• May 2020

    Study finds nurse-administered behavioral interventions could help chemotherapy patients manage anticipatory nausea and vomiting

Research published in Cancer Medicine demonstrated that the use of two behavioral interventions, mindfulness relaxation (MR) and relaxing music (RM), helped to reduce incidents of mid-chemotherapy anticipatory nausea and vomiting (ANV) in patients.

ANV is considered a classically conditioned response to chemotherapy. Patients begin to associate side effects, such as nausea and vomiting, with pre-treatment cues, such as the sights and sounds of a hospital or care center. As a result, patients begin to experience known chemotherapy side effects, specifically nausea and/or vomiting, up to 48 hours before their actual treatment.

Despite advances in antiemetic medications that have helped reduce the instances and severity of chemotherapy-related nausea and vomiting, conditioned symptoms (those unrelated to the body’s actual response to treatment) are still considered an important complication because once established, conditioned symptoms are refractory to these medications. Behavioral intervention, however, has proven effective in addressing conditioned symptoms.

This study sought to determine the effectiveness of utilizing oncology nurses specifically to deliver behavioral health interventions preemptively for ANV. The intervention was embedded within each patients’ normal chemotherapy protocol to maximize convenience and potential clinical generalization, and in an effort to increase interpersonal engagement between the patient and the treatment team.

The primary hypothesis was that, for cancer patients receiving chemotherapy, MR would reduce the occurrence of ANV at the midpoint and endpoint of chemotherapy more effectively than RM or standard of care approaches.

Of the 474 patients participating in the trial, patients receiving MR or RM interventions were found to experience significantly less ANV at the midpoint of chemotherapy compared with patients who were randomized to receive standard of care support. Endpoint chemotherapy measures, however, revealed no major demonstrated difference in outcomes between MR and RM. Both interventions registered as superior to standard of care support. Notably, the study’s inclusion of nearly 500 patients from 13 cancer treatment centers suggested that widespread implementation of these types of interventions by oncology nurses could serve as a viable alternative to current methods, which require the addition of a mental health professional to oncology team staffing. Identifying and better understanding the specific components of MR and RM that reduce nausea requires further research.

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