Posted 02.26.2020 | by AMRA

Chemotherapy treatment for cancer can cause a variety of unpleasant side effects including nausea and vomiting. As many as 30% of chemotherapy patients may develop what is diagnosed as anticipatory nausea and vomiting. That is, nausea and vomiting become conditioned responses, and the patients suffer these symptoms just anticipating a drug infusion.

Patients’ anticipatory symptoms commonly manifest by the third chemotherapy session. Once anticipatory nausea and vomiting is conditioned, it tends to persist throughout treatment and may prove unresponsive to anti-emetic medication. An ideal intervention would prevent anticipatory symptoms before they start and could be easily administered by existing nursing personnel.

Hunter et al. [Cancer Medicine] investigated the relative efficacy of a brief nurse-administered mindfulness intervention compared to relaxing music or standard care in preventing anticipatory nausea and vomiting in chemotherapy patients.

The researchers randomly assigned 474 chemotherapy patients (92% female; 86% Caucasian; 85% diagnosed with breast cancer) to mindful relaxation, relaxing music, and standard care conditions. For the mindful relaxation group, nurses individually taught patients a 20-minute exercise involving mindfulness, imagery, and relaxation prior to their first chemotherapy treatment. Patients were also given a recording to use for daily home practice, and at the start of each chemotherapy session.

In the relaxing music group, participants listened to relaxing music (nature sounds, vocal tracks) for 20 minutes prior to the start of their first chemotherapy treatment, and were given a recording of the music to relax with at home daily, and to listen to at the beginning of each new chemotherapy session. In the standard care group, participants met with a nurse for 20 minutes before their first chemotherapy session and were given general information about management of side effects.

Patients completed a questionnaire about their nausea and vomiting symptoms at the midpoint of their chemotherapy treatment (the second or third session, depending on treatment length) and at the end of their treatment.

The results showed that at chemotherapy midpoint, both mindful relaxation (13%) and relaxing music (12%) participants were significantly less likely to have experienced anticipatory nausea than standard care (27%) participants. At chemotherapy midpoint, a significantly greater number of standard care patients (9%) experienced moderate to intolerable anticipatory nausea compared to mindful relaxation (1%) and music relaxation (2%) participants.

At the treatment endpoint, significant differences between the groups disappeared with anticipatory nausea being experienced by 22% of the mindful relaxation group, 24% of the relaxing music group, and 25% of the standard care group. Anticipatory vomiting was rare (≤5%) in all groups due to the effectiveness of newer anti-emetic medications.

The study shows that mindful relaxation and relaxing music interventions modestly reduce the incidence and severity of anticipatory nausea compared to standard care at the chemotherapy treatment midpoint.

Limitations of the study include lack of detail on the mindfulness intervention to decipher the degree to which it utilized mindfulness practices as opposed to the other intervention activities (imagery, muscle relaxation). The results do not account for possible differences in anti-emetic medication use across groups.

Reference:

Hunter, J. J., Maunder, R. G., Sui, D., Esplen, M. J., Chaoul, A., Fisch, M. J., . . . Wong, L. (2020). A randomized trial of nurse-administered behavioral interventions to manage anticipatory nausea and vomiting in chemotherapy. Cancer Medicine.

[Link to study]