Shelke Abhay R, Roscoe Joseph A, Morrow Gary R, Colman Lauren K, Banerjee Tarit K, Kirshner Jeffrey J
University of Rochester Cancer Center, James P. Wilmot Cancer, Rochester, NY 14642, USA.
J Pain Symptom Manage. 2008 Apr;35(4):381-7. doi: 10.1016/j.jpainsymman.2007.05.008. Epub 2008 Feb 4.
Several studies have shown that patients' expectancies for the development of nausea following chemotherapy are robust predictors of that treatment-related side effect, and some studies have shown that interventions designed to influence expectancies can affect patients' reports of symptoms. In this randomized, multicenter, Community Clinical Oncology Program trial, we investigated the effect of an expectancy manipulation designed to reduce nausea expectancy on chemotherapy-induced nausea in 358 patients scheduled to receive chemotherapy treatment. Patients in the intervention arm received general cancer-related educational material plus specific information about the efficacy of ondansetron, specifically designed to diminish nausea expectancy. Patients in the control arm received only the general cancer-related educational material. Nausea expectancy was assessed both prior to and following the educational intervention. We observed a significant reduction in nausea expectancy in the intervention group (P=0.024) as compared to the control group (P=0.34). In the intervention group, patients' expectations of nausea assessed prior to the intervention correlated significantly with average nausea (r=0.27, P=0.001), whereas nausea expectancy assessed following the intervention did not (r=0.1, P=0.22). Although the expectancy manipulation reduced patients' reported expectations for the development of nausea, the occurrence of nausea was not reduced. Furthermore, post-intervention nausea expectancy compared to pre-intervention expectancy was less predictive of subsequent nausea. Explanations for these findings include the possibility that the expectancy manipulation was not strong enough, and the possibility that changing nausea expectancies does not change occurrence of nausea.
多项研究表明，患者对化疗后发生恶心的预期是该治疗相关副作用的有力预测指标，并且一些研究表明，旨在影响预期的干预措施可影响患者的症状报告。在这项随机、多中心的社区临床肿瘤项目试验中，我们调查了一种旨在降低恶心预期的预期操纵对358名计划接受化疗的患者化疗引起的恶心的影响。干预组的患者接受了一般癌症相关的教育材料以及关于昂丹司琼疗效的具体信息，这些信息是专门设计用来降低恶心预期的。对照组的患者只接受了一般癌症相关的教育材料。在教育干预前后均对恶心预期进行了评估。与对照组（P = 0.34）相比，我们观察到干预组的恶心预期显著降低（P = 0.024）。在干预组中，干预前评估的患者恶心预期与平均恶心程度显著相关（r = 0.27，P = 0.001），而干预后评估的恶心预期则不然（r = 0.1，P = 0.22）。虽然预期操纵降低了患者报告的恶心发生预期，但恶心的发生率并未降低。此外，与干预前预期相比，干预后恶心预期对后续恶心的预测性更低。这些发现的解释包括预期操纵不够有力的可能性，以及改变恶心预期不会改变恶心发生率的可能性。
