Oncology Nursing Forum (ONF) published an article in its early newsletter format in 1977 entitled "Variables Affecting Nausea and Vomiting" (Mayer Scogna, 1977). That literature review provided an excellent analysis of the state of the art in the management of chemotherapy-induced nausea and vomiting (CINV) at that time. Healthcare providers knew that the vomiting center, chemoreceptor trigger zone (CTZ), and vagal afferents in the gastrointestinal (GI) tract were intimately involved in CINV and that multiple and varied chemoreceptors existed in the CTZ. Unfortunately, interventions lagged compared to the knowledge of the pathophysiology of the CINV process. Only 13 studies on the effectiveness of available antiemetics were published from 1964 to 1977, and no new agents had been developed since the 1950s (Mayer Scogna, 1977). That study investigated whether extrinsic factors, subjective attitude about effectiveness of chemotherapy, hours of sleep prior to treatment, activity level, or food intake affected CINV and found that they did not. Mayer Scogna (1977) recognized anticipatory nausea and vomiting, referring to this as a conditioned psychological component, and noted the lack of reliable tools to objectively measure nausea and vomiting.