Patients with greater levels of stress, pain, and various neuropsychological symptoms experienced higher levels of chemotherapy-induced nausea (CIN), according to results of a recent study. Study findings were reported in the journal Oncology Nursing Forum.

The study evaluated stress, resilience, and neuropsychological symptom severity in adults with cancer receiving chemotherapy, evaluating outcomes in terms of the patient’s CIN profile. CIN was measured using the Memorial Symptom Assessment Scale, with patients reporting 6 times across 2 chemotherapy cycles.

Based on patterns of CIN occurrences, patients were classified into 4 groups. Patients with 1 or fewer occurrences of CIN were in the “none” CIN group, those experiencing CIN levels alternating across specific intervals were in the “increasing-decreasing” CIN group, and the remaining groups featured decreasing CIN or consistently high CIN. A variety of tools were used to assess stress/resilience and neuropsychological outcomes.

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From a total of 1343 patients, 548 patients were in the “none” CIN group, 289 patients in the increasing-decreasing CIN group, 119 patients in the decreasing CIN group, and 387 patients in the high CIN group.

Compared with the group having no CIN, those in the high CIN group were significantly younger, more likely to have a lower annual household income, and a greater likelihood of childcare responsibilities.

Additionally, the high CIN group had lower Karnofsky Performance Status scores, a lower likelihood of exercising regularly, a greater likelihood of gastrointestinal cancer, and a lower likelihood of gynecologic cancer, compared with the increasing-decreasing CIN group. Other demographic and clinical differences were also seen across CIN groups.

Overall, higher degrees of global stress, cancer-specific stress, and cumulative life stress were associated with higher rates of nausea in the study population. Higher rates of CIN were also linked to clinically meaningful levels of depression, anxiety, sleep disturbance, fatigue, pain, and decrements in energy and cognitive function.

With more than half the patients in the study reporting CIN, the study investigators considered this symptom to be a significant clinical problem. “To manage this distressing symptom, clinicians need to continuously assess patients for CIN, stress, and co-occurring symptoms,” the investigators wrote in their report.

They also indicated that patients in the high CIN class should be evaluated for adherence to their antiemetic treatment regimen and a possible need for prescription adjustment.


Singh KP, Cooper BA, Tofthagen CS, et al. Higher levels of stress and neuropsychological symptoms are associated with a high nausea profile in patients with cancer receiving chemotherapy. Oncol Nurs Forum. 2023;50(4):461-473. doi:10.1188/23.ONF.461-473