Shelke, A.R., Roscoe, J.A., Morrow, G.R., Colman, L.K., Banerjee, T.K., & Kirshner, J.J. (2008). Effect of a nausea expectancy manipulation on chemotherapy-induced nausea: A University of Rochester Cancer Center Community Clinical Oncology Program study. Journal of Pain and Symptom Management, 35, 381–387.

To evaluate the effectiveness of educational interventions in reducing patients’ nausea expectations by dispelling misconceptions about chemotherapy-induced nausea and vomiting (CINV) and building confidence in antiemetic regimens

Patients were randomized one of two arms. Both arms received the same educational materials except that arm 2 patients received an additional handout emphasizing the benefits and effectiveness of ondansetron in the control of nausea and vomiting. Both arms received a standardized antiemetic regimen including ondansetron and dexamethasone on day one. Nausea and vomiting were measured in a patient-reported diary from day one to day four following chemotherapy treatment.

• The study consisted of 322 patients who were chemotherapy-naïve.
• The mean age in arm 1 (control group) was 57.8 years (SD = 13.4 years, n = 163). The mean age in arm 2 (intervention group) was 57.4 years (SD = 12.1 years, n = 59).
• The majority of the patients were female (73%).
• Diagnoses were not reported.
• In arm 1, 52.1% of patients were receiving adriamycin, 34.4% were receiving carboplatin, and 13.5% were receiving cisplatin. In arm 2, 52.8% of patients were receiving adriamycin, 31.4% were receiving carboplatin, and 15.7% were receiving cisplatin.

The study was conducted at 18 medical oncology practices (all Community Clinical Oncology Programs [CCOPs]) across the United States.

All patients were in active treatment.

This was a randomized, multicenter, clinical trial.

• Expectation of nausea was measured using a five-point Likert-type scale anchored at one end by “1” = I am certain I WILL NOT have nausea” and the other end “5” = I am certain I WILL have nausea.
• Patients measured nausea and emesis four times a day and recorded their experiences in report diaries.
• Assessments were documented from the treatment day until the fourth day following the chemotherapy treatment.
• Nausea severity was assessed on a 7-point rating scale.

• No significant difference was found between groups in frequency or severity of nausea.
• Approximately 76% reported no nausea, and approximately 25% experienced or average nausea.
• A significant reduction in nausea expectancy was seen in the intervention group as compared to the control group (p = 0.024).

Although the expectancy manipulation reduced patients’ reported expectations for the development of nausea, the occurrence of nausea was not reduced. Changing nausea expectancies did not affect the occurrence of nausea.

• The expectancy manipulation in this study may not have been strong enough. The educational intervention was a one-page handout with basic statements.
• Use of a reliability and validity expectancy measurement tool was not documented.
• Past experiences of nausea and vomiting (motion or morning sickness) or the influence of past exposures to family or friends undergoing chemotherapy, which may have influenced chemotherapy-related nausea, was not considered.

Educational interventions to increase awareness of nausea prior to first chemotherapy administration may reduce patients’ expectations for subsequent CINV. However, these interventions may not reduce actual nausea severity or occurrence.