A randomized trial of nurse‐administered behavioral interventions to manage anticipatory nausea and vomiting in chemotherapy

Purpose Chemotherapy side effects diminish quality of life and can lead to treatment delay. Nausea and vomiting can occur prior to chemotherapy because of classical conditioning. We studied the effects of 20‐minute behavioral interventions, administered by oncology nurses, of higher intensity (mindfulness relaxation—MR) or lower intensity (relaxing music—RM), on anticipatory nausea and vomiting (ANV). Patients and methods Patients undergoing chemotherapy for solid tumors were randomized to MR (N = 160), RM (N = 159), or standard care SC (N = 155). Subjects were mostly female (91.8%) and white (86.1%) with breast cancer (85%). Most patients had early stage disease (Stage I: 26%; II: 52.9%; III: 19%; IV: 0.1%). Anticipatory nausea and vomiting were assessed at the midpoint and end of the chemotherapy course using the Morrow Assessment of Nausea and Emesis (MANE). Results Compared to SC, there was reduced anticipatory nausea at the midpoint of chemotherapy in those receiving MR (OR 0.44, 95% CI 0.20‐0.93) and RM (OR 0.40, 95% CI 0.20‐0.93), controlling for age, sex, cancer stage, and emetogenic level of chemotherapy. There was no difference between treatment groups in anticipatory nausea at the end of chemotherapy or in anticipatory vomiting and postchemotherapy nausea and vomiting at either time point. Conclusion A brief nurse‐delivered behavioral intervention can reduce midpoint ANV associated with chemotherapy. Chemotherapy administration can result in conditioned nausea and vomiting. This multi‐centred randomized controlled trial demonstrates the superiority of 2 preemptive behavioural interventions in reducing conditioned nausea.