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

Abstract

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...

Role of classical conditioning in learning gastrointestinal symptoms

“…Referring to recent studies, Bovbjerg [3] pointed out that in the absence of prophylactic antiemetic therapy, the percentage of patients experiencing vomiting after their first chemotherapy would reach 90%. Despite modern antiemetic treatment, about 25% to 30% of chemotherapy patients report these side-effects even prior to a subsequent infusion upon being re-exposed to the stimuli that usually signal the drugs' infusion [4][5][6] . These symptoms are called anticipatory nausea (AN) and/or anticipatory vomiting (ANV).…”

The influence of patients’ gender and education level on the incidence of chemotherapy-induced anticipatory nausea and vomiting

“…Hetil., 2013, 154, 820-824. A kemoterápia okozta hányás kezelése során gyakori probléma a kemoterápiás szerek és protokollok emetogén potenciáljának megfelelő hányáscsillapítás ellenére a kezelések ismétlésekor fellépő anticipátoros hányás [1,2,3]. A hányáscsillapítás nemzetközi standardok, ajánlá-sok alapján történik [4,5,6].…”

“…Ritkán az első kemoterápia előtt, közvetlenül a kezelést megelőzően is felléphet. Az anticipátoros hányás azonban inkább tanult válasz, az irodalmi adatok szerint a betegek 30%-ában (18 és 57% között) léphet fel [1,2,3,11], jellemzően a második, harmadik kemoterápia alkalmával fordul elő, pszichológiai válaszként a beteget ért kemoterápia okozta traumára. Kezelés nélkül a kemoterápiás ciklusok folyamán rosszabbodik a helyzet [12].…”

“…Gyakran a kezelőszoba illata, a személyzet ruhájának lát-ványa, bizonyos hangok, mint a perfúzorok jelzőhang-jai váltják ki. A betegek egy részénél akkor is jelentkezik a hányás, ha az előző kemoterápiák alkalmával nem lépett fel [1,12].…”

“…A szerotoninantagonisták (5HT3 receptort blokkolók) alkalmazása után azt várták, hogy az incidencia csökkenni fog. Az utóvizsgálatok eredmé-nyei azonban nem voltak egyértelműek, egyesek csök-kenést [1], mások az incidencia emelkedését igazolták [12,14]. Mindenesetre elmondható, hogy a hányinger gyakoribb, mint a hányás.…”