Behavioral Treatment for the Anticipatory Nausea and Vomiting Induced by Cancer Chemotherapy

Morrow, Gary R.; Morrell, Christine

doi:10.1056/nejm198212093072402

Cited by 295 publications

(114 citation statements)

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“…Literature sources document that after multicycle chemotherapy treatment the prevalence of ANV may be as high as 25-40%. Morrow and Morrell (1982) found that, of 406 chemotherapy patients, 81 (20%) had mild to intolerable nausea, and 35 (8.6%) had had vomiting prior to their chemotherapy. Our results show that the use of granisetron may have resulted in fewer patients displaying symptoms of ANV, though these results may be confounded by the selection of good responders during the study.…”

Section: Discussionmentioning

confidence: 99%

“…Chang (1981) showed that ANV is poorly responsive to treatment with conventional antiemetics, and much effort has been put into understanding the aetiology of ANV by Morrow et al (1991). Behavioural treatment (Morrow & Morrell, 1982) to desensitise patients by means of counselling or by relaxation techniques has been considered.…”

mentioning

confidence: 99%

“…Behavioural treatment (Morrow & Morrell, 1982) to desensitise patients by means of counselling or by relaxation techniques has been considered.…”

mentioning

confidence: 99%

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The incidence of anticipatory nausea and vomiting after repeat cycle chemotherapy: the effect of granisetron

Aapro

Kirchner²,

Terrey³

1994

Br J Cancer

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Summary Anticipatory nausea and vomiting (ANV) after repeated cycles of cytotoxic chemotherapy is thought to be a conditioned response to a conditioning stimulus. Good control of acute and delayed emesis may result in a lower incidence of ANV. We have analysed data from 574 chemotherapy patients who received granisetron as their antiemetic treatment during repeat cycle chemotherapy. Per treatment cycle, less than 10% of patients displayed symptoms of anticipatory nausea and 2% or less had symptoms of anticipatory vomiting. It is concluded that the use of granisetron as an antiemetic during the acute phase of chemotherapy may result in a lower incidence of ANV in patients undergoing repeat cycle chemotherapy.The treatment of many forms of malignant disease often involves the use of cytotoxic agents whose toxic effects include nausea and/or vomiting. Andrykowski et al. (1985) showed that, in patients undergoing the initial phase of chemotherapy, emesis is an unconditioned response. However, after a few cycles of emetogenic chemotherapy during which the patient experiences emesis, the association of factors linked with chemotherapy (visual, gustatory, olfactory, environmental) may themselves initiate emesis. These factors are considered to be conditioned stimuli eliciting a conditioned response (emesis). Typically, these factors may precipitate emesis prior to the administration of chemotherapy, and this emesis is referred to as anticipatory nausea and vomiting (ANV). The incidence of ANV may vary widely from centre to centre owing to heterogeneity of patients and treatments. Early reviews of the prevalence of ANV showed that it ranges from 28.3% (Nicholas, 1982) to 44% (Nesse et al., 1980). Love et al. (1982) reported a prevalence of anticipatory vomiting of 38%. The percentage of patients who reported ANV was subdivided by Morrow et al. (1982) into 24% who experienced anticipatory nausea and 9% anticipatory vomiting. The relationship between the development of ANV and the number of chemotherapy treatments has also been documented (Redd & Andresen, 1981;Nicholas, 1982;Redd et al., 1982).Chang (1981) showed that ANV is poorly responsive to treatment with conventional antiemetics, and much effort has been put into understanding the aetiology of ANV by Morrow et al. (1991). Behavioural treatment (Morrow & Morrell, 1982) to desensitise patients by means of counselling or by relaxation techniques has been considered.It is now accepted that the development of ANV is a function of the emetogenicity and frequency of chemotherapy treatments. In a study by Wilcox et al. (1982), prevention of post-chemotherapy nausea and vomiting by conventional antiemetics was associated with the prevention of symptoms of ANV. The recent introduction of the potent and selective 5-HT3 antagonists as antiemetics (granisetron, ondansetron and tropisetron) has been regarded as being a significant advance in the control of acute emesis. In this paper we analyse the incidence of the symptoms of ANV of patients who have undergone repeat cycle...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The incidence of anticipatory nausea and vomiting after repeat cycle chemotherapy: the effect of granisetron

Aapro

Kirchner²,

Terrey³

1994

Br J Cancer

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“…Several randomized trials have shown effects of hypnosis on both procedural and malignant pain [84,85] and on anxiety, depression, and mood in newly diagnosed cancer patients [86][87][88]. Trials also have generally found hypnosis and relaxation training to be beneficial against chemotherapy-induced nausea in adults [89,90], although some studies found no differences between groups [91].…”

Section: Helpful Complementary Therapiesmentioning

confidence: 99%

Complementary and Alternative Therapies for Cancer

2004

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“…Although there is not yet any evidence of conditioning of the pyloric sphincter, there is strong evidence in humans that nausea and vomiting can be classically conditioned. This potent conditioning has been a problem for many patients receiving chemotherapy for cancer (Burish & Carey, 1984;Morrow & Morrell, 1982;Nesse, Carli, Curtis, & Kleinman, 1980;Redd & Andersen, 1981). Additionally, the observation in rats that amiemetic drugs can reduce the expression of conditioned taste aversions produced by LiCl suggests that nausea becomes conditioned to and triggered by taste stimuli (Coil, Hankins, Jenden, & Garcia, 1978; but see Goudie, Stolerman, Demellweek, & D'Mello, 1982).…”

Section: How Does Food Aversion Learning Lead To Anorexia?mentioning

confidence: 99%

Learned food aversion: A component of anorexia syndromes.

Bernstein¹,

Borson²

1986

Psychological Review

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Several syndromes that have been characterized in terms of anorexia or appetite loss may actually be due, at least in part, to specific food aversion learning. Evidence reviewed here indicates that a number of experimental treatments, such as tumor implant and subdiaphragmatic vagotomy, that lead to anorexia in laboratory animals also lead to the development of specific aversions to the single available diet. These aversions appear to be responsible for a significant proportion of the ensuing reduction in food intake and body weight. The case for learned food aversions as a contributing factor in clinical problems of appetite loss is more speculative. However, there are certain clinical situations that provide the expected conditions for significant food aversion learning. A careful examination of dietary patterns of patients with these disorders is proposed as a first step toward evaluating the hypothesis that aversion learning is involved in the etiology or maintenance of clinically important anorexia.The physiological mechanisms regulating food intake have been the focus of productive investigation over the past two decades. One goal of this research has been to enhance our understanding of basic mechanisms of energy regulation and to apply this knowledge to the treatment of clinical disorders of appetite. Much of this work has been directed at identifying the causes of obesity and developing effective treatments. However, the loss of appetite and weight is also a significant and prevalent medical problem that arises in a wide variety of clinical situations. There has, to date, been relatively little success in understanding the pathophysiology of serious appetite and weight loss, and treatment has depended on relatively drastic measures such as prolonged intravenous or intragastric feeding. Interventions grounded in an understanding of the mechanisms by which undernutrition develops could, in theory, offer promise of improved outcome.In general, the study of the physiological mechanisms responsible for the regulation of appetite has delimited one research domain. A separate line of inquiry has been the study of conditioned taste aversions, with an emphasis on defining basic Pavlovian conditioning mechanisms (Barker, Best, & Domjan, 1977). Because these two areas of investigation differ markedly in focus, there has been relatively little interchange between them. However, in both types of studies, a change in ingestive behavior in response to an experimental manipulation is the main dependent variable. Therefore, it is reasonable to explore the potential contribution of taste aversion learning to the development of appetite and weight loss.In this article we will argue that several syndromes character-

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Behavioral Treatment for the Anticipatory Nausea and Vomiting Induced by Cancer Chemotherapy

Cited by 295 publications

References 15 publications

The incidence of anticipatory nausea and vomiting after repeat cycle chemotherapy: the effect of granisetron

The incidence of anticipatory nausea and vomiting after repeat cycle chemotherapy: the effect of granisetron

Complementary and Alternative Therapies for Cancer

Learned food aversion: A component of anorexia syndromes.

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