| To
better focus research in this area, we need to develop a more complete
understanding of the root neurological and physiological mechanisms
of both nausea and vomiting. Enhanced control of chemotherapy-induced
nausea is clearly needed, and better control depends on optimizing
current pharmaceutical treatments along with generating new knowledge
that might be translated into therapeutic benefit.
We believe that an
impediment to progress has been an insularity that has prompted
two parallel research efforts:
- One
searching for biological understanding to enhance pharmacological
intervention(s); and
- The
other searching for psychological understanding to aid
in developing more effective behavioral intervention(s).
While both approaches
have been successful, it is time to have the two views merge into
a biobehavioral framework that combines them both. The Biobehavioral
Model of Nausea, shown below, is a step in merging these two lines
of research to organize and generate new knowledge and understanding.
| Figure
2.1: Biobehavioral Model of Nausea
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While a number of potential
inputs and stimuli are known to promote nausea, little is known
about common pathways for its expression or integration. Nausea
and/or vomiting may result from a variety of challenges, such
as:
- Aberrant
motion;
- Pregnancy;
- Ingestion
of various toxins (such as the majority of chemotherapy drugs);
- As
a side effect of medications, e.g. opioids; or
- Psychological mechanisms
that seem involved primarily in the anticipatory NV that develops
in approximately 30% of cancer patients undergoing chemotherapy,
but may also influence posttreatment NV.
These various causes
may not be independent. For example, patients undergoing chemotherapy
treatment who are susceptible to motion sickness have more nausea
and vomiting than patients who are not susceptible (Morrow,
1985). Research has also shown that autonomic changes
are related to the development and expression of motion-induced
nausea and vomiting.
Question
2.1
Investigators
find that there is variation in cancer patients' response to chemotherapy
drugs associated with individual characteristics. Research consistently
shows that younger patients have more nausea and vomiting than
elderly patients, and female patients experience more nausea and
vomiting than males
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