Nausea and vomiting are expected and common, but are distressing side effects of most anticancer chemotherapy agents. Yet, data about these effects lack precision. Knowledge of the duration, amount, frequency, and distress of each of the side effects is hypothesized to be the key to the control of the symptoms. Although there are data about the control of these symptoms by cognitive and behavioral therapies, most of the previous research has been aimed at patients experiencing pretherapy anticipatory nausea and vomiting. In addition, most studies of therapeutic interventions involved extremely small patient samples. Further, inadequate data about predictors of posttherapy nausea and vomiting are available to guide the development of pattern specific strategically timed interventions. Individual differences in posttherapy nausea and vomiting pattern cannot be explained by anticancer chemotherapeutic drug dosage or protocol. This study is designed to analyze the pattern of occurrence of nausea and vomiting in patients receiving common antitumor chemotherapy drug combinations, and to describe the predictors of the dyad symptoms that may account for individual differences in their occurrence. Dependent variables measured include the nausea and vomiting experienced for 48 hours following therapy within each cycle for 6 cycles. Independent predictor variables measured include (a) pretreatment symptom distress, (b) prior experience with nausea and vomiting, (c) expectation of posttherapy side effects, (d) state anxiety, (e) trait anxiety, (f) physiologic measures of anxiety, and (g) behavioral manifestations of anxiety. A stratified sample of 280 adults will be followed for 6 cycles of selected initial anti-tumor chemotherapy regimens. Data collection will include: Phase I, all private and public sites in the Columbia area; Phase II, 2-3 additional sites in the mid-Missouri area; and Phase III, 2-3 additional sites in outstate Missouri. Nonparametric statistical analysis of variance and correlation procedures will be used to determine if a relationship exists between anxiety and nausea and vomiting. Multivariate analysis methods will then be used to determine the best predictors of posttherapy nausea and vomiting. These data will become the baseline for the development of nursing interventions to decrease patient distress from posttherapy nausea and vomiting. This study follows 3 pilot studies designed to develop and test reliable and valid measures of nausea and vomiting that are sensitive to changes in these symptoms between cycles of antineoplastic chemotherapy. Each tool provides a total score and subscale scores for nausea and vomiting.
