Analysis of pretreatment nonpharmacologic, pharmacologic factors, and yoga intervention on CINV outcomes in breast cancer patients undergoing adjuvant chemotherapy.
1093 Background: Chemotherapy induced nausea and vomiting (CINV) is affected by both pretreatment patient factors, chemotherapy and antiemetic regimen and psychological interventions. In this study we evaluated the effects of mind body intervention such as yoga in modulating CINV outcomes controlled for the above factors. Methods: Chemotherapy naïve breast cancer patients with stage II and III disease participating in a randomized controlled trial comparing yoga (n=45) vs. supportive therapy (n=53) were assessed for CINV outcomes during adjuvant chemotherapy. Morrows Assessment of nausea and emesis was used to asses CINV symptoms including their frequency, severity and anticipatory nature. We developed a multiple regression analyses to test the role of intervention on CINV beyond that explained by the independent prognostic factors [age (<50/≥50 years), stage of disease (II vs III), menopausal status (pre vs post), antiemetic regimen (5HT3 antagonists vs. antidopaminergics), administration of anxiolytics (yes/ no) and type of chemotherapy regimen (FAC vs. CMF)] that were included in model A. Model B includes these six variables plus intervention (yoga vs. supportive therapy) in predicting nausea and vomiting outcomes. Results: Intervention emerged as a primary predictor for nausea frequency (β= -0.38, p=0.002), intensity (β= -0.44, p=0.001 ), anticipatory nausea frequency (β=-0.26 , p= 0.04) and intensity (β=-0.38 , p=0.004 ). Age group emerged as a primary predictor for anticipatory vomiting frequency (β=-0.39 , p=0.01 ) and secondary predictor for nausea frequency (β=-0.41, p= 0.006). Administration of anxiolytics emerged as a primary predictor for vomiting intensity (β=-0.40, p= 0.001) and secondary predictor for anticipatory nausea frequency (β=-0.26 , p= 0.05). Conclusions: Yoga intervention influences CINV outcomes when controlled for pretreatment and pharmacological factors during chemotherapy in breast cancer patients poorly controlled for nausea and vomiting.