title: Distress before chemotherapy predicts delayed but not acute nausea.
abstract: BACKGROUND
  Posttreatment nausea (PTN) is a common side effect of cytotoxic cancer chemotherapy. Previous retrospective research has suggested that the severity of PTN may be, in part, related to pretreatment psychological factors (e.g., emotional distress and expectations for nausea).
  
  
  METHODS
  The purpose of the present study was to examine these relationships prospectively, with distress and nausea expectations assessed by validated self-report measures completed in the clinic before the participants' first outpatient treatment infusion and with PTN (0-100) assessed by end-of-day diaries completed at home on each of the first 5 days after treatment. The participants were chemotherapy-naive women (N=56) scheduled for standard adjuvant treatment for stage I-II breast cancer (mean age=45.6 years). PTN was evaluated for acute (days 0-1) and delayed (days 2-5) responses.
  
  
  RESULTS
  The results revealed a significant relationship between pretreatment distress and the severity of the patients' subsequent delayed nausea (p<0.007) but not a relationship with acute PTN (p<0.19). No significant relationships were seen between expectations and PTN. However, there was evidence of an additive effect of nausea expectations and distress, with the highest levels of delayed PTN seen in patients with both expectations and higher distress before treatment. The results suggest a selective effect of pre-infusion psychological variables on the delayed phase of nausea after chemotherapy, consistent with an emerging view that the different phases of nausea are mediated by different neural pathways.
  
  
  CONCLUSIONS
  Future research should examine the possibility that delayed nausea, which the literature suggests is more resistant to antiemetic drugs than acute nausea, might be responsive to psychological interventions before initial treatments.
authors.affiliation: Biobehavioral Medicine Program, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. sara.higgins@mssm.edu
authors.forename: Sara C
authors.initials: SC
authors.lastname: Higgins
authors.forename: Guy H
authors.initials: GH
authors.lastname: Montgomery
authors.forename: Dana H
authors.initials: DH
authors.lastname: Bovbjerg
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D017024:Chemotherapy, Adjuvant; D003603:Cytotoxins / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000523:psychology*; D009367:Neoplasm Staging; D011446:Prospective Studies; D012650:Self Disclosure; D013315:Stress, Psychological / Q000150:complications*; D013997:Time Factors
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D003603:Cytotoxins