Anita Roselyn Peoples

Anticipatory nausea and vomiting due to chemotherapy

As a specific variation of chemotherapy-induced nausea and vomiting, anticipatory nausea and vomiting (ANV) appears particularly linked to psychological processes. The three predominant factors related to ANV are classical conditioning; demographic and treatment-related factors; and anxiety or negative expectancies. Laboratory models have provided some support for these underlying mechanisms for ANV. ANV may be treated with medical or pharmacological interventions, including benzodiazepines and other psychotropic medications. However, behavioral treatments, including systematic desensitization, remain first line options for addressing ANV. Some complementary treatment approaches have shown promise in reducing ANV symptoms. Additional research into these approaches is needed. This review will address the underlying models of ANV and provide a discussion of these various treatment options.

Current Pharmacotherapy for Chemotherapy-Induced Nausea and Vomiting in Cancer Patients

Introduction: Nausea and vomiting are two of the most frequent and troubling side effects patients experience during chemotherapy, interfering with compliance with cancer therapies and quality of life. While newly available treatments have improved our ability to manage nausea and vomiting, anticipatory and delayed nausea and vomiting are still major problems for patients receiving chemotherapy. Many cancer patients consider delaying future chemotherapy cycles and some contemplate stopping chemotherapy altogether because of their fear of experiencing further nausea and vomiting. Areas covered: The purpose of this article is to provide an overview of the pathopsychophysiology of chemotherapy-induced nausea and vomiting (CINV), the recommended guidelines for treatment, and current agents in late-stage clinical trials, and future research needs to address the continued challenges of treatment-related nausea and vomiting. Expert opinion: Despite advances in pharmaceutical and behavioral therapies, and the provision of standard clinical guidelines for effectively managing CINV, patients continue to experience it. Moreover, control of nausea, acute and delayed, and anticipatory nausea and vomiting remains an important, unmet need among cancer patients. It is critical to focus attention on better understanding the mechanisms underlying nausea, anticipatory symptoms and delayed symptoms.

Randomized Placebo-Controlled Trial of Cognitive Behavioral Therapy and Armodafinil for Insomnia After Cancer Treatment

PURPOSE Insomnia is a distressing and often persisting consequence of cancer. Although cognitive behavioral therapy for insomnia (CBT-I) is the treatment of choice in the general population, the use of CBT-I in patients with cancer is complicated, because it can result in transient but substantial increases in daytime sleepiness. In this study, we evaluated whether CBT-I, in combination with the wakefulness-promoting agent armodafinil (A), results in better insomnia treatment outcomes in cancer survivors than CBT-I alone. PATIENTS AND METHODS We report on a randomized trial of 96 cancer survivors (mean age, 56 years; female, 87.5%; breast cancer, 68%). The primary analyses examined whether ≥ one of the 7-week intervention conditions (ie, CBT-I, A, or both), when compared with a placebo capsule (P) group, produced significantly greater clinical gains. Insomnia was assessed by the Insomnia Severity Index and sleep quality by the Pittsburgh Sleep Quality Inventory. All patients received sleep hygiene instructions. RESULTS Analyses controlling for baseline differences showed that both the CBT-I plus A (P = .001) and CBT-I plus P (P = .010) groups had significantly greater reductions in insomnia severity postintervention than the P group, with effect sizes of 1.31 and 1.02, respectively. Similar improvements were seen for sleep quality. Gains on both measures persisted 3 months later. CBT-I plus A was not significantly different from CBT-I plus P (P = .421), and A alone was not significantly different from P alone (P = .584). CONCLUSION CBT-I results in significant and durable improvements in insomnia and sleep quality. A did not significantly improve the efficacy of CBT-I or independently affect insomnia or sleep quality.

Effects of armodafinil and cognitive behavior therapy for insomnia on sleep continuity and daytime sleepiness in cancer survivors

STUDY OBJECTIVES This study involves the analysis of a secondary outcome of a trial examining whether cognitive behavior therapy for insomnia (CBT-I), a wake-promoting medication (armodafinil), or both results in greater improvement in prospectively assessed sleep continuity and daytime sleepiness than a placebo-alone group among a heterogeneous group of cancer survivors. Whether or not armodafinil alone, and/or when combined with CBT-I, affected adherence with CBT-I was evaluated. DESIGN This study is a randomized, placebo-controlled, clinical trial. SETTING This study was conducted at two northeastern academic medical centers. PARTICIPANTS Eighty-eight cancer survivors with chronic insomnia were recruited between October 2008 and November 2012. Participants were assigned to one of four conditions: 1) CBT-I and placebo (CBT-I+P); 2) CBT-I and armodafinil (CBT-I + A); 2) armodafinil alone (ARM); or 4) placebo alone (PLA). INTERVENTIONS CBT-I was delivered in seven weekly individual therapy sessions (three in person, four via telephone). The armodafinil dosage was 50 mg BID. MEASUREMENTS AND RESULTS Sleep continuity was measured with daily sleep diaries assessing sleep latency (SL), wake after sleep onset (WASO), and total sleep time (TST). The Epworth Sleepiness Scale (ESS) measured daytime sleepiness. Compared to the PLA group, the CBT-I+P and CBT-I+A groups reported a significant reduction in SL with effect sizes of 0.67 and 0.58, respectively. A significant reduction was observed in WASO in the CBT-I+A group with an effect size of 0.64. An increasing trend of TST was observed in the CBT-I+P, CBT-I+A, and PLA groups, but not in the ARM group. No statistically significant reductions in daytime sleepiness (ESS) were observed for any of the groups. CONCLUSION CBT-I alone and in combination with armodafinil caused significant improvement in sleep continuity. The addition of armodafinil did not appear to improve daytime sleepiness or enhance adherence to CBT-I.

Social Support, Insomnia, and Adherence to Cognitive Behavioral Therapy for Insomnia After Cancer Treatment

ABSTRACT Objective/Background: While cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be efficacious in treating cancer survivors’ insomnia, 30–60% of individuals have difficulty adhering to intervention components. Psychosocial predictors of adherence and response to CBT-I, such as social support, have not been examined in intervention studies for cancer survivors. Participants: Data from a randomized placebo-controlled 2 x 2 trial of CBT-I and armodafinil (a wakefulness promoting agent) were used to assess adherence. Ninety-six cancer survivors participated in the trial (mean age 56, 86% female, 68% breast cancer). Methods: CBT-I and armodafinil were administered over the course of seven weeks, and participants were assessed at baseline, during intervention, postintervention, and at a three-month follow-up. Social support was assessed using a Functional Assessment of Chronic Illness Therapy subscale, insomnia severity was assessed using the Insomnia Severity Index, and adherence was measured based on CBT-I sleep prescriptions. Results: At baseline, social support was negatively correlated with insomnia severity (r = –0.30, p = 0.002) and associations between social support, CBT-I, and insomnia were maintained through the three-month follow-up. Social support was positively associated with adherence to CBT-I during intervention weeks 3, 4, and 5, and with overall intervention adherence. At postintervention, both social support and treatment with CBT-I independently predicted decreased insomnia severity (p < 0.01) when controlling for baseline insomnia severity. Conclusions: Higher social support is associated with better intervention adherence and improved sleep independent of CBT-I. Additional research is needed to determine whether social support can be leveraged to improve adherence and response to CBT-I.

Abstract 5041: The effect of YOCAS©® Yoga on prescription sleep medication and over-the-counter sleep medication usage in cancer survivors with impaired sleep quality

Background: Impaired sleep quality (ISQ) is highly prevalent among cancer survivors; 30-90% of cancer survivors report some form of ISQ following treatment. Cancer survivors with ISQ are often provided with sleep medications, which fall into two classes: prescription sleep medications (PSM) or over-the-counter sleep medications (OSM). The most common PSM are non-benzodiazepine hypnotics (NBH), benzodiazepines (BENZO), and tricyclic antidepressants (TCA). PSM have an uncertain efficacy, carry a risk of dependency, and may cause deleterious side effects. OSM (usually diphenhydramine and doxylamine) are believed to be safer, but the user can develop tolerance and often report a “groggy” feeling the next day. The aim of this secondary data analysis is to examine the effect of YOCAS©® Yoga for ISQ in cancer survivors on PSM and OSM usage. We also examined the baseline association between PSM, sleep quality, and side effects. Methods: We previously conducted a RCT among 410 cancer survivors suffering from moderate to severe ISQ between 2 and 24 months after treatment. The YOCAS©® program consisted of breathing exercises, 16 Gentle Hatha and Restorative yoga postures, and meditation. Participants attended two 75-minute sessions per week for four weeks. At baseline, participants listed all current prescription sleep medications while also completing questionnaires on sleep quality and side effects commonly experienced by cancer survivors. ANCOVA models were used to calculate the difference between groups while controlling for age, gender, race, and baseline values (where appropriate). Results: Previously published results showed YOCAS©® Yoga significantly improved ISQ compared to the control group. At baseline, 26% and 13% of participants reported using PSM and OSM, respectively. PSM users had significantly worse sleep quality (PSQI score: PSM=10.5 vs. No PSM=8.6; p Conclusion: PSM use was associated with ISQ along with side effects such as fatigue and memory problems at baseline. YOCAS©® yoga significantly reduced the use of NBH, which is currently the most used PSM. There was also a trend towards the reduction of OSM use with yoga. Clinicians may consider prescribing alternative therapies for ISQ such as YOCAS©® yoga, which improve ISQ and reduce the dependency on certain sleep medications. Citation Format: Luke J. Peppone, Michelle Janelsins, Jonathan Friedberg, Mohamed Tejani, Charles Kamen, Marie Flannery, Anita Peoples, James Atkins, Marianne Melnik, Karen Mustian. The effect of YOCAS©® Yoga on prescription sleep medication and over-the-counter sleep medication usage in cancer survivors with impaired sleep quality. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5041. doi:10.1158/1538-7445.AM2014-5041