Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
previously neutral stimuli becoming conditioned stimuli and thus the
completion of the DDCs may have induced more episodes of nausea
and vomiting. This conditioned response to nausea and vomiting is
not new (Pratt and Lazar 1984; Warr et al 2005). Some patients
reported that completing the DDCs reminded them of their illness
and for some it evoked symptoms of nausea and vomiting. In this
instance the DDCs were the trigger that caused the anticipatory
nausea/vomiting (ANV). Comments included: ‘every time I filled in
the DDCs I thought about my next chemotherapy and it made me
feel queasy’. Morrow (2002) found that the frequency of ANV
increases almost linearly with the number of chemotherapy cycles
given. This study showed the pattern of ANV increased as patients
progressed through their chemotherapy cycles, peaking at the third
and fourth cycles.
Bloechi-Daum et al (2006) and others have reported the adverse
effects of chemotherapy induced nausea and vomiting on patients’
daily lives. Anecdotal evidence and comments from the patients
who participated in this study suggest that anticipatory nausea and
vomiting (ANV) may have a major impact on their quality of life.
Some of the patients who completed the DDCs also suggested they
found it ‘a struggle’ emotionally to fill them in, especially after their
first cycle of chemotherapy. Others said the presence of nausea
contributed to the decrease in their overall wellbeing. It is
documented in the literature that at least 20% of patients suffer
from ANV before their second cycle of chemotherapy (Lee et al
2005; Morrow 1998). In this study breast cancer patients receiving
FEC chemotherapy in the intervention group documented more
episodes of ANV than patients in the other chemotherapy groups.
ANV is a highly unpleasant symptom that precludes other mental
and physical activity and according to Fabi et al (2003), greater
attention is required in clinical practice to manage these symptoms.
Behavioural intervention strategies for anticipatory symptoms have
achieved varying levels of success after the symptoms have become
apparent (Marchioro et al 2000). There are several suggestions
within the literature (Dibble et al 2004; Blasco et al 2000; Morrow
1998; Pickett 1991) that identifying patients who are at high risk of
anticipatory symptoms before they receive any chemotherapy could
prevent some of these problems. Age under 50, female gender, a
history of motion sickness, and previous experience of emesis are
generally considered risk factors for emetogenic therapies. There is
also evidence of a gender difference in that the most sensitive
patients appear to be pre-menopausal women (Gall 1998).
In a study conducted by Dibble et al (2004) with a group of breast
cancer patients receiving chemotherapy, it was found that patients
with a history of motion sickness had significantly more vomiting
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