Comparing the effectiveness of behavioral treatment for chemotherapy-induced nausea and vomiting when administered by oncologists, oncology nurses, and clinical psychologists.

Abstract

Adequate control of side effects during medical treatment of cancer increases patient compliance and quality of life. Antiemetic drugs are not an effective treatment for the one in three cancer patients on chemotherapy who experience anticipatory nausea and vomiting (ANV); the behavioral treatment of systematic desensitization has been found effective for ANV when delivered by clinical psychologists. This study examined the effectiveness of systematic desensitization when delivered by medical personnel versus clinical psychologists. Seventy-two consecutive cancer patients with ANV were randomly assigned to no-treatment control or to systematic desensitization from 5 behaviorally trained clinical psychologists, 6 clinical oncologists, or 10 oncology nurses. The treatment was found effective in reducing anticipatory nausea, anticipatory vomiting, posttreatment nausea, and posttreatment vomiting compared to control patients, with no significant differences in effectiveness found between clinical psychologists and oncology staff. Although medical personnel should not engage patients in psychotherapy or other interventions that cannot be completed successfully, they can treat patients effectively with systematic desensitization and should be encouraged to learn and use this and other behavioral intervention techniques to benefit total patient care.

Chemotherapy-induced Nausea and Vomiting

“…58,64 Patients who receive a combined intervention of relaxation plus guided imagery have a reduced incidence of nausea during chemotherapy, lower incidence, duration, and severity of post-chemotherapy nausea, shorter duration of post-treatment vomiting, 65,66 and a more positive experience with chemotherapy than patients who receive antiemetic treatment alone. 67 Other interventions include hypnosis, or suggestive therapy [68][69][70][71] systematic desensitization 72 biofeedback, 56 wristbands, 73 and electrical stimulation at the wrist. 74 No single mode of delivery of these behavioral interventions is universally effective or flawless.…”

Efficacy and Costs of Two Forms of Stress Management Training for Cancer Patients Undergoing Chemotherapy

“…7,8 Early studies in this area focused on the use of psychosocial interventions to improve quality of life among chemotherapy patients who had developed anticipatory nausea and vomiting. This research demonstrated that a variety of professionally administered interventions, including progressive muscle relaxation training with guided imagery, 9,10 systematic desensitization, 11 and biofeedback, 12 were effective in relieving nausea, vomiting, and emotional distress in the period just before chemotherapy administration. Some of the same interventions were also found to have beneficial effects on nausea, vomiting, and emotional distress in the hours and days after chemotherapy administration.…”

“…Some of the same interventions were also found to have beneficial effects on nausea, vomiting, and emotional distress in the hours and days after chemotherapy administration. 10,11 These studies encouraged further research that has proceeded in two directions. One direction has involved modifying the delivery of the interventions so that they might become more accessible to chemotherapy patients experiencing aversive treatment side effects.…”

Use and Helpfulness of Self-Administered Stress Management Therapy in Patients Undergoing Cancer Chemotherapy in Community Clinical Settings

“…Findings from previous studies have demonstrated that professionally administered interventions including guided imagery (Burish & Lyles, 1981;Lyles, Burish, Krozely, & Oldham, 1982), systematic desensitization (Morrow, 1986), and biofeedback (Burish & Jenkins, 1992) have been consistently effective in reducing nausea, vomiting, and emotional distress following chemotherapy. Similarly, self-administered psychological interventions have been shown to improve QOL, reduce psychological distress related to other clinical conditions (e.g., migraine headache) (McGrath et al, Self-Administered Stress Management Therapy 59 1992), and reduce cancer-related side effects (Morrow et al, 1992;Wilson, Taliaferro, & Jacobsen, 2006).…”

“…For example, Morrow et al (1992) developed a behavioral treatment for chemotherapy-induced nausea and vomiting that could be delivered by oncologists and oncology nurses and compared its efficacy to the same treatment delivered by a professional psychologist or a no intervention control group. Interventions delivered by oncology professionals were found to be as effective as psychologists and superior to no intervention in relieving anticipatory nausea, anticipatory vomiting, and posttreatment nausea.…”