, and dysphoria. Such symptoms often compromise patients 1 quality of life and may lead to the decision to postpone or even reject future, potentially life-saving, treatments. In this article, we discuss the hypotheses that have been offered to explain the development of such symptoms. We also review, in greater detail, the research evidence for the efficacy of five treatments for such symptoms: hypnosis, progressive muscle relaxation training with guided imagery, systematic desensitization, attentional diversion or redirection, and biofeedback. We discuss the implications of this treatment research, paying particular attention to factors associated with treatment outcome, mechanisms of treatment effectiveness, and issues associated with clinical application. Chemotherapy is the treatment of choice for hundreds of thousands of cancer patients diagnosed each year in the UnitedStates (Silverberg & Lubera, 1986). Its frequent use with cancer patients is the result of recent advances in antineoplastic medication; new and more effective medications have increased the life expectancy for many patients and, in some cases, have resulted in remission and cure. Unfortunately, such long-term gain can come at considerable short-term cost to the cancer patient in the form of aversive and debilitating side effects. Among the more common drug-induced side effects are alopecia, stomatitis, immunosuppression, anorexia, nausea, and vomiting.In addition to these pharmacological side effects, chemotherapy patients also experience psychological side effects.Psychological side effects, which should not necessarily be regarded as abnormal or indicative of psychopathology, are those that cannot be attributed directly to the antineoplastic medications; instead, such symptoms are believed to result from psychological processes (e.g., learning) that occur in the chemotherapy context. These symptoms can occur before chemotherapy (in which case they are referred to as anticipatory side effects) as well as during and after the actual chemotherapy infusion. When they occur after chemotherapy has been administered (and while the drugs remain pharmacologically active within the system), it is practically impossible to distinguishWe wish to thank Kate B. Carey and the anonymous reviewers for their many helpful suggestions on an earlier draft of this review.

Sixty cancer chemotherapy patients were randomly assigned to one of four treatments: (a) relaxation training with guided relaxation imagery (RT), (b) general coping preparation package (PREP), (c) both RT and PREP, or (d) routine clinic treatment only. All patients were assessed on self-report, nurse observation, family observation, and physiological measures and were followed for five sequential chemotherapy treatments. Results indicate that the PREP intervention increased patients' knowledge of the disease and its treatment, reduced anticipatory side effects, reduced negative affect, and improved general coping. RT patients showed some decrease in negative affect and vomiting, but not as great as in past studies. The data suggest that a relatively simple, one-session coping preparation intervention can reduce many different types of distress associated with cancer chemotherapy and may be more effective than often-used behavioral relaxation procedures.

Summary:endpoint following BMT. QOL is a multidimensional concept incorporating aspects of an individual's physical health, personal, cognitive, and occupational functioning, While problems with sleep and energy level (ie fatigue) are commonly reported during recovery from bone sociability, and feelings of personal distress and wellbeing. 1-2 A number of excellent reports investigating one marrow transplantation (BMT), little in-depth information regarding these two problem areas in BMT or more dimensions of QOL in adult BMT recipients have appeared in recent years. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In general, these studies sugpatients is available. Using both questionnaire and telephone interview methods, information regarding curgest that while many BMT recipients evidence a relatively normal QOL following BMT, significant numbers of adult rent sleep and energy level problems was obtained from 172 adult BMT survivors drawn from five different BMT recipients report deficits in one or more QOL domains. These deficits span a range of QOL domains and BMT treatment centers. Respondents were a mean of 43.5 months post-BMT at the time of the initial assesscan persist for years following BMT.Sleep problems and problems with fatigue, reduced ment. Similar questionnaire data was obtained from 137 respondents (80%) at a follow-up assessment 18 months energy level, or loss of stamina or strength are two areas of QOL deficit which have been identified as significant after the initial assessment. Results suggested that half to two-thirds of disease-free BMT recipients experience concerns following BMT. In a study of 125 adult long-term survivors (6-18 years) of BMT, fatigue (56% of sample) problems with regard to current energy level or sleep quality. While for the majority of patients these proband sleep disturbance (43%) were two of the three most frequently reported current physical problems. 8 Greater age lems were rated as mild, 15-20% of BMT recipients showed moderate to severe problems in these areas with at BMT was significantly associated with greater current fatigue. In a study of 135 adult BMT recipients (6-149 corresponding decrements in quality of life. Furthermore, both cross-sectional and longitudinal analyses months post-BMT), among 18 life domains rated, 'strength' was the domain with which patients were least satisfied.7 suggested that problems in these areas did not simply abate with time. Only low to moderate correlations were In another study, 23% of 162 adult long-term survivors (1 to 13 years post-BMT) of allogenic BMT reported 'variobtained between indices of sleep and energy problems and measures of anxious and depressed mood. Finally, able' or 'poor' sleeping habits. 14 Similarly, 27% of 59 adult autologous BMT recipients reported poor or variable sleep the presence of current sleep problems was associated with older age at BMT, receipt of TBI during pre-BMT habits 1 year following BMT. 9 Syrjala et al 15 reported that 27% of 31 patients 1 year post-allogeneic BMT scored in co...

Considerable controversy and contradictory data exist about the notion that psychosocial factors can predict longevity in cancer patients. This study further addresses that issue by eliminating some of the methodological weaknesses of prior studies and focusing on a more tightly defined patient population. Forty-nine female metastatic breast cancer patients were given a variety of psychological tests. At the time of the analyses, all patients in the study had died from their disease. Patients were evenly divided into short-term survivors and long-term survivors based on length of survival as calculated both from date of diagnosis and from date of testing. The results indicated that there were no consistent differences between groups on any psychosocial variable assessed. These data suggest that, for breast cancer patients with metastatic disease, disease-related variables probably outweigh the influence of select psychosocial factors in determining length of survival.