AUTONOMIC MEASURES ASSOCIATED WITH CHEMOTHERAPY-RELATED NAUSEA - TECHNIQUES AND ISSUES

Advances in antiemetic therapy for cancer patients have been hindered by a lack of understanding of the physiological mechanisms associated with nausea and their corresponding measurement techniques. Here we re view conceptual and methodological issues involved in developing an au tonomic frame of reference for nausea and outline two strategies for a ssessing autonomic function. A primarily research-oriented strategy us es heart rate, blood volume pulse, pallor, and skin temperature to ass ess autonomic activity and reactivity over 24 hr. Peak values of these measures relative to time of emesis, heart I ate spectral analyses of autonomic activity, and analyses of the standard deviation of success ive differences of beat-to-beat intervals were all associated with sub sequent nausea. A primarily clinically oriented strategy assesses norm al and abnormal results on eight common bedside clinical tests of auto nomic function. The total number of abnormal tests was associated with subsequent nausea. A better understanding of chemotherapy side effect mechanisms is likely to result in less polypharmacy and more effectiv e individualized treatment for cancer patients.