The current role of anti-emetic drugs in oncology: a recent revolution in patient symptom control

Sagar, Stephen M.

doi:10.1016/0305-7372(91)90009-o

Cited by 47 publications

(21 citation statements)

References 143 publications

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“…The anti-inflammatory properties of cortisol may act to prevent the release of serotonin in the gut or prevent activation of 5-HT receptors in the gastrointestinal system (Fredrikson et al, 1992). When used as a complement to other classes of antiemetics, cor-ticosteroids have also been suggested to potentiate the main antiemetic effect by sensitising the pharmacological receptor (Sagar, 1991). Our results suggest that endogenous cortisol, too modifies the antiemetic effect.…”

Section: Discussionmentioning

confidence: 76%

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Endogenous cortisol exerts antiemetic effect similar to that of exogenous corticosteroids

Hursti

Fredrikson²,

Steineck³

et al. 1993

Br J Cancer

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Summary Lower pre-chemotherapy night time cortisol excretion predicted more severe cisplatin induced nausea and vomiting in 42 ovarian cancer patients receiving ondansetron as a single antiemetic agent. Dexamethasone administration added to the antiemetic effect of ondansetron principally in patients who had low excretion of cortisol.Corticosteroids as single antiemetic agents have a well documented effect on mild to moderate chemotherapy induced emesis (Cassileth et al., 1983). During highly emetogenic chemotherapy, there is a synergistic antiemetic effect of corticosteroids and metoclopramide or 5-hydroxytryptamine (5-HT3) receptor antagonists (Kris et al., 1989;Smith et al., 1991). Recently we reported that nausea during chemotherapy with low emetic potential was inversely related to urinary cortisol excretion (Fredikson et al., 1992 Patients rated their nausea during the past 24 h at the morning of the first and second day after the cisplatin infusion by choosing one of four alternatives ranging from none to severe nausea. At the first morning patients also used a 100 mm visual analog scale (VAS) to report the severity of nausea. A zero score is anchored at the left end with 'no nausea at all' and a maximum score of 100 'worst possible nausea'. Emetic episodes (vomiting or retching) were recorded by patients during both days.In the statistical analyses patients responding with 'no' or 'mild' nausea were treated as one group and those responding 'moderate' or 'severe' nausea formed the other group. Regarding the emetic episodes, patients with complete or major response ( <2 emetic episodes) formed one group whereas minor response and failure (> 3 emetic episodes) formed the other group. A median split approach was used to form groups with relatively high and low cortisol excretion. Relative risk was used to describe the association between urinary cortisol levels and nausea and vomiting. Relative risk was calculated as the ratio between the proportions of patients with moderate or severe nausea, or > 3 emetic episodes in respective groups of interest. Calculation of 95% confidence intervals was performed as described by Greenland & Robins (1985). Student's t-test with one-tailed P-values was used to analyse VAS-ratings of nausea and the total number of emetic episodes. ResultsThe median used to form groups high and low in cortisol excretion was 23.2pmolmin-'. The high and low excretion group had a mean (standard error of the mean) of 38.7 (2.5) and 16.5 (0.9) pmol min-', respectively. The groups did not differ concerning the percentage of 1-vs 2-day chemotherapy course (chi2 = 0.12, P = 0.73). The mean cortisol excretion in patients receiving dexamethasone was 28.8 pmol min-' and in those receiving placebo 25.8 pmol min-' (t (40) = 0.68, P = 0.50). Evaluating the importance of age for the studied variables, patients were categorised by their median age (50 years). No significant association was found between patient's age, cortisol excretion, nausea intensity or emetic episodes (t (40)<1.12, chi2 (1)<0.54, ...

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Section: Discussionmentioning

confidence: 76%

“…The mechanism of action whereby corticosteroids affect nausea is by and large unknown although several central and peripheral pathways have been suggested (Fredrikson et al, 1992;Sagar, 1991). The exposure of emetogenic trigger sites to toxic stimuli may be reduced by modified capillary permeability of the CNS (Livera et al, 1985).…”

Section: Discussionmentioning

confidence: 99%

Endogenous cortisol exerts antiemetic effect similar to that of exogenous corticosteroids

Hursti

Fredrikson²,

Steineck³

et al. 1993

Br J Cancer

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“…25 25 -1992: Hursti et al. 1993 sugzested that the anti-inflammatorv effect of cortisol could have antiemetic properties bv preventing the release of serotonin in the gut or by sensitising peripheral receptors involved in the action of antiemetic drugs (Sagar. 1991).…”

Section: Discussionmentioning

confidence: 99%

Delayed chemotherapy-induced nausea is augmented by high levels of endogenous noradrenaline

Fredrikson

Hursti²,

Steineck³

et al. 1994

Br J Cancer

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“…15,16,17,18 (by stimulating release of endorphins, antagonizing prostaglandins and depleting tryptophan). 19,20 and reduced postoperative pain (by inhibiting the cyclooxygenase and lipoxygenase inflammatory pathways). 21 Griffies et al (1989).…”

Section: Review Of Literaturementioning

confidence: 99%

Role of Corticosteroids in Reduction of Post-Operative Oedema in Craniofaciomaxillary Surgery

Malhari¹,

Sharma²,

Rattan³

2016

jemds

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Postoperative oedema and ecchymosis are common complaints following facial plastic surgical procedures. The resulting oedema and ecchymosis is socially disturbing and sometimes frightening for the patient. Serious consequences of oedema include airway obstruction, conjunctival chemosis with possible transient loss of vision and pain. Perioperative administration of steroids has been used in Craniofaciomaxillary procedures with a belief that it reduces postoperative swelling and shortens time to recovery after surgery. Various perioperative regimens of systemic corticosteroid administration have been reported to result in a significant reduction in postoperative facial oedema following cranioplasty, orbital floor exploration, mandibular and maxillary osteotomy, facial plasty, hair transplant and rhinoplasty. A number of experimental animal studies have demonstrated decreased oedema in flap models or replants. However, several clinical studies evaluating the use of steroids perioperatively in a variety of orthognathic and facial surgical procedures have failed to provide concrete evidence for or against steroid usage. Proponents of steroid use (Nordstrom et al, Flood et al and Gurlek et al) claim, it decreases postoperative oedema, decreases ecchymosis, improves surgical outcome, reduces home convalescence, decreases hospital stay and causes euphoria. Opponents of steroid use (Munro et al, Rapaport et al, and Owsley et al) claim lack of evidence, serious complications like inhibition of Hypothalamic Pituitary-Adrenal axis, avascular necrosis of hip and humerus, alter blood sugar levels, increased risk of hypertension, increase in the incidence of wound infection and lack of cost effectiveness. A prospective double-blind study conducted to evaluate the role of Dexamethasone 8 mg intravenous administration and Triamcinolone 0.7 mg/kg administration at the end of procedure in reduction of postoperative facial oedema in Craniofaciomaxillary surgeries. Thirty-four consecutive patients were randomized to Dexamethasone, Triamcinolone administration and control group. Facial size was measured on POD1, POD2 and POD3. Facial oedema scores were derived from comparison of photographs on admission and 48 hrs. postoperatively. Findings were tabulated and statistically analysed. Following observations were noted. The duration of surgery and postoperative facial oedema did not correlate. We found that oedema was maximum in the periorbital region in all the three groups followed by oedema on forehead, malar and mandibular regions. We also observed that there was direct correlation between forehead and periorbital oedema. We observed that there was postoperative facial oedema on POD1, reached its peak on POD2 and then started declining within each group. The use of steroids either intravenous (8 mg Dexamethasone) or local infiltration (Triamcinolone 0.7 mg/kg) did not significantly reduce the postoperative facial oedema in our patient when compared to the control.

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The current role of anti-emetic drugs in oncology: a recent revolution in patient symptom control

Cited by 47 publications

References 143 publications

Endogenous cortisol exerts antiemetic effect similar to that of exogenous corticosteroids

Endogenous cortisol exerts antiemetic effect similar to that of exogenous corticosteroids

Delayed chemotherapy-induced nausea is augmented by high levels of endogenous noradrenaline

Role of Corticosteroids in Reduction of Post-Operative Oedema in Craniofaciomaxillary Surgery

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