This is known as anticipatory nausea and vomiting (ANV) and it usually makes the nausea and vomiting even more severe when the chemotherapy is actually given. This can eventually become such a set psychological pattern that it affects the amount of chemotherapy that can be given. And once the psychological pattern of ANV is established, it is much harder to control nausea and vomiting before and after treatment.
Anticipatory nausea is the result of a conditioned reflex. This means that if chemotherapy made you throw up once or twice, then you will feel nauseated whenever you take the treatment or even when something triggers the very idea of treatment. This conditioned aversion often takes hold after two to four chemotherapy sessions and can last a long time. A standard joke among doctors is the one about the patient who met her oncologist on the street three years after therapy and threw up on the spot.
Your anxiety state, how you feel about yourself and your cancer and how you respond to stress and disease are all important factors in setting up this psychological pattern. And once the pattern is established, all kinds of stimuli can trigger feelings of nausea—the colors or odors in the room where the chemotherapy is given, the smell of alcohol used to prepare you for the IV needle, the sight of the nurse entering the room.
To deal with this problem, you will have to take steps both to relax before your chemotherapy and to not inadvertently set up situations that become associated with nausea.
• Try to relax in a quiet, darkened room before your treatment sessions.
• Use behavioral techniques to help you relax and control any triggering stimuli—hypnosis, relaxation therapy,
imagery or listening to a tape of your favorite music or a relaxation tape ( see Relaxation ).
