The article, by William H. Redd, PhD, and colleagues, is a review of several articles and studies on behavioral intervention to treat cancer therapy side effects. Redd is a professor in the program for cancer prevention and control at the Mount Sinai School of Medicine.

Redd tells ACS News Today that his purpose in writing the review was to increase awareness of behavioral intervention treatments so that more physicians and others who work with cancer patients will begin to use them.

"In my clinical opinion, I would estimate about 25% of patients could obtain these services," Redd says, although he emphasizes there are no statistics available.

Such behavioral interventions include:

• Contingency management. Basically, this means promising a child a reward for cooperation during a procedure or series of procedures. The reward might be stars toward the acquisition of a special toy.
• Distraction. For adults or children, this involves engaging the patient in a highly interesting or absorbing activity — such as storytelling for children or guided imagery for adults — during an invasive procedure. The idea is that the aversive reaction is blocked by their involvement in the task at hand.
• Emotive imagery. For children, this tactic is a step beyond storytelling, in which the storyteller personalizes the story so that the child is a character in it.
• Hypnosis. In this study, hypnosis is a simple process in which the patient learns to focus attention on thoughts and images not related to the source of distress.

"The behavioral interventions focus on improving the quality of life of the person with cancer," says Terri Ades, RN, MS, AOCN, director of quality of life and health promotions strategy at the American Cancer Society (ACS).

"Many of these quality of life issues, such as nausea, anxiety, and pain are dealt with on a daily basis by patients who are undergoing cancer treatment," Ades emphasizes.

Nausea can occur two different ways, she explains. Not only can people become nauseated during or after chemotherapy — they often become nauseated in anticipation of it. Sometimes just seeing the oncology nurse who administers the chemotherapy can cause them to vomit, Ades notes.

The review by Redd and his colleagues concludes that behavioral interventions were effective at reducing anticipatory nausea and vomiting in children and adults.

But the evidence is less clear on whether such methods have an effect on the nausea and vomiting that comes after the chemotherapy is administered, the authors state.

Other uses for these interventions include getting patients to sit still, relaxing them before or during a procedure, and reducing pain, according to the article. Behavioral interventions can reduce anxiety and stress, they write, but are less effective in reducing pain. For pain hypnosis-like methods offer the most promise.

"In working with children with cancer, I’ve seen storytelling be very effective in helping children to be still during a procedure, such as a bone marrow test or a spinal tap," Ades remarks. "Adults are more likely to try distraction during their chemotherapy to avoid the anticipatory nausea."

Ades says that behavioral interventions are included in the National Comprehensive Cancer Network clinical practice guidelines for managing chronic cancer pain and nausea and vomiting used by most cancer centers.

"If patients are not offered these methods, we hope that by reading the guidelines written in an understandable language for the patient, they will begin to ask their doctor about the use of these interventions as part of their care," Ades suggests.