Etiology and treatment of the psychological side effects associated with cancer chemotherapy: A critical review and discussion.

Cancer patients receiving chemotherapeutic treatments routinely experience a wide range of distressing side effects, including nausea, vomiting, and dysphoria. Such symptoms often compromise patients' quality of life and may lead to the decision to postpone or even reject future, potentially life-saving, treatments. In this article, we discuss the hypotheses that have been offered to explain the development of such symptoms. We also review, in greater detail, the research evidence for the efficacy of five treatments for such symptoms: hypnosis, progressive muscle relaxation training with guided imagery, systematic desensitization, attentional diversion or redirection, and biofeedback. We discuss the implications of this treatment research, paying particular attention to factors associated with treatment outcome, mechanisms of treatment effectiveness, and issues associated with clinical application. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conditioned aversive responses in cancer chemotherapy patients: Theoretical and developmental analysis.

Reviews the literature on conditioned responses to cancer chemotherapy and examines the etiology, prevalence, and development of such responses. Studies on anticipatory nausea and vomiting (ANV) are considered in relation to the hypothesis that they develop through a respondent learning process, and an extension of this hypothesis is outlined that includes a moderating role of anxiety in the conditioning process. Factors associated with ANV include characteristics of treatment and individual factors such as an inhibitive coping style, taste and odor sensations during treatment, age and marital status, and degree of posttreatment nausea. It is concluded that research in this area of psychosocial oncology is entering a critical phase of development that will require more systematic, integrative, and theory-based approaches for continued advancement. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conditioned emotional distress in women receiving chemotherapy for breast cancer.

This study investigated whether women undergoing outpatient chemotherapy for breast cancer can develop classically conditioned emotional distress. Women scheduled to begin chemotherapy were randomly assigned either to an experimental group (exposed to a distinctive stimulus before each chemotherapy infusion) or a control group. After repeated infusions of chemotherapy, patients' responses to the distinctive stimulus were assessed in a location not associated with chemotherapy administration. At the test trial, experimental group patients showed evidence of increased emotional distress (self-reported on a visual analog scale) after the presentation of the distinctive stimulus, whereas control group patients did not. Post hoc analyses indicated that these increases in distress were not secondary to other conditioned responses (e.g., nausea, taste aversion). Thus, results supported the hypothesis that the pairing of a distinctive stimulus with chemotherapy would result in the development of a conditioned emotional response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy.

Assessed the effectiveness of electromyograph (EMG) and skin-temperature (ST) biofeedback and relaxation training (RXT) in reducing the aversiveness of cancer chemotherapy (CHEMO). 81 cancer patients (aged 18–75 yrs) were randomized to 1 of 6 groups formed by a 3?×?2 factorial design. Outcome was assessed with physiological, patient-reported, and nurse-reported indices taken over 5 consecutive CHEMO treatments. RXT patients showed decreases in nausea and anxiety during CHEMO and physiological arousal after CHEMO. EMG and ST biofeedback reduced some indices of physiological arousal but had no other effects on CHEMO side effects. RXT may be effective in reducing the adverse consequences of CHEMO. It is suggested that the positive effects found for biofeedback were due to the RXT that was given with the biofeedback, not to the biofeedback alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conditioned increases in behavioral activity and accumbens dopamine levels produced by intravenous cocaine.

In vivo microdialysis, behavioral activity assessments, and a conditioned place preference (CPP) test were used to investigate dopaminergic correlates of cocaine-conditioned behaviors. Over 12 days, rats were given either intravenous cocaine (4.2 mg/kg) or saline (6 cocaine and 6 saline infusions) daily in distinctively different environments. The following day, rats were tested in the cocaine- and saline-paired environments; 48 hr later, CPP was determined. The cocaine-associated environment elicited greater nucleus accumbens dopamine (NAcc DA) levels, hyperactivity, and place preference, though the emergence of DA increases was not in synchrony with peak behavioral activation. Although conditioned behavioral effects after repeated cocaine are well documented, direct evidence of increased NAcc DA in response to a cocaine-paired environment has not been previously reported. Discrepancies with previous work are attributed to a number of methodological differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

老年乳腺癌术后多西紫杉醇联合环磷酰胺辅助化疗的毒副作用研究

Objective: The aim of this study was to investigate the side effects of docetaxel with cyclophosphamide as postoperative adjuvant chemotherapy for elderly breast cancer patients. Methods: Thirty-six operable elderly breast cancer patients at intermediate risk based on the St Gallen risk classi.cation underwent modified radical mastectomy and then were given four cycles of TC regimen (docetaxel 75 mg/m2 i.v. on day 1; cyclophosphamide 600 mg/m2 i.v. on day 1; every 21 days ). Primary prophylaxis granulocyte colony stimulating factor (G-CSF) 200μg i.h. was administered on day 4-6. Results: The main side effect was neutropenia. Grade 3 neutropenia developed in 36.1% and G4 in 19.4%, respectively. Most of the other side effects were G1-2. Dose reduction occurred in 11.1% patients. The completion rate of chemotherapy was 100%. Conclusion:Docetaxel with cyclophosphamide as postoperative adjuvant chemotherapy regimen with G-CSF primary prophylaxis is tolerable for elderly patients in general good condition.     

Anxiety as a predictor of behavioral therapy outcome for cancer chemotherapy patients.

Studied whether baseline anxiety levels are predictive of outcome on treatments designed to reduce the negative affect and conditioned nausea associated with cancer chemotherapy. 72 18–79 yr old patients classified as having low, moderate, or high anxiety received progressive muscle relaxation training, electromyograph (EMGH) biofeedback, and/or skin temperature biofeedback. Physiological, multiple affect adjective checklist, and postchemotherapy ratings were obtained during baseline, training, and follow-up sessions. Compared with moderate- and high-anxiety Ss, low-anxiety Ss reported less anxiety and depression before behavioral training but nonetheless exhibited significantly greater reductions in anxiety, depression, and diastolic blood pressure as a result of training. Baseline anxiety levels were not related to reduced nausea. Overall, these data suggest that cancer patients who have higher baseline levels of anxiety and who are perhaps most in need of an effective behavioral treatment may be the least likely to benefit from behavioral treatments aimed at reducing the distress associated with chemotherapy. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral intervention in cancer treatment: Controlling aversion reactions to chemotherapy.

During the protracted course of cancer chemotherapy, approximately 25% of patients develop aversion reactions to treatment by becoming nauseated and/or vomiting before their chemotherapy treatments. This phenomenon has been conceptualized as a result of respondent conditioning. Since commonly used antiemetic drugs do not reliably control anticipatory nausea/emesis, behavioral techniques of control have been studied. They include hypnosis used in conjunction with guided-relaxation imagery, progressive muscle relaxation with guided imagery, and systematic desensitization. (67 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing aversion to side effects in preventive medical treatment decisions.

Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by making it easier for respondents to determine how the treatment might change their net cancer risk. Participants (N=4,248) were presented with a hypothetical preventive treatment situation that was or was not accompanied by a small side effect. In both conditions, the net absolute risk reduction was 12%. Adding an array of stick figures to risk probabilities reduced side effect aversion substantially, but adding a bar graph was not beneficial. The ability of arrays to reduce side effect aversion was not attributable to greater accuracy in evaluating the treatment's net benefit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neonatal testosterone propionate treatment in the female gerbil: Morphological and behavioral effects.

The present experiment examined the effects of a single neonatal injection of 1 mg or 100 μg of testosterone propionate (TP) on the sexual behavior and morphology of the female Mongolian gerbil. Four groups were created: vehicle-treated males (VM), 1-mg TP-treated females (HTP), 100-μg TP-treated females (LTP), and vehicle-treated females (VF). In adulthood, tests of sexual behavior were carried out after gonadectomy and appropriate hormone replacement therapy. Results indicated that LTP, HTP, and VM animals were significantly less receptive than VF animals. In addition, VM animals displayed significantly more male sexual activity than HTP, LTP, or VF animals. Immediately after the final test for male sexual behavior, subjects were weighed, anogenital distances recorded, and scent glands measured (length and width). Results indicated that a significant degree of morphological masculinization had occurred in HTP subjects for all measures and for LTP subjects for scent gland width and anogenital distance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anticancer chemotherapy. Prevention of toxicity

A MAJOR CHALLENGE: Prevention of short and long term toxicity of chemotherapy is an important challenge in oncology in order to maintain the dose/intensity of protocols and to increase patient comfort. AVAILABLE CHEMOPROTECTORS: Amifostine protects against the blood, kidney and nerve toxicity of cisplatin. Protection is less evident for carboplatin and should be further evaluated for alkylating agents, anthracyclines and taxans. Dexrazoxane protects against the cumulative cardiotoxicity of anthracyclines without reduction of antitumor efficacy. It must be used beyond a cumulative dose of 300 mg/m2 doxorubicin (or equivalent) in responsive patients. Its use in the curative treatment of lymphoma should be assessed by further clinical trials. Mesna must be widely used to prevent the urotoxicity of cyclophosphamide and ifosfamide. An oral preparation is now available for outpatients. Protection of the gonadic function could be achieved by LH-FH analogs in young women. PERSPECTIVES: Due to their high cost and the risk of diminishing the antitumor efficacy in curable diseases, a precise evaluation of present and future chemoprotectors is necessary before wider use.     

The treatment of cancer through experiential psychotherapy.

L. LeShan and M. L. Gassman (1958) may be credited with pioneering the psychotherapeutic treatment of cancer. Currently this avenue of therapy is being spearheaded by LeShan and also by O. C. Simonton et al (1978). Two cases are described wherein the cancers extinguished and the patients apparently remained cancer-free to the present, 7 yrs following therapy. The specific methods of experiential psychotherapy, particularized to these 2 cases, are described under the clinical hypothesis that some psychotherapeutic procedures may be coupled with the reduction of neoplastic growth and the elimination of cancer cells. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conditioned behavioral responses to a context paired with the predator odor trimethylthiazoline.

Contextual fear conditioning is the learning of a fear response in a specific context in response to repeated application of aversive stimuli (e.g., foot shocks) or danger-related stimuli (predator odors) within that context. Cat odor, a danger-related stimulus common in laboratory studies of fear in the past, has often been replaced recently with trimethylthiazoline (TMT), a component of fox feces. No contextual fear conditioning in response to TMT has been reported so far, whereas cat odor has often been shown to induce such fear conditioning in rats. Using TMT in both a 1-compartment and a 2-compartment setup, the authors found conditioned fear behavior (expressed as avoidance behavior) in the 2-compartment setup but not--as reported by others--in the 1-compartment setup. Detailed analysis revealed 2 different coping strategies in the 2-compartment setup: Half of the rats showed pronounced avoidance behavior, whereas the other half showed intense risk assessment behavior. These results indicate that expression of conditioned fear behavior in response to a TMT-paired context is dependent on the experimental setup used, as well as the strategy of the individual rat. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevention and treatment of organ toxicity during high-dose chemotherapy: an overview

By using increased doses or dose intensities of cytostatic agents, improvements in clinical outcome may be achieved in some cancer cases. However, high-dose chemotherapy may produce dose-limiting adverse reactions such as myelosuppression, neurotoxicity, cardiotoxicity, gastrointestinal toxicity, nausea and vomiting. The use of bone marrow transplantation, autologous infusion of circulating hematopoietic progenitors and hematopoietic growth factors have been shown to significantly reduce the severity and duration of the pancytopenia associated with cytostatic chemotherapy and chemoradiotherapy. In addition, recent developments in the control of nausea and vomiting with selective 5-HT3 antagonists have improved the tolerability of chemotherapy. The antiemetic efficacy of these agents has been shown to be equivalent to combination therapy with metoclopramide plus dexamethasone in the prevention of cisplatin-induced emesis. Progress in the prevention and treatment of organ toxicity is now required, if treatment with higher doses and dose intensities of cytostatic drug treatments are to be used for the future treatment of human malignancies.     

Experimental study on antagonizing action of herba Epimedii on side effects induced by glucocorticoids

The experimental result has shown that the water extract of Herba Epimedii (Epimedium sagittalum) works very well in preventing and curing the side effects induced by long-term use of glucocorticoids in rats, especially in antagonizing adrenocortical atrophy and osteoporosis.