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Biobehavioral Factors in Chemotherapy-Induced Nausea and Vomiting

Joseph A. Roscoe, Gary R. Morrow, Jane T. Hickok, Karen M. Mustian, and Abhay R. Shelke

Although emesis can be considered a reflex to clear toxins from the body and involves mostly lower brain structures, nausea's purpose appears to be a warning signal to the individual to not engage in behaviors that he or she was doing at the time. As such, it involves the functioning of cognition and memory from higher developed neural structures. Given this, it should not be surprising that biobehavioral factors are important in predicting and controlling nausea. This article reviews the individual characteristics that are clinically useful in predicting which patients will have an increased probability of experiencing nausea or emesis during chemotherapy treatment, and also briefly review psychologic and biobehavioral treatments that can be useful in managing chemotherapy-related nausea.

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Effect of Yoga and Mediational Influence of Fatigue on Walking, Physical Activity, and Quality of Life Among Cancer Survivors

Po-Ju Lin, Brian J. Altman, Nikesha J. Gilmore, Kah Poh Loh, Richard F. Dunne, Javier Bautista, Chunkit Fung, Michelle C. Janelsins, Luke J. Peppone, Marianne K. Melnik, Kim O. Gococo, Michael J. Messino, and Karen M. Mustian

Background: Cancer-related fatigue (CRF) negatively affects survivors’ walking, engagement in physical activity (PA), and quality of life (QoL). Yoga is an effective therapy for treating CRF; however, evidence from large clinical trials regarding how reducing CRF through yoga influences CRF’s interference with survivors’ walking, engagement in PA, and QoL is not available. We examined the effects of yoga and the mediational influence of CRF on CRF’s interference with walking, PA, and QoL among cancer survivors in a multicenter phase III randomized controlled trial. Patients and Methods: Cancer survivors (n=410) with insomnia 2 to 24 months posttreatment were randomized to a 4-week yoga intervention—Yoga for Cancer Survivors (YOCAS)—or standard care. A symptom inventory was used to assess how much CRF interfered with survivors’ walking, PA, and QoL. The Multidimensional Fatigue Symptom Inventory-Short Form was used to assess CRF. Two-tailed t tests and analyses of covariance were used to examine within-group and between-group differences. Path analysis was used to evaluate mediational relationships between CRF and changes in CRF’s interference with walking, PA, and QoL among survivors. Results: Compared with standard care controls, YOCAS participants reported significant improvements in CRF’s interference with walking, PA, and QoL at postintervention (all effect size = −0.33; all P≤.05). Improvements in CRF resulting from yoga accounted for significant proportions of the improvements in walking (44%), PA (53%), and QoL (45%; all P≤.05). Conclusions: A significant proportion (44%–53%) of the YOCAS effect on CRF’s interference with walking, PA, and QoL was due to improvements in CRF among cancer survivors. Yoga should be introduced and included as a treatment option for survivors experiencing fatigue. By reducing fatigue, survivors further improve their walking, engagement in PA, and QoL.