The Effect of Hypnotherapy on Anticipatory Nausea in Head and Neck Cancer Patients Undergoing Chemotherapy

Background: One of the chemotherapy side effects on head and neck cancer patients is anticipatory nausea. However, the anticipatory nausea problem has not been properly resolved. Nausea might be psychologically reduced by hypnotherapy. There only have been very few studies conducted to examine the effects of hypnotherapy in alleviating anticipatory nausea.Purpose: This study aimed to determine the effect of hypnotherapy using Hanung induction technique on anticipatory nausea in head and neck cancer patients undergoing chemotherapy.Methods: This research employed a pre-post test of quasi-experiment with control group design. Consecutive sampling technique was used to obtain 64 subjects who met inclusion and exclusion criteria and were equally divided into the intervention and control groups. Hypnotherapy as the intervention was carried out in two sessions, each of which lasted for 20 minutes, with a week distance between sessions. The data were collected using a visual analog scale (VAS), which was used twice to measure anticipatory nausea and analyzed using the paired and independent-sample t-test.Result: The results showed that the mean score of anticipatory nausea in the intervention group reduced from 7.6±1.4 to 2.3 ±1.2 after hypnotherapy, while the mean in the control group increased from 6.4±1.6 to 6.7±1.4. There was a significant difference in the score of anticipatory nausea after the implementation of hypnotherapy between the intervention and the control group (p<0.001).Conclusion: The study concluded that hypnotherapy is effective in reducing the intensity of anticipatory nausea in head and neck cancer patients undergoing chemotherapy. Therefore, hypnotherapy can be applied by oncology nurses as an intervention in treating anticipatory nausea.

Prevalence of anticipatory nausea and vomiting in children undergoing cytotoxic chemotherapy for malignant disease - the SiCK2 (Sickness prior to Chemotherapy in Kids) study

IntroductionAnticipatory nausea and vomiting (ANV) is thought to be a conditioned response to nausea and vomiting experienced in previous chemotherapy cycles, and has a significant negative impact on quality of life for children having treatment for cancer. The prevalence of this aversive experience with current antiemetics remains uncertain.MethodsSelf-report questionnaires completed by patients and parents across seven sites in the UK. Nausea and vomiting symptoms 24 hours prior to commencing chemotherapy were assessed with the Pediatric Nausea Assessment Tool (PeNAT). Data were also collected on the patients’ age, sex, oncological diagnosis, and previous experience of chemotherapy induced nausea and vomiting. Correlation between demographic data, chemotherapy information and prior reported experience of chemotherapy related nausea and vomiting was under-taken using multiple ordinal regression.Results191 episodes of anticipatory nausea and vomiting status were returned. 34% of patients described severe or very severe anticipatory nausea and/or vomiting. The severity of anticipatory nausea and vomiting was predicted two factors related to prior chemotherapy: control of anticipatory (OR 0.23 95%CI 0.09 to 0.53) and acute/delayed (OR 0.37, 95% CI 0.16 to 0.83) nausea and vomiting, and one current factor, the administration of antiemetic medication prior to arrival at the hospital (OR 3.0, 95%CI 1.3 to 6.8).ConclusionsThis study re-enforces, disappointingly, the continued high prevalence of anticipatory nau-sea and vomiting in children about to receive chemotherapy. There is clearly a need to improve interventions for this rarely discussed aversive experience of childhood cancer. Its high prevalence suggests trials of interventions should be possible to power effectively, and develop interventions that are both acceptable and deliverable.

SAT0405 CLINICAL AND PSYCHOLOGICAL PREDICTORS OF GASTROINTESTINAL INTOLERANCE TO METHOTREXATE IN PATIENTS WITH PSORIATIC ARTHRITIS

Background:Methotrexate (MTX) is a first-line treatment for psoriatic arthritis (PsA). Gastrointestinal intolerance (GI) to the drug is a common adverse event that limits its use and can be mediated by autonomic dysfunction or classical conditioning phenomena to repeated drug exposure. Anxiety and depression could promote these processes.Objectives:To assess the prevalence of GI to MTX and its association with anxiety and depression in PsA patients.Methods:One hundred unselected PsA patients in stable MTX treatment were characterized by disease characteristics, adherence to treatment by Morisky Medication Adherence Scale (MMAS-8) and comorbidity by Rheumatic Disease Comorbidity Index (RDCI). Depressive and anxious symptoms were assessed by Hospital Anxiety and Depression Scale (HADS). The presence and the severity of nausea, vomiting, abdominal pain and diarrhoea after administration (associative symptoms) and just before or even at the thought of taking MTX (anticipatory symptoms) were recorded.Results:Patients had a mean age of 56.9±12.0 years and a disease duration of 9.5 years (0.1-58.0 years). They were male, smokers and overweight in 40.0%, 20.0% and 65.0% of cases, respectively. The prevalence of both significant anxious and depressive symptoms was 42.0%. DAPSA showed remission, low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) in 24.0%, 41.0%, 32.0% and 3.0% of patients, respectively. MTX was taken orally by 15.0% of patients and associated with another conventional or biological DMARD in 14.0% and 35.0% of cases, respectively. Symptoms of GI to MTX were complained by 69.3% of patients. Specifically, the prevalence of nausea, diarrhea, vomiting and abdominal pain was 59.0%, 23.0%, 21.0% and 30.0% with associative pattern and 43.0%, 12.0%, 10.0% and 16.0% with anticipatory pattern, respectively. Patients with anxious symptoms experienced more frequently moderate to severe associative nausea (71.4% vs 50.0%, p=0.032) and abdominal pain (42.9% vs 20.7%, p=0.017), and anticipatory nausea (42.9% vs 19.0%, p=0.009), vomiting (14.3% vs 6.9%,p=0.046), and abdominal pain (26.2% vs 8.6%, p=0.018) than non-anxious patients. Patients with depressive symptoms more commonly had associative diarrhea (33.0% vs 15.5%, p=0.037), with no difference in the prevalence of anticipatory symptoms. The presence of associative and anticipatory nausea was associated with higher anxiety scores (p=0.006 and p=0.02 respectively) without differences in the depression score. Associative nausea characterized younger patients (p=0.001), female (p=0.02), with lower BMI (p=0.02) and treated with higher MTX doses (p=0.05). Anticipatory nausea was associated with a lower age (p=0.02), a lower BMI (p=0.005), a longer disease duration (p=0.028), a lower DAPSA (p=0.02), an higher MTX doses (p=0.02) and a lower comorbidity burden (p=0.03). The anticipatory and associative nausea determined lower compliance according to MMAS-8 (p=0.007 and p=0.001, respectively). An anxious profile characterized patients with moderate to severe associative nausea also in the logistic regression model corrected for age (≥65 years), gender, BMI (≥25 kg/m2) and MTX dose (≥0.2mg/kg/week) (OR 3.0, IC 1.1-8.4, p=0.036), and patients with anticipatory nausea also in the model corrected for age (≥65 years), gender, BMI (≥25 kg/m2) and MTX dose (≥0.2mg/kg/week) and disease duration (≥6 years) (OR 3.0, IC 1.1-8.0,p=0.027).Conclusion:Up to two-thirds of patients with PsA who have been treated with MTX experienced symptoms of GI, leading to reduced therapeutic adherence. Associative and anticipatory symptoms characterize patients with a specific clinical and psychological profile.Disclosure of Interests:Gerlando Natalello: None declared, Enrico De Lorenzis: None declared, Giacomo Tanti: None declared, Pietro Rubortone: None declared, Maria Rosaria Magurano: None declared, Giusy Peluso: None declared, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer

Intervensi Untuk Mengatasi Mual Antisipatori Pada Pasien Kanker Yang Menjalani Kemoterapi: A Litelatur Review

Intervensi Untuk Mengatasi Mual AntisipatoriPada Pasien Kanker Yang Menjalani KemoterapiLitelatur ReviewDadi Hamdani.1 Anggorowati.2 Awal Prasetyo.31 Departemen Ilmu Keperawatan, Fakultas Kedokteran Universitas Diponegoro, Semarang, Indonesia2 Departemen Ilmu Keperawatan, Fakultas Kedokteran Universitas Diponegoro, Semarang, Indonesia3 Departemen Ilmu Kedokteran, Fakultas Kedokteran Universitas Diponegoro, Semarang, IndonesiaEmail: [email protected] AbstrakLatar Belakang: Gejala mual muntah merupakan salah satu efek samping yang berat akibat pemberian obat kanker yang membuat stres pasien. Akibatnya, 27% pasien memilih menghentikan siklus terapi sehingga berpengaruh terhadap harapan hidupnya. Tujuan Utama : Menjelaskan berbagai intervensi untuk mengatasi mual antisipatori yang dialami pasien kanker yang menjalani kemoterapi. Metodologi : Basis data elektronik diidentifikasi dari EBSCO, Springer PubMed, Science Direct dan ProQuest dengan kata kunci: intervensi, mual, muntah, antisipatori, kanker dan kemoterapi. Kriteria inklusi dalam penelitian ini adalah artikel diterbitkan pada tahun 2009 – 2019, tersedia dalam teks lengkap, artikel menggunakan bahasa Inggris, dengan subyek manusia, desain RCT. Artikel terjaring adalah 7 artikel penelitian eksperimental yang kemudian dianalisis menggunakan PRISMA tanpa meta-analisis. Hasil : Sebanyak 7 artikel membahas tentang intervensi untuk menurunkan mual antisipatori terhadap pasien kanker yang menjalani kemoterapi. Semua penelitian pada kelompok intervensi memiliki efek positif dalam mengurangi mual dan muntah secara bermakna dengan nilai signifikansi: Satu artikel behavioral treatment (p<0,05), satu artikel Program yoga (p<0.01), dua artikel progressive muscle relaxation (p<0,05), satu artikel akupresur (p<0,05), dua artikel hipnoterapi (p<0,05). Kesimpulan : Intervensi hipnoterapi, progressive muscle relaxation, yoga, akupresur dan behavioral treatment merupakan teknik mengurangi mual antisipatori yang dialami oleh pasien kanker yang menjalani kemoterapi.Kata Kunci: intervensi; mual antisipatori; kanker; kemoterapi. Interventions To Reduce Anticipatory NauseaIn Cancer Patients Undergoing ChemotherapyAbstractBackground: Symptoms of nausea vomiting are one of the severe side effects due to the administration of cancer drugs that stress patients. As a result, 27% of patients choose to stop the therapy cycle so that it affects their life expectancy. Main Purpose: Describe various interventions to reduce the successful anticipatory nausea of cancer patients who support chemotherapy. Methodology: Basic electronic transmission data from EBSCO, Springer PubMed, Science Direct and ProQuest with keywords: intervention, nausea, vomiting, anticipatory, cancer and chemotherapy. The inclusion criteria in this study were articles published in 2009 - 2019, available in full text, articles using English, with human subjects, RCT designs. Netted articles were 7 experimental research articles which were then analyzed using PRISMA without meta-analysis. Results: A total of 7 articles discussed interventions to reduce anticipatory nausea for cancer patients who supported chemotherapy. Some studies in the intervention group have a positive effect in reducing nausea and vomiting. One behavioral care article (p<0,05), one yoga program article (p<0.01), two progressive muscle relaxation articles (p<0,05), one acupressure article (p<0,05), two hypnotherapy articles (p<0,05). Conclusion: Interventions in hypnotherapy, progressive muscle relaxation, yoga, acupressure and behavioral treatment are sexual anticipatory reduction techniques involving cancer patients who experience chemotherapy.Keywords: intervention; anticipatory nausea; cancer; chemotherapy.

Conditioning nausea in a laboratory setting: A pilot study

Cancer patients can experience nausea as they approach the place where they have received chemotherapy treatment. This nausea is likely the result of Pavlovian conditioning, where the previously neutral environment acquires conditioned properties, in this case conditioned nausea, because its association with feeling ill. To investigate this phenomenon under controlled conditions, we studied the acquisition of conditioned nausea using a distinct environment paired with an emetic drug in healthy young adults. We measured two indices of conditioning: i) conditioned place aversion, and ii) conditioned drug-like (nausea) responses. Healthy volunteers (N=32) first rated their preference for two testing rooms, and then underwent four conditioning sessions in which they received either syrup of ipecac (5 ml) or placebo. A Paired Group (PG; N=17) always received ipecac in their initially preferred room and placebo in the other, while an Unpaired Group (UG; N=15) received ipecac and placebo in both rooms. Conditioned responses were assessed with i) time spent in each room, ii) room liking and preference, and iii) feelings of nausea in each room. There was no evidence of conditioned place aversion as measured by either time spent or ratings of room liking. However, the PG did report a small increase in nausea in the ipecac-paired room. Although the conditioned responses in this study were not robust, this procedure is a first step towards studying conditioned aversive drug responses in humans, which will enable development of future studies to prevent or treat anticipatory nausea.