Nausea and emesis: evidence for a biobehavioral perspective

Abstract. For most people, nausea and vomiting (NV) are simply unfortunate consequences of overindulgent college days or overenthusiastic amusement rides. Yet for most cancer patients, nausea and vomiting (also referred to as emesis) remain among the most frequent side effects of cancer chemotherapy. Patients typically view control of nausea as more important than control of emesis, while physicians and nurses judge emesis control to be more important to antiemetic efficacy than nausea control. The 5-HT3 receptor antagonists have been shown to be clinically more effective in controlling emesis, particularly that caused by regimens containing high-dose cisplatin, than previously available agents. Disappointingly, however, these drugs do not appear to be more effective than previous antiemetics in reducing nausea. In addition, the 5-HT3 receptor antagonists may become less effective over repeated chemotherapy administrations, and they remain expensive. An impediment to research progress has been an insularity that has prompted two parallel research efforts: one searching for biological understanding to enhance pharmacological intervention(s) and the other searching for psychological understanding to aid in developing more effective behavioral intervention(s). While both approaches have been successful, it is time to have the two views merge into a biobehavioral framework that combines them both. This paper draws on both physiological and psychological origins of NV to begin the development of a biobehavioral model of development that integrates features of both approaches.