How do patient expectancies, quality of life, and postchemotherapy nausea interrelate?
How do patient expectancies, quality of life, and postchemotherapy nausea interrelate?
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DOI：
10.1002/cncr.23594
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发表时间：
2008-08-01
期刊：
影响因子：
6.2
通讯作者：
Colman, Lauren K.
中科院分区：
文献类型：
--
作者：
Colagiuri, Ben;Roscoe, Joseph A.;Colman, Lauren K.
背景越来越多的证据表明患者的期望和化疗引起的恶心之间存在关系。然而，这项研究往往未能充分控制其他可能的影响因素。在目前的研究中，患者的预期化疗后恶心的发生和严重程度的贡献进行了检查，使用更严格的统计技术（即分层回归）比其他类似的研究，依赖于双变量相关性，卡方检验，逐步回归，并进一步扩展到以前的研究，包括生活质量（QoL）的分析。总共有671名首次接受化疗的患者参加了一项比较止吐方案的试验，他们回答了关于恶心预期的问题。然后，患者填写日记，评估首次输注后4天内恶心的发生率和严重程度。在控制了年龄、性别、对运动病的敏感性、诊断和生活质量后，化疗后恶心的预期越强，恶心的平均值和峰值越大。有趣的是，被归类为高度期待（第一个四分位数）的患者比被归类为有点期待、轻微期待和没有期待（分别为第二、第三和第四个四分位数）的患者经历了显著更大的平均和峰值恶心，而这些较低水平的期望之间没有显著差异。此外，平均恶心的增加导致化疗后生活质量显著降低。患者的预期似乎有助于化疗后恶心，高度预期发生恶心的患者似乎处于特定的风险中。针对这些患者的干预措施应减少恶心的负担，也可能改善生活质量。
BACKGROUND. increasing evidence suggests a relation between patient expectancies and chemotherapy-induced nausea. However, this research has often failed to adequately control for other possible contributing factors. In the current study, the contribution of patient expectancies to the occurrence and severity of postchemotherapy nausea was examined using more stringent statistical techniques (namely hierarchical regression) than other similar studies that have relied on bivariate correlations, chi-square tests, and stepwise regression, and further extended upon previous research by including quality of life (QoL) in the analysis.METHODS. In all, 671 first-time chemotherapy patients taking part in a trial comparing antiemetic regimens answered questions regarding their expectancies for experiencing nausea. Patients then completed a diary assessing both the occurrence and severity of their nausea in the 4 days after their first infusion.RESULTS. Stronger expectancies for nausea corresponded with greater average and peak nausea after chemotherapy and this was after controlling for age, sex, susceptibility to motion sickness, diagnosis, and QoL. Interestingly, patients classified as highly expectant (first quartile) experienced significantly greater average and peak nausea than those classified as somewhat expectant, slightly expectant, and not expectant (second, third, and fourth quartiles, respectively), whereas there were no significant differences between these lower levels of expectancy. Furthermore, increases in average nausea led to a significant reduction in QoL after chemotherapy.CONCLUSIONS. Patient expectancies appear to contribute to postchemotherapy nausea and patients that are highly expectant of experiencing nausea appear to be at particular risk. Interventions that target these patients should reduce the burden of nausea and may also improve QoL.