• Prospective evaluation of antiemetic outcome following high-dose chemotherapy with hematopoietic stem cell support

      Ballen, Karen K.; Heseth, Ann M.; Heyes, Christine; Becker, Pamela S.; Emmons, Robert V. B.; Fogarty, Kevin E.; LaPointe, Janet; Liu, Qin; Hsieh, Chung-Cheng; Hesketh, Paul J. (2002-01-10)
      Considerable progress has been made in improving the control of chemotherapy-induced emesis. The impact of available antiemetic options for patients receiving stem cell transplants is unclear, as few prospective data have been collected. We prospectively evaluated antiemetic outcome in patients receiving stem cell transplantation over a 7-day period following the initiation of chemotherapy. The primary endpoints were the number of emetic episodes and the extent of nausea measured on a four-point scale. Eighty-two patients were evaluated. Ninety-five percent of patients had nausea during the first week of treatment; 80% had at least one emetic episode. The percentage of patients with emesis was as follows: day 1: 13%, day 2: 21%, day 3: 30%, day 4: 38%, day 5: 44%, day 6: 39%, day 7: 18%. In multivariate analysis, gender, emesis with prior chemotherapy, history of morning or motion sickness, type of transplant (auto vs allo), use of total body irradiation, or use of dexamethasone did not effect emesis control. Most patients receiving high-dose chemotherapy experience incompletely controlled emesis. Control of nausea and emesis progressively worsened with each subsequent day following initiation of chemotherapy, reaching a nadir on day 5. New treatment approaches are needed to improve emesis control in this patient population.
    • Recollections and repercussions of the first inhaled cigarette

      DiFranza, Joseph R.; Savageau, Judith A.; Fletcher, Kenneth E.; Ockene, Judith K.; Rigotti, Nancy A.; McNeill, Ann D.; Coleman, Mardia A.; Wood, Constance (2004-02-01)
      CONTEXT: It has not been determined if a youth's reaction to the first smoking experience is predictive of future nicotine dependence, or whether the impact of the first cigarette can be altered by manipulating levels of tar, nicotine and menthol. OBJECTIVE: To determine if the recalled response to the first cigarette is predictive of the development of symptoms of nicotine dependence and whether it is influenced by the type of cigarette smoked. DESIGN AND SETTING: A retrospective/prospective longitudinal study of the natural history of nicotine dependence employing individual interviews conducted three times annually in two urban school systems over 3 years. Subjects were asked to recall their first smoking experience. PARTICIPANTS: A cohort of 237 subjects who had inhaled on a cigarette. MAIN OUTCOME MEASURES: Symptoms associated with smoking; the Hooked on Nicotine Checklist of 10 symptoms of dependence. RESULTS: Reactions to the initial smoking experience were unrelated to gender or cigarette brand, strength or mentholation. Relaxation in response to the first inhalation was the strongest predictor of symptoms of nicotine dependence. Dizziness and nausea were also independent predictors of dependence symptoms. CONCLUSIONS: The data suggest that increased sensitivity to nicotine as manifested by relaxation, dizziness, or nausea in response to the first exposure to nicotine represents a risk factor for the development of nicotine dependence.