Anticipatory Nausea and Vomiting (Emesis)
Variables Correlated with ANV
Many variables have been investigated as potential factors that correlate with the incidence of ANV in hopes of developing a list of risk factors. There is currently no agreement on which factors predict ANV. A patient with fewer than three of the first eight characteristics listed below, however, is unlikely to develop ANV, and screening following the first chemotherapy infusion could identify those patients at increased risk.
Variables Found to Correlate With ANV
- Age younger than 50 years.
- N&V after last chemotherapy session.
- Posttreatment nausea described as moderate, severe, or intolerable.
- Posttreatment vomiting described as moderate, severe, or intolerable.
- Feeling warm or hot all over after last chemotherapy session.
- Susceptibility to motion sickness.
- Sweating after last chemotherapy session.
- Generalized weakness after last chemotherapy session.
- Female gender.
- High-state anxiety (anxiety reactive to specific situations).[12,13]
- Greater reactivity of the autonomic nervous system and slower reaction time.
- Patient expectations of chemotherapy-related nausea before beginning treatment.[15,16]
- Percentage of infusions of chemotherapy followed by nausea.
- Postchemotherapy dizziness.
- Longer latency of onset of posttreatment N&V.
- Emetogenic potential of various chemotherapeutic agents. Patients receiving drugs with a moderate to severe potential for posttreatment N&V are more likely to develop ANV.
- Morning sickness during pregnancy.
Treatment of ANV
Antiemetic drugs do not seem to control ANV once it has developed; however, a variety of behavioral interventions have been investigated. These include progressive muscle relaxation with guided imagery, hypnosis, systematic desensitization, electromyography and thermal biofeedback, and distraction via the use of video games.[24,25] Progressive muscle relaxation with guided imagery, hypnosis, and systematic desensitization has been studied the most and is the recommended treatment. Referral to a psychologist or other mental health professional with specific training and experience in working with cancer patients is recommended when ANV is identified. The earlier ANV is identified, the more likely treatment will be effective; thus, early screening and referral are essential. In addition, physicians and nurses underestimate the incidence of chemotherapy-induced nausea and vomiting.[Level of evidence: II]
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- Roscoe JA, Morrow GR, Hickok JT, et al.: Nausea and vomiting remain a significant clinical problem: trends over time in controlling chemotherapy-induced nausea and vomiting in 1413 patients treated in community clinical practices. J Pain Symptom Manage 20 (2): 113-21, 2000.
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