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

A study on the impact of systematic desensitization training on competitive anxiety among Latin dance athletes

Objective

In the domain of competitive events, Latin dance athletes have always suffered competitive anxiety, which is a prevalent and prevailing psychological facet, in pre-, intra-, and post-competitive engagements. Usually, the implementation of systematic desensitization training is an efficacious approach to reduce competitive anxiety levels in routine sports to fortify psychological resilience of athletes (like swimming, volleyball, and basketball). This study focuses on the effect of systematic desensitization training on competition anxiety in the training of Latin dancers to establish good mental ability and promote the competitive ability of athletes.

Methodology

The "Sports Competition Anxiety Test Questionnaire" was used to evaluate and classify the competitive anxiety levels of 150 Latin dance athletes. Then, the top 48 participants were selected (24 in the intervention cohort and 24 in the non-intervention cohort) as the study participants after stratifying anxiety score levels from the highest to the lowest. The intervention group was treated with an 8-week psychological intervention by employing systematic desensitization training techniques (encompassing imagery desensitization and in vivo desensitization). The anxiety levels of the subjects were quantified by employing the "Sport Competition Trait Anxiety Inventory" (CCTAI-C) and the "Competitive State Anxiety Inventory" (CSAI-2) to scrutinize the efficacy of systematic desensitization training in regulating competitive anxiety levels among Latin dance athletes.

Results

After applying systematic desensitization training, the intervention group displayed a notable reduction in sport cognitive trait anxiety. Specifically, there was a decrease of 29.37% in social evaluation anxiety, 20.31% in competition preparation anxiety, 16.98% in performance anxiety, 25.16% in failure anxiety, 34.47% in opponent's ability anxiety, and 25.16% in injury anxiety. Moreover, for competitive state anxiety, cognitive state anxiety and somatic state anxiety decreased by 39.19 and 21.43%. The state self-confidence increased by 14.42%.

Conclusion

The result indicated that systematic desensitization training not only mitigates anxiety but also positively intervenes in sports-related anxiety. Moreover, systematic desensitization training can significantly diminish competitive anxiety among Latin dance athletes to bolster confidence during competitions. Integrating desensitization training into the regular regimen of Latin dance practice has the potential to fortify dancers' psychological resilience against anxiety.

Prevention and treatment of anticipatory chemotherapy-induced nausea and vomiting in pediatric cancer patients and hematopoietic stem cell recipients: Clinical practice guideline update

This 2021 clinical practice guideline update provides recommendations for preventing anticipatory chemotherapy-induced nausea and vomiting (CINV) in pediatric patients. Recommendations are based on systematic reviews that identified (1) if a history of acute or delayed CINV is a risk factor for anticipatory CINV, and (2) interventions for anticipatory CINV prevention and treatment. A strong recommendation to optimize acute and delayed CINV control in order to prevent anticipatory CINV is made. Conditional recommendations are made for hypnosis, systematic desensitization, relaxation techniques, and lorazepam for the secondary prevention of anticipatory CINV. No recommendation for the treatment of anticipatory CINV can be made.

A randomized trial of nurse-administered behavioral interventions to manage anticipatory nausea and vomiting in chemotherapy

PURPOSE

Chemotherapy side effects diminish quality of life and can lead to treatment delay. Nausea and vomiting can occur prior to chemotherapy because of classical conditioning. We studied the effects of 20-minute behavioral interventions, administered by oncology nurses, of higher intensity (mindfulness relaxation-MR) or lower intensity (relaxing music-RM), on anticipatory nausea and vomiting (ANV).

PATIENTS AND METHODS

Patients undergoing chemotherapy for solid tumors were randomized to MR (N = 160), RM (N = 159), or standard care SC (N = 155). Subjects were mostly female (91.8%) and white (86.1%) with breast cancer (85%). Most patients had early stage disease (Stage I: 26%; II: 52.9%; III: 19%; IV: 0.1%). Anticipatory nausea and vomiting were assessed at the midpoint and end of the chemotherapy course using the Morrow Assessment of Nausea and Emesis (MANE).

RESULTS

Compared to SC, there was reduced anticipatory nausea at the midpoint of chemotherapy in those receiving MR (OR 0.44, 95% CI 0.20-0.93) and RM (OR 0.40, 95% CI 0.20-0.93), controlling for age, sex, cancer stage, and emetogenic level of chemotherapy. There was no difference between treatment groups in anticipatory nausea at the end of chemotherapy or in anticipatory vomiting and postchemotherapy nausea and vomiting at either time point.

CONCLUSION

A brief nurse-delivered behavioral intervention can reduce midpoint ANV associated with chemotherapy.

2016 updated MASCC/ESMO consensus recommendations: Anticipatory nausea and vomiting in children and adults receiving chemotherapy

PURPOSE

We aimed to update the 2011 recommendations for the prevention and treatment of anticipatory nausea and vomiting in children and adults receiving chemotherapy.

METHODS

The original systematic literature search was updated. Randomized studies were included in the evidence to support this guideline if they as follows: were primary studies published in a journal in full text (i.e., abstracts, letters, book chapters, and dissertations were excluded); published in English; evaluated an intervention for the prevention or treatment of anticipatory nausea and vomiting; reported the proportion of patients experiencing complete control of anticipatory nausea and vomiting consistently and; included at least ten participants per study arm for comparative studies and at least ten participants overall for noncomparative studies.

RESULTS

Eighty-eight new citations were identified. Of these, nine were brought to full-text screening; none met inclusion criteria. The guideline panel continues to recommend that anticipatory nausea and vomiting are best prevented through optimization of acute and delayed phase chemotherapy-induced nausea and vomiting control. Benzodiazepines and behavioral therapies, in particular progressive muscle relaxation training, systematic desensitization and hypnosis, continue to be recommended for the treatment of anticipatory nausea and vomiting.

CONCLUSIONS

No new information regarding interventions aimed at treating or preventing ANV that met criteria for inclusion in this systematic review was identified. The 2015 MASCC recommendations affirm the content of the 2009 MASCC recommendations for the prevention and treatment of anticipatory nausea and vomiting.

Guideline for the prevention and treatment of anticipatory nausea and vomiting due to chemotherapy in pediatric cancer patients

This guideline provides an approach to the prevention and treatment of anticipatory chemotherapy-induced nausea and vomiting (CINV) in children. It was developed by an international, inter-professional panel using AGREE II methods and is based on systematic literature reviews. Evidence-based recommendations for pharmacological and non-pharmacological interventions to prevent and treat anticipatory CINV in children receiving antineoplastic agents are provided. Gaps in the evidence used to support the recommendations are identified. The contribution of this guideline to anticipatory CINV control in children requires prospective evaluation.

Effects of Psycho-Oncologic Interventions on Emotional Distress and Quality of Life in Adult Patients With Cancer: Systematic Review and Meta-Analysis

Purpose

This study aimed to evaluate the effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer.

Methods

Literature databases were searched to identify randomized controlled trials that compared a psycho-oncologic intervention delivered face-to face with a control condition. The main outcome measures were emotional distress, anxiety, depression, and quality of life. Outcomes were evaluated for three time periods: post-treatment, ≤ 6 months, and more than 6 months. We applied standard meta-analytic techniques to analyze both published and unpublished data from the retrieved studies. Sensitivity analyses and meta-regression were used to explore reasons for heterogeneity.

Results

We retrieved 198 studies (covering 22,238 patients) that report 218 treatment-control comparisons. Significant small-to-medium effects were observed for individual and group psychotherapy and psychoeducation. These effects were sustained, in part, in the medium term (≤ 6 months) and long term (> 6 months). Short-term effects were evident for relaxation training. Studies that preselected participants according to increased distress produced large effects at post-treatment. A moderator effect was found for the moderator variable “duration of the intervention,” with longer interventions producing more sustained effects. Indicators of study quality were often not reported. Small-sample bias indicative of possible publication bias was found for some effects, particularly with individual psychotherapy and relaxation training.

Conclusion

Various types of psycho-oncologic interventions are associated with significant, small-to-medium effects on emotional distress and quality of life. These results should be interpreted with caution, however, because of the low quality of reporting in many of the trials.

Use and helpfulness of self-administered stress management therapy in patients undergoing cancer chemotherapy in community clinical settings

The purpose of this multicenter longitudinal randomized controlled trial was to examine the efficacy of self-administered stress management training (SSMT) in improving quality of life and reducing psychological distress among patients receiving cancer chemotherapy. Participants were randomized to SSMT (n = 111) or usual psychosocial care only (n = 109). Mixed linear modeling demonstrated no significant improvements in primary outcome measures; however, participants assigned to SSMT reported using significantly more relaxation techniques (p < 0.0001), showed improvements on emotional adjustment scores, and demonstrated a stabilizing effect on the functional adjustment scores. Findings highlight the usefulness of SSMT in community clinical settings.

Nonpharmacologic strategies for managing common chemotherapy adverse effects: a systematic review

PURPOSE

Adverse effects of chemotherapy can be severe and can have a significant impact on a person's quality of life. With chemotherapy treatment increasingly administered in the ambulatory setting, there is a need for patients to be informed about effective self-care strategies to manage treatment adverse effects. Advice for patients needs to be based on evidence. This systematic review provides an overview of the intervention research in this area as well as an effectiveness review of nonpharmacologic (self-care) strategies evaluated in high-quality randomized controlled trials (RCTs).

METHODS

An extensive literature search was conducted to identify RCTs relating to self-care strategies for reducing nausea/vomiting, constipation, diarrhea, fatigue, hair loss, or mucositis. Relevant studies published in peer-reviewed journals between 1980 and August 2007 were included. Study characteristics, results and methodologic quality were examined. High-quality RCTs were further analyzed to establish the effectiveness of specific self-care strategies.

RESULTS

The search identified 77 RCTs. Findings from RCTs of reasonable quality provide limited support for cognitive distraction, exercise, hypnosis, relaxation, and systematic desensitization to reduce nausea and vomiting, psycho-education for fatigue, and scalp cooling to reduce hair loss.

CONCLUSION

Although some strategies seem promising, the quality of the RCTs was generally quite low, making it difficult to draw conclusions about the effectiveness of self-care strategies. Future studies require better design and reporting of methodologic issues to establish evidence-based self-care recommendations for people receiving chemotherapy.

Teamwork approach to clinical hypnosis at a pediatric pulmonary center

The aim of this report is to demonstrate the success of a teamwork approach for providing instruction in self-hypnosis at a Pediatric Pulmonary Center. In order to add to the hypnosis service provided by a pulmonologist at the Center, the Center social worker learned how to use clinical hypnosis. During a 3-year period, she instructed 72 patients (average age 11.6 years) in self-hypnosis. Eighty-two percent of the patients reported improvement or resolution of the primary symptoms, which included anxiety, asthma, chest pain, dyspnea, habit cough, hyperventilation, sighing, and vocal cord dysfunction. The social worker and pulmonologist consulted with each other on a regular basis regarding their hypnosis work, and achieved similar successful results following their hypnosis interventions. Thus, clinical hypnosis at a Pediatric Pulmonary Center can be provided by a team of varied professionals. As a team, these professionals can support each other in their on-going development of hypnosis skills.

Chemotherapy-related nausea and vomiting - past reflections, present practice and future management

Although much progress has occurred in the last decade regarding the management of chemotherapy-induced nausea and vomiting, these remain among the most intolerable side-effects of treatment and patients continue to report the negative impact such symptoms have on their ability to enjoy life. Inadequate control of nausea and vomiting reduces patients' quality of life and functional status and jeopardizes the delivery of optimal treatment, so making its management a priority for oncology health care workers. This article will reflect on past and present evidence regarding the management of chemotherapy-induced nausea and vomiting while highlighting some of the most recent scientific advances before drawing conclusions about the future management of this troublesome symptom for patients receiving chemotherapy.

Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy

PURPOSE

Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy. The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver.

PATIENTS AND METHODS

Four hundred eleven patients about to start chemotherapy were randomly assigned to receive usual psychosocial care only, a professionally administered form of stress management training, or a patient self-administered form of stress management training. Quality-of-life assessments were conducted before randomization and before the second, third, and fourth treatment cycles. Intervention costs were estimated from both payer and societal perspectives.

RESULTS

Compared with patients who received usual care only, patients receiving the self-administered intervention reported significantly (P < or = .05) better physical functioning, greater vitality, fewer role limitations because of emotional problems, and better mental health. In contrast, patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only. Costs of the self-administered intervention were estimated to be 66% (from a payer perspective) to 68% (from a societal perspective) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy.

CONCLUSION

Evidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment.

Psychological factors in the etiology and treatment of severe nausea and vomiting in pregnancy

The assumption is frequently made that women with severe nausea and vomiting during pregnancy are transforming psychological distress into physical symptoms. Psychoanalytic theory supporting this assumption is reviewed, along with the few methodologically flawed empirical studies that have been conducted. Little support can be found for the hypothesis that nausea and vomiting during pregnancy is such a conversion disorder, but there are suggestions that psychological responses to the physiologic condition(s) underlying this problem may become entrenched, or conditioned. This possibility is supported by findings that psychological treatments, such as hypnosis, can be effective. This implies that psychological responses can interact with the physiology of nausea and vomiting during pregnancy to exacerbate the condition. As such, psychological treatments for the symptoms of this disorder need to be further explored.

The role of behavioral conditioning in the development of nausea

Literature related to the prevalence and etiology of anticipatory nausea and vomiting associated with chemotherapy is reviewed. Physiologic causes and psychological factors, including expectations, beliefs, and conditioning, are examined to help explain these phenomena. The efficacy of pharmacologic and behavioral treatments is discussed. Similarities between the experience of anticipatory nausea and vomiting and morning sickness suggest that the conditioning model may be relevant to understanding the development of pregnancy-related nausea.

Behavioral intervention for cancer treatment side effects

The use of increasingly aggressive methods of cancer treatment during the last 20 years has brought clinical attention to the need for more effective management of pain, nausea, and other aversive side effects of state-of-the-art cancer therapy. One of the most promising approaches to effective management is nonpharmacologic intervention based on behavioral research and theory. The purpose of this review is to examine the effectiveness of behavioral intervention methods in the control of aversive side effects of cancer treatments. Fifty-four published studies using a variety of research designs were identified for review. Results indicated the following: 1) Behavioral intervention can effectively control anticipatory nausea and vomiting in adult and pediatric cancer patients undergoing chemotherapy; however, the evidence for the efficacy of behavioral intervention to control post-chemotherapy nausea and vomiting is less clear. 2) Behavioral intervention integrating several behavioral methods can ameliorate anxiety and distress associated with invasive medical treatments. 3) Although a variety of behavioral methods have been shown to reduce acute treatment-related pain, there is increasing evidence that these methods are not equally effective. Hypnotic-like methods, involving relaxation, suggestion, and distracting imagery, hold the greatest promise for pain management. Unfortunately, research is scant on the use of behavioral intervention to control prolonged pain associated with invasive medical procedures. It is clear that the application of behavioral theory and methods has an important place in the care of patients undergoing invasive cancer treatments.

Prevention and Management of Chemotherapy-Induced Nausea and Vomiting, Part 2

Credit

This lesson is good for 0.3 CE units, with a passing grade of 70%.

Goal

The goal of this program is to inform the participant about cost-effective ways to prevent, identify, and manage nausea and vomiting induced by antineoplastic agents.

Objectives

At the completion of this program the participant will be able to: 1. List antineoplastic agents associated with a high incidence of nausea and vomiting. 2. Identify patient-specific risk factors for developing chemotherapy-induced nausea and vomiting (CINV) and how these factors may influence treatment of this syndrome. 3. Compare the three major types of CINV, including the pathophysiologic mechanism, time of onset, and symptom duration of each type. 4. Explain the mechanism of action and appropriate place in therapy for each type of antiemetic agent. 5. Differentiate between pharmacologic regimens for the prevention and treatment of CINV in adults. 6. Identify drug-specific factors that must be considered when developing a formulary management strategy for the antiemetic agents. 7. Describe specific information that the pharmacist can share with patients to help them understand and manage CINV.

Psychosocial interventions for cancer: review and analysis using a three-tiered outcomes model

This study describes a three-tiered measurement model for psychosocial interventions with cancer patients and compares this model to extant measurement strategies. Progress has been made toward demonstrating that psychosocial interventions reduce depression, anxiety, functional impairment, and symptoms. However, Chambless and Hollon (1998) note that the literature on psychosocial interventions for cancer fails to meet criteria for establishing treatment "efficacy" and does not address issues of cost-effectiveness. The lack of a timely model of clinical outcomes may be hindering demonstration of efficacy and wider implementation of these interventions. Outcomes assessed by 65 interventions were classified as Global Health Outcomes (medical endpoints, health-related quality of life (HRQOL), or resource utilization), Dimensions of HRQOL (distress, symptoms, functional ability, or interpersonal well-being), or Mechanisms of Action (evaluation of psychological or physiological processes). A total of 28% of reviewed studies assessed Global Outcomes, 82% assessed Dimensions of HRQOL, and 49% assessed Mechanisms of Action. While most studies assessed patients' symptoms and distress, measurements of resource utilization, HRQOL, and interpersonal HRQOL were under-reported. A greater emphasis on treatment costs, quality of life, and mediating/moderating processes associated with improvement in outcomes could inform decisions regarding allocation of health-care resources and lead to more widely available and efficient interventions for patients.

The role of anxiety and adaptation to illness in the intensity of postchemotherapy nausea in cancer patients

The aim of this work was to assess whether cancer patients presenting high anxiety levels or poor adaptation to cancer experience higher levels of postchemotherapy nausea, regardless of the emetogenicity of the chemotherapy schedule. Sixty-three patients were interviewed before receiving their chemotherapy schedule and some psychological variables were assessed. Nausea intensity was also assessed after treatment. The results showed that patients with relatively higher levels of nausea reported higher levels of anxiety prior to chemotherapy and lower levels of adaptation to cancer. Thus, evidence for a modulating effect of psychological factors in postchemotherapy emesis is suggested.

Social work with adult cancer patients: a vote-count review of intervention research

The meaning of a cancer diagnosis has changed in the past decades, bringing with it a myriad of psychosocial interventions to improve the psychological or functional status of those coping with the disease. Today, social workers in oncology need to be current with research in order to integrate empirical and practical knowledge. In an effort to assist in this process, we reviewed empirical studies to address the following questions: (1) When are patients likely to be willing to accept help? (2) Is there sufficient evidence to show that some types of psychosocial treatment are effective in improving psychological or physical functioning? (3) Are certain treatments preferable for some cancer patients depending on the type of cancer and stage of disease? Using a vote-count review of 40 intervention studies in psychosocial oncology, 36 documented some positive outcomes from treatments, 4 studies exhibited null findings, and no studies were found to have clearly negative results. Studies revealed the most positive results from interventions during the treatment phase, next from interventions at diagnosis, and lastly from interventions during the terminal stage. Individual and group formats showed a comparable level of efficacy. Interventions that included cognitive behavioral methods had the most consistently positive results. Those intervention studies where social workers were involved in the research were less successful at demonstrating efficacy. This difference was due primarily to the fact that social workers often did not include cognitive behavioral interventions in their research. Based on the results of this study, social workers might want to reevaluate their intervention strategies.

Weight gain associated with adjuvant tamoxifen therapy in stage I and II breast cancer: fact or artifact?

There is a perception that tamoxifen causes weight gain in breast cancer patients. The purpose of this research study was to determine if weight gain is associated with tamoxifen therapy and to observe the impact of weight gain on recurrence and survival. Prognostic indicators, changes in weight, and disease status from diagnosis to the end of treatment were studied in 200 consecutive Stage I and II breast cancer patients, not receiving systemic chemotherapy, admitted from 1986 to the present, with observation periods ranging from 3-5 years. A mean weight gain of 1.2 Kgs was seen in all patients; however, weight gain was not significantly different for those receiving tamoxifen vs. those not receiving tamoxifen, (P = 0.66, CI 95% for the difference -1.8 Kgs to +1.2 Kgs). Weight gain during treatment with tamoxifen was not correlated with treatment duration or with recurrence or survival. Age at diagnosis was positively correlated to weight gain in all groups. Our data failed to show that tamoxifen is associated with weight gain. The moderate weight gain observed in this patient population is comparable to the general aging disease-free population and may no be treatment-related. These findings may help to alleviate some concerns of both physicians and patients when tamoxifen is the drug of choice for adjuvant therapy.