***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE AND METHODS Although a high prevalence of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy ( CT ) has been reported , little has been done to develop strategies to prevent these problems . A double-blind , placebo-controlled study was therefore design ed to assess the usefulness of adding low-dose alprazolam ( 0.5 mg to 2 mg per day ) to a psychologic support program including progressive relaxation training design ed to prevent the aforementioned conditions . Fifty-seven women undergoing adjuvant CT for stage II primary breast cancer agreed to participate in the assessment , which was conducted at four time points : before starting CT , 6 weeks after CT , before the fourth CT , and after the fourth CT . The Hospital Anxiety and Depression Scale ( HADS ) , Montgomery and Asberg Depression Rating Scale ( MADRS ) , Hamilton Anxiety Scale ( HAS ) , Revised Symptom Checklist ( SCL-90-R ) , Morrow Assessment of Nausea and Emesis ( MANE ) , and World Health Organization ( WHO ) grading of acute and subacute toxicities were used to compare the alprazolam ( AA ) and placebo ( PA ) arms of the study . RESULTS At the second evaluation , the results showed a higher rate of anticipatory nausea ( 18 % v 0 % ) in the PA compared with the AA arm ( P = .038 ) . These differences were no more significant at each of the further assessment s. Significant differences were found for the intake of hypnotics at each assessment visit , with the rate of hypnotic users being significantly higher in the PA ( 19 % ) compared with the AA ( 0 % ) arm at the fourth assessment ( P < .05 ) . Anxiety and depression scores of self- and observer-report were similar in the two arms . A significant relationship was found between the development of anticipatory nausea and the self-report of anxiety and depression score measured by HADS at baseline . The average HADS total score at baseline was 15.33 ( SD = 6.56 ) for patients who developed anticipatory nausea and 11.23 ( SD = 6.67 ) for other patients . CONCLUSION The adjunct of alprazolam to a psychologic support program delays the occurrence of anticipatory nausea and controls sleeping problems secondary to adjunct CT . Although studies are needed to improve the efficacy reported here , physicians may already consider the use of alprazolam for cancer patients undergoing CT Fifty-four pediatric cancer patients were studied to determine the relative efficacy of two forms of behavioral intervention for reducing chemotherapy-related distress . Following baseline assessment , subjects were r and omly assigned to receive either hypnosis , non-hypnotic distraction/relaxation , or attention placebo ( control ) during the subsequent identical chemotherapy course . Observational and interview measures of anticipatory and postchemotherapy nausea , vomiting , distress , and functional disruption served as outcome data . Results indicated that treatment condition was the single best predictor of change from baseline to intervention , with children in the hypnosis group reporting the greatest reduction of both anticipatory and postchemotherapy symptoms . The cognitive distraction/relaxation intervention appeared to have a maintenance effect in which symptoms did not get much worse or much better , while children in the control group had symptoms that consistently became worse over time . Emetic potential of the chemotherapy and the prophylactic use of antiemetics each appeared to contribute to the overall severity of symptoms . While the efficacy of hypnosis in the management of chemotherapy distress is supported , the complexities of interacting biologic and psychologic factors are highlighted We examine whether overshadowing by salient stimuli is effective in reducing the ability of a certain environment ( the putative conditioned stimulus ) to evoke conditioned nausea in healthy humans that experience nausea-evoking rotation ( as the unconditioned stimulus , US ) in that environment . Twenty-four rotation-susceptible subjects ( 12 males , 12 females ) were r and omly assigned to receive either overshadowing by salient tasting beverages ( OS+ ) , or a control treatment ( a familiar beverage , water ; OS− ) prior to rotation on three consecutive days ( acquisition ) . To control for taste experiences , the alternative beverage was consumed 12 h later in the home environment ( OS+ : water , OS− : salient beverage ) . At Day 4 ( test ) , all subjects drank the familiar beverage ( water ) prior to rotation ( US ) . Rotation was st and ardized as 2 × 1-min rotation/day . Nausea was determined by a 7-item symptom scale measuring symptom number ( SN ) prior to ( anticipatory ) , immediately after , and 15 and 30 min after rotation and by the Nausea Profile ( NP ) question naire immediately after rotation . Cortisol and tumour necrosis factor (TNF)-α in saliva were sample d at the same time-points . SN and cortisol were also measured at home . Overshadowing reduced anticipatory ( conditioned ) SN . Post-rotation nausea ( i.e. the unconditioned response ) measured by the NP decreased within the OS+ group only . Anticipatory cortisol and TNF-α were not affected by overshadowing . Treatment × gender interactions manifested for post-rotation cortisol and TNF-α . Groups did not differ in SN and cortisol at home . Overshadowing is effective in reducing symptoms of anticipatory nausea and rotation-induced unconditioned nausea ; its effect on endocrine and immunological parameters is gender specific . Its application in alleviation of anticipatory nausea in cancer patients is considered The infusion of cytotoxic drugs in cancer patients is often accompanied by posttreatment nausea ( PN ) . In addition , patients complain about nausea prior to an infusion [ i.e. , anticipatory nausea ( AN ) ] . AN is mainly explained by classical conditioning , with the infusion as the unconditioned stimulus ( US ) and with the stimuli signaling the infusion as conditioned stimuli ( CS ) . Despite this conditioning etiology , a specifically derived therapy to attenuate the CS-US contingency is missing . The purpose of this study is to develop and to test an overshadowing procedure for prevention of AN , and also for the modification of PN intensity . Sixteen cancer patients were assigned to one of two groups : Overshadowing+ ( OV+ ) and Overshadowing- ( OV- ) . At the start of all infusions of two consecutive chemotherapy cycles A and B ( acquisition ) , OV+ subjects drank a saliently tasting beverage ( the overshadowing CS ) , whereas group OV- drank water . All patients received water in cycle C ( test ) . Self-reported symptoms and heart rates were recorded . As expected , in cycle C ( test ) , no patient of group OV+ showed AN , whereas two patients of group OV- developed AN . There was a tendency for a reduction of the intensity of PN , in terms of duration and latency after overshadowing , in cycle C : OV+ patients tended to show a shorter duration and a longer latency between end of infusion and PN onset . In OV- , there was a significantly larger heart rate deceleration in both measurement periods , in the anticipatory and the posttreatment measurement period . Data suggest to apply overshadowing for prevention of AN and modification of PN . Physiological markers of conditioned nausea are revealed . After its procedural implementation , the technique can be used in larger sample s now CONTEXT Demographic , personal , clinical , and behavioral factors predicting chemotherapy-induced nausea and vomiting ( CINV ) have been assessed in the past , but inconsistencies exist in the literature , studies have method ological shortcomings , and many risk factors have been examined in cross-sectional studies and univariate analyses . OBJECTIVES To evaluate the predictive power of personal and treatment-related characteristics in the development of CINV , using a large and prospect ively evaluated sample of a heterogeneous group of cancer patients receiving routine chemotherapy . METHODS This was a multicountry , multisite prospect i ve study over three cycles of chemotherapy .  Adult patients from eight European countries about to receive highly and moderately emetogenic chemotherapy were recruited . Clinicians completed a case report form at or before the initial chemotherapy treatment , recording patient demographic and baseline clinical characteristics . Participants completed a daily patient diary for six days per chemotherapy cycle describing their CINV experience . Baseline patient data also included a history of nausea/vomiting ( yes/no ) , patient expectation of nausea ( 0 - 100 mm visual analogue scale [ VAS ] ) , prechemotherapy anxiety ( 0 - 100 mm VAS ) , and prechemotherapy nausea ( 0 - 100 mm VAS ) measured during the 24-hour period before chemotherapy initiation . RESULTS There were 991 evaluable patients with complete Cycle 1 data , 888 for Cycle 2 data , and 769 for Cycle 3 data . A complex picture of predictor variables was shown , with different contribution of variables to the acute , delayed , and overall phases of CINV . Key predictor variables included the use of antiemetics inconsistent with international guidelines , younger age , prechemotherapy nausea , and no CINV complete response in an earlier cycle ( all at P < 0.05 ) . Anxiety , history of nausea/vomiting , and expectations of nausea were important predictors for some phases and cycles but not consistently across the CINV pathway . CONCLUSION The results of this study provide clarity for the relative contribution of a set of characteristics in the development of CINV . Following evidence -based clinical antiemetic guidelines is of paramount importance , alongside treating patients with increased risk for CINV more aggressively , which both could lead to more optimal CINV management . These data can assist clinicians in making decisions about the antiemetic management of their patients Purpose Some patients experience  nausea and /or vomiting ( NV )  before receipt of chemotherapy . Our objective was to evaluate the impact of prior chemotherapy-induced NV ( CINV ) on the incidence of anticipatory NV in later cycles . Methods This multicenter , prospect i ve non-interventional study enrolled chemotherapy-naïve adults scheduled to receive highly or moderately emetogenic chemotherapy ( HEC/MEC ) for cancer in six Asia Pacific countries , excluding those with emesis within 24 h before cycle 1 chemotherapy . On day 1 before chemotherapy , patients answered four questions regarding  emesis in the past 24 h , nausea , expectation of post-chemotherapy nausea , and anxiety in the past 24 h , the latter three scored from 0–10 ( none – maximum ) . Multivariate logistic regression was used to assess the impact of prior CINV on anticipatory NV in cycles 2 and 3 . Results Five hundred ninety-eight patients ( 59 % female ) were evaluable in cycle 2 ( 49 % HEC , 51 % MEC ) . The incidence of anticipatory emesis was low before cycles 2 and 3 ( 1.5–2.3 % ) . The incidence of clinical ly significant anticipatory nausea ( score of ≥3 ) was 4.8 , 7.9 , and 8.3 % before cycles 1 , 2 , and 3 , respectively , with adjusted odds ratio ( OR ) , 3.95 ( 95 % confidence interval ( CI ) , 2.23–7.00 ; p < 0.001 ) for patients with clinical ly significant nausea in prior cycles , compared with none . The adjusted ORs for other anticipatory NV endpoints ranged from 4.54–4.74 for patients with prior CINV . The occurrence of clinical ly significant anxiety in the prior cycle also result ed in a significantly increased likelihood of anticipatory nausea . Conclusions These findings highlight the importance of preventing CINV in cycle 1 to reduce anticipatory NV in subsequent cycles Adequate control of side effects during medical treatment of cancer increases patient compliance and quality of life .  Antiemetic drugs are not an effective treatment for the one in three cancer patients on chemotherapy who experience anticipatory nausea and vomiting ( ANV ) ; the behavioral treatment of systematic desensitization has been found effective for ANV when delivered by clinical psychologists . This study examined the effectiveness of systematic desensitization when delivered by medical personnel versus clinical psychologists . Seventy-two consecutive cancer patients with ANV were r and omly assigned to no-treatment control or to systematic desensitization from 5 behaviorally trained clinical psychologists , 6 clinical oncologists , or 10 oncology nurses . The treatment was found effective in reducing anticipatory nausea , anticipatory vomiting , posttreatment nausea , and posttreatment vomiting compared to control patients , with no significant differences in effectiveness found between clinical psychologists and oncology staff . Although medical personnel should not engage patients in psychotherapy or other interventions that can not be completed successfully , they can treat patients effectively with systematic desensitization and should be encouraged to learn and use this and other behavioral intervention techniques to benefit total patient care This study was design ed to determine ( a ) the relationship of coping style to cancer chemotherapy side efects and ( b ) whether coping style moderated the impact of a relaxation intervention on anxiety , depression , and nausea associated with  chemotherapy . Forty-eight cancer patients were assigned r and omly to receive either progressive muscle relaxation training before chemotherapy ( experimental group ) or st and ard care ( control group ) . Spearman correlations indicated that a “ blunting ” or distraction-oriented coping style was associated with less anticipatory anxiety , less depression , and less nausea during and after chemotherapy . Spearman correlations also indicated that a “ monitoring ” or information-gathering coping style was associated with more anticipatory anxiety , and more nausea before and during chemotherapy . Although there was a signijicant effect of the relaxation intervention on posttreatment nausea , there were no other between-group differences . The results did suggest , however , that relaxation was efective in reducing anticipatory anxiety among “ blunters , ” but not “ monitors , ” perhaps because relaxation is a distraction strategy and therefore is consistent with a blunting coping style . The effects of coping and 
    Output:
    
The guideline panel continues to recommend that anticipatory nausea and vomiting are best prevented through optimization of acute and delayed phase chemotherapy-induced nausea and vomiting control .
Benzodiazepines and behavioral therapies , in particular progressive muscle relaxation training , systematic desensitization and hypnosis , continue to be recommended for the treatment of anticipatory nausea and vomiting .