Side effects associated with the use of dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy

J Vardy, K S Chiew, J Galica, G R Pond, I F Tannock, J Vardy, K S Chiew, J Galica, G R Pond, I F Tannock

Abstract

The role of dexamethasone to reduce delayed emesis following highly emetogenic chemotherapy is proven, but there is less evidence of benefit after mild-moderately emetogenic regimens. Here, we develop and evaluate a Dexamethasone Symptom Questionnaire (DSQ) to assess the side effects of dexamethasone in the week after patients receive moderately emetogenic chemotherapy. The DSQ was first optimised with the aid of a focus group. Sixty patients receiving oral dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy for cancer completed and then evaluated the DSQ. Patients reported that the DSQ was clearly worded and addressed items important to them. Patients receiving dexamethasone reported moderate-severe problems with insomnia (45%), indigestion/epigastric discomfort (27%), agitation (27%), increased appetite (19%), weight gain (16%) and acne (15%) in the week following chemotherapy. The side effects of dexamethasone may outweigh its benefits when used with moderately emetogenic chemotherapy. A randomised, double-blind crossover trial is underway to determine the effect of dexamethasone on nausea and vomiting, and the impact of side effects of dexamethasone and of nausea and vomiting on quality of life.

References

    1. (1992) Ondansetron+dexamethasone vs metoclopramide+dexamethasone+diphenhydramine in prevention of cisplatin-induced emesis. Italian Group for Antiemetic Research. Lancet 340: 96–99
    1. (1995) Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. The Italian Group for Antiemetic Research. N Engl J Med 332: 1–5
    1. (1997a) NCCN antiemesis practice guidelines. Oncology (Huntingt) 11: 57–89
    1. (1997b) Ondansetron versus metoclopramide, both combined with dexamethasone, in the prevention of cisplatin-induced delayed emesis. The Italian Group for Antiemetic Research. J Clin Oncol 15: 124–130
    1. (1998) Prevention of chemotherapy- and radiotherapy-induced emesis: results of Perugia Consensus Conference. Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC). Ann Oncol 9: 811–819
    1. (1999) ASHP therapeutic guidelines on the pharmacologic management of nausea and vomiting in adult and pediatric patients receiving chemotherapy or radiation therapy or undergoing surgery. Am J Health Syst Pharm 56: 729–764
    1. (2001) ESMO recommendations for prophylaxis of chemotherapy-induced nausea and vomiting (NV). Ann Oncol 12: 1059–1060
    1. Aapro MS, Plezia PM, Alberts DS, Graham V, Jones SE, Surwit EA, Moon TE (1984) Double-blind crossover study of the antiemetic efficacy of high-dose dexamethasone versus high-dose metoclopramide. J Clin Oncol 2: 466–471
    1. Adams M, Soukop M, Barley V, Yosef H, Anderson H, Boesen E, Trask CW, Rufenacht E, de Bruijn KM (1995) Tropisetron alone or in combination with dexamethasone for the prevention and treatment of emesis induced by non-cisplatin chemotherapy: a randomized trial. Anticancer Drugs 6: 514–521
    1. Ballatori E, Roila F, De Angelis V, Ciccarese G, Palladino MA, Tonato M, Del Favero A, Herrstedt J, Dicato M, du Bois A, Hesketh P, Kris M, Gralla RJ (1997) Clinical and methodological issues in antiemetic therapy: a worldwide survey of experts’ opinions. Multinational Association of Supportive Care in Cancer. Support Care Cancer 5: 269–273
    1. Cassileth PA, Lusk EJ, Torri S, DiNubile N, Gerson SL (1983) Antiemetic efficacy of dexamethasone therapy in patients receiving cancer chemotherapy. Arch Intern Med 143: 1347–1349
    1. Edwards AL (1983) Techniques of Attitude Scale Construction. New York, NY: Irvington Publishers
    1. Feinstein AR (1983) An additional basic science for clinical medicine: iv. The development of clinimetrics. Ann Internal Med 99: 843–848
    1. Gralla R (1997) Anti-emesis with cancer chemotherapy. Eur J Cancer 33: S63–S67
    1. Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hesketh PJ, Chinnery LW, Clark-Snow R, Gill DP, Groshen S, Grunberg S, Koeller JM, Morrow GR, Perez EA, Silber JH, Pfister DG (1999) Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. American Society of Clinical Oncology. J Clin Oncol 17: 2971–2994
    1. Herrstedt J, Aapro MS, Smyth JF, Del Favero A (1998) Corticosteroids, dopamine antagonists and other drugs. Support Care Cancer 6: 204–214
    1. Hesketh PJ, Harvey WH, Harker WG, Beck TM, Ryan T, Bricker LJ, Kish JA, Murphy WK, Hainsworth JD, Haley B (1994) A randomized, double-blind comparison of intravenous ondansetron alone and in combination with intravenous dexamethasone in the prevention of high-dose cisplatin-induced emesis. J Clin Oncol 12: 596–600
    1. Ioannidis JP, Hesketh PJ, Lau J (2000) Contribution of dexamethasone to control of chemotherapy-induced nausea and vomiting: a meta-analysis of randomized evidence. J Clin Oncol 18: 3409–3422
    1. Kirshner B, Guyatt G (1985) A methodological framework for assessing health indices. J Chronic Dis 38: 27–36
    1. Koeller JM, Aapro MS, Gralla RJ, Grunberg SM, Hesketh PJ, Kris MG, Clark-Snow RA (2002) Antiemetic guidelines: creating a more practical treatment approach. Support Care Cancer 10: 519–522
    1. Kris MG, Gralla RJ, Tyson LB, Clark RA, Cirrincione C, Groshen S (1989) Controlling delayed vomiting: double-blind, randomized trial comparing placebo, dexamethasone alone, and metoclopramide plus dexamethasone in patients receiving cisplatin. J Clin Oncol 7: 108–114
    1. Latreille J, Stewart D, Laberge F, Hoskins P, Rusthoven J, McMurtrie E, Warr D, Yelle L, Walde D, Shepherd F, Dhaliwell H, Findlay B, Mee D, Pater J, Zee B, Johnston D (1995) Dexamethasone improves the efficacy of granisetron in the first 24 h following high-dose cisplatin chemotherapy. Support Care Cancer 3: 307–312
    1. Lofters WS, Pater JL, Zee B, Dempsey E, Walde D, Moquin JP, Wilson K, Hoskins P, Guevin RM, Verma S, Navari R, Krook JE, Hainsworth J, Palmer M, Chin C (1997) Phase III double-blind comparison of dolasetron mesylate and ondansetron and an evaluation of the additive role of dexamethasone in the prevention of acute and delayed nausea and vomiting due to moderately emetogenic chemotherapy. J Clin Oncol 15: 2966–2973
    1. Osoba D (1997) Current applications of health-related quality-of-life assessment in oncology. Support Care Cancer 5: 100–104
    1. Osoba D, Zee B, Warr D, Latreille J, Kaizer L, Pater J (1997) Effect of postchemotherapy nausea and vomiting on health-related quality of life. The Quality of Life and Symptom Control Committees of the National Cancer Institute of Canada Clinical Trials Group. Support Care Cancer 5: 307–313
    1. Roila F, Tonato M, Ballatori E, Del Favero A (1996) Comparative studies of various antiemetic regimens. Support Care Cancer 4: 270–280
    1. Roila F, Tonato M, Cognetti F, Cortesi E, Favalli G, Marangolo M, Amadori D, Bella MA, Gramazio V, Donati D, Ballatori E, Del Favero A (1991) Prevention of cisplatin-induced emesis: a double-blind multicenter randomized crossover study comparing ondansetron and ondansetron plus dexamethasone. J Clin Oncol 9: 675–678
    1. Roila F, Warr D, Clark-Snow RA, Tonato M, Gralla RJ, Einhorn LH, Herrstedt J (2005) Delayed emesis: moderately emetogenic chemotherapy. Support Care Cancer 13: 104–108
    1. Rusthoven JJ, Osoba D, Butts CA, Yelle L, Findlay H, Grenville A (1998) The impact of postchemotherapy nausea and vomiting on quality of life after moderately emetogenic chemotherapy. Support Care Cancer 6: 389–395
    1. Smith DB, Newlands ES, Rustin GJ, Begent RH, Howells N, McQuade B, Bagshawe KD (1991) Comparison of ondansetron and ondansetron plus dexamethasone as antiemetic prophylaxis during cisplatin-containing chemotherapy. Lancet 338: 487–490
    1. Smyth JF, Coleman RE, Nicolson M, Gallmeier WM, Leonard RC, Cornbleet MA, Allan SG, Upadhyaya BK, Bruntsch U (1991) Does dexamethasone enhance control of acute cisplatin induced emesis by ondansetron? BMJ 303: 1423–1426
    1. Warr D (1997) Standard treatment of chemotherapy-induced emesis. Support Care Cancer 5: 12–16

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera