Certain Neuropsychological Factors May Predict Occurrence of Chemotherapy-Induced Nausea

A recent analysis revealed that patients with cancer who scored highly on depression and anxiety scales were more likely to suffer from symptoms of chemotherapy-induced nausea.

An analysis of a longitudinal study revealed that certain characteristics in patients with cancer, such as symptoms of depression and anxiety, were independently associated with chemotherapy-induced nausea (CIN), according to a presentation at the Oncology Nursing Society’s 46th Annual Congress.

Other factors linked with CIN were younger age, income higher than $30,000, lower Karnofsky performance score, higher comorbidity burden, and a greater likelihood of stomach disease and blood disorders.

“For clinical implications, we can see that a number of neuropsychological symptoms and stress characteristics were associated with membership in the high nausea subgroup,” Komal Singh, PhD, RN, MS, of Arizona State University, said during her presentation of the data at the meeting. “Clinicians need to assess patients for chemotherapy induced nausea, and the associated neuro psychological symptoms and stress characteristics for appropriate interventions.”

Latent class analysis, or a patient-centered analytic approach, was performed to identify 3 subgroups of patients with distinct CIN profiles. Then, parametric and nonparametric tests were conducted to evaluate for differences in clinical, neuropsychological, and stress characteristics among the groups.

In total, 1343 patients from 2 comprehensive cancer centers, a Veteran’s affairs hospital, and 3 community-based oncology programs were recruited. Inclusion criteria involved those who were 18 years of age or older; had a diagnosis of breast, gynecological, gastrointestinal, or lung cancer; received chemotherapy within the preceding 4 weeks; and scheduled at least 2 additional cycles of chemotherapy. 

Demographics provided by the questionnaire were age, gender, ethnicity, marital status, living arrangements, education, employment status, and income. Measures of clinical assessment included in the analysis were Karnofsky performance status scale, the Self-Administered Comorbidity Questionnaire, Alcohol Use Disorders Identification Test, the MAX2 index, a smoking questionnaire, and medical records. Instruments for assessing neuropsychological symptom severity and stress were also used.

CIN occurrence was done through the Memorial Symptom Assessment Scale (MSAS). Nausea was evaluated 6 times over 2 cycles of chemotherapy and patients were dichotomized as having or not having CIN. Patients completed the MSAS 1 week prior to chemotherapy, 1 week after chemotherapy, and then again 2 weeks after chemotherapy.

Patients were categorized into 1 of 3 classes, with 40.8% being in the none CIN group and 28.8% in the high CIN group. The intermediate group of patients was further broken down into patients with decreasing CIN over the course of therapy (8.9%) and those with increasing and decreasing symptoms (21.5%).

In the group of patients with consistently high CIN, depression scores by the Center for Epidemiologic Studies Depression Scale, or CES-D, were significantly higher versus those in the none CIN group (16.1 vs 10.3; P <.001). Scores by the Trait Anxiety Inventory and the State Anxiety Inventory scales were both higher in patients with high CIN (37.9 and 37.4, respectively) versus non-CIN patients (32.9 and 31.2; P <.001).

Other differences between the non-CIN group and the high-CIN group were levels of cognitive dysfunction, degree of morning and evening fatigue or energy, and pain intensity and interference. Scores related to perceived stress were also higher in the high-CIN group (20.45 vs 16.71; P <.001), with subscales of avoidance, intrusion, and hyperarousal also showing statistically significant associations with the high- versus non-CIN group.

Of note, treatment-specific factors were also associated with being in the high-CIN versus the non-CIN group. Receipt of targeted therapies and low emetogenic chemotherapy was less likely in the high-CIN group whereas 14-day cycles of chemotherapy and highly emetogenic agents were more frequent.

Limitations of the study include the lack of information on patient adherence to therapy, which was not assessed. Other risk factors for CIN, such as a history of morning sickness and motion sickness, were not taken into consideration. The patient population was comprised of predominantly White female, college-educated patients with metastatic disease, leading the investigators to conclude that the findings may not be generalizable to all patients with cancer.

“Research focused on evaluating biological mechanisms that contribute to interindividual variability in chemotherapy-induced nausea occurrence may help with designing targeted interventions to alleviate nausea, especially among patients in the highest subgroup,” concluded Singh.


Singh K. Differences In Neuropsychological Symptoms And Stress Among Oncology Patients With Distinct Nausea Profiles. Presented at: Oncology Nursing Society’s 46th Annual Congress; April 20, 22, 27, and 29, 2021. Virtual.