Anti-Nausea Drug May Boost Survival for Some Cancer Patients
Patients who undergo surgery for certain types of cancer may have better short-term survival if they receive a particular anti-nausea drug, a preliminary study suggests.
Among more than 74,000 patients who had cancer surgery, researchers found that those who received the drug -- called dexamethasone -- were less likely to die in the next 90 days.
The vast majority of all patients survived that long. But those given dexamethasone during surgery were about one-third less likely to die, the study found.
Dexamethasone has gained attention during the pandemic because it was shown to help some patients seriously ill with COVID-19. But the medication, an anti-inflammatory corticosteroid, has a long history of use.
When given during surgery, it helps control postoperative nausea and vomiting.
The new findings suggest dexamethasone might improve short-term survival after some cancer surgeries, said senior researcher Dr. Maximilian Schaefer, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
But to prove that, he said, there would need to be a clinical trial where patients with these cancers were randomly assigned to either receive dexamethasone during surgery or not.
"I think these findings lay the groundwork for clinical trials," Schaefer said.
He reported the findings Saturday at the annual meeting of the American Society of Anesthesiologists (ASA), in San Diego. Studies presented at meetings are generally considered preliminary until they are published in a peer-reviewed journal.
This study is not the first to look at whether giving dexamethasone during cancer surgery is associated with patients' short-term survival. Several have investigated the question and have come to mixed conclusions depending on the type of cancer -- suggesting no effect, a survival benefit, or a higher risk of death.
In theory, dexamethasone could have both positive and negative effects on survival. The drug, Schaefer said, has been shown to inhibit tumor growth in the lab, but it also suppresses the immune system.
In their study, Schaefer's team found a survival benefit specifically among patients with cancers considered "non-immunogenic." That means the cancer does not elicit a strong immune response, and the immune system does not play a major role in controlling its growth.
Those cancers include tumors of the breast, uterus, ovaries, esophagus, pancreas, thyroid, bones and joints.
Among patients who had surgery for those cancers, the study found, about 0.8% of those given dexamethasone died within 90 days. That compared with just over 3% of those who did not receive the anti-nausea drug.
Still, it's not clear that dexamethasone is responsible for the benefit, said Dr. Juan Cata, a member of the ASA's Committee on Research, and an associate professor of anesthesiology at MD Anderson Cancer Center in Houston.
"This is a very well-done study," said Cata, who was not involved in the research.
But, he said, the study was observational: It looked at records from 74,058 patients who had cancer surgery between 2005 and 2020. And in any observational study, Cata said, it's difficult to account for all the differences between patients who receive a treatment and those who do not.
Schaefer and his team weighed the variables they could, such as patients' age (dexamethasone is often given to younger patients), sex, indicators of their overall health and whether they'd had chemotherapy before surgery. And patients who received dexamethasone were still one-third less likely to die within 90 days of surgery.
There could, though, be other differences at work, too, according to Cata. He noted that dexamethasone patients were, on average, in surgery significantly longer -- and the question is why.
There's also the question of what caused patients' deaths. Cata said that deaths within 90 days of surgery are often related to postoperative complications rather the cancer itself.
While the findings do not prove cause and effect, Schaefer said they do have implications for medical practice. They can give anesthesiologists "more confidence," he said, in giving dexamethasone to patients undergoing surgery for non-immunogenic cancers.
Cata said the drug is an effective and low-cost way to help prevent post-surgery nausea and vomiting -- and that alone is meaningful to patients.
The study received no outside funding, and none of the researchers reported financial conflicts of interest.
The American Cancer Society has more on nausea related to cancer treatment.
SOURCES: Maximilian Schaefer, MD, PhD, director, Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; Juan Cata, MD, associate professor, anesthesiology and perioperative medicine, University of Texas MD Anderson Cancer Center, Houston, and member, American Society of Anesthesiologists Committee on Research; American Society of Anesthesiologists meeting, San Diego, presentation, Oct. 9, 2021
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