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Nausea and vomiting after breast cancer surgery, and relationship with tumor receptor status

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Abstract

Background

Breast surgery is associated with frequent post-operative nausea and vomiting (PONV). Studies have suggested that hormonal status affects PONV. Estrogen has been implicated in many emetic syndromes. Estrogen receptor (ER) and progesterone receptor (PR) status in breast tissue are hormonally affected. Kakugawa et al., in 2007, found a clear trend toward higher serum level of estrone, estradiol, and dehydroepiandrosterone sulfate in post menopausal women with PR-positive cancer.

Purpose

To investigate the possibility of an association between ER and/or PR status of breast tumor and incidence of PONV after breast cancer surgery.

Methods

This observational study included 315 female patients undergoing major breast surgery. Relevant patient data, and intra-operative and postoperative details were noted. Incidence of PONV was noted using the PONV score. Patients were divided into two age groups: less than or equal to 50 years and more than 50 years of age. The ER and/or PR status of the patient was unknown to the investigator until the final analysis.

Results

Use of the chi-squared test revealed no association between ER and/or PR and total PONV. Patients below 50 years had higher incidence of total PONV (p = 0.023). In patients above 50 years, the incidence of PONV was higher in the ER-positive group (p = 0.018).

Conclusion

The incidence of PONV is higher for patients below 50 years of age. The positive association between ER positivity and PONV in patients above 50 years of age could be attributed to the altered hormonal milieu in these patients and should be investigated further.

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References

  1. Sadhasivam S, Saxena A, Kathirvel S, Kannan TR, Trikha A, Mohan V. The safety and efficacy of prophylactic ondansetron in patients undergoing modified radical mastectomy. Anesth Analg. 1999;89:1340–5.

    PubMed  CAS  Google Scholar 

  2. Beattie WS, Lindblad T, Buckley DN, Forrest JB. The incidence of post-operative nausea and vomiting in women undergoing laparoscopy is influenced by the day of menstrual cycle. Can J Anaesth. 1991;38(3):298–302.

    Article  PubMed  CAS  Google Scholar 

  3. Lagiou P, Tamimi R, Mucci LA, Trichopoulos D, Adami HO, Hsieh CC. Nausea and vomiting in pregnancy in relation to prolactin, estrogen, and progesterone: a prospective study. Obstet Gynecol. 2003;101:639–44.

    Article  PubMed  CAS  Google Scholar 

  4. Kakugawa Y, Minami Y, Tateno H, Inoue H, Fujiya T. Relation of serum levels of estrogen and dehydroepiandrosterone sulfate to hormone receptor status among postmenopausal women with breast cancer. Breast Cancer. 2007;14(3):269–76.

    Article  PubMed  Google Scholar 

  5. Layeeque R, Siegel E, Kass R, Henry-Tillman RS, Colvert M, Mancino A, Klimberg VS. Prevention of nausea and vomiting following breast surgery. Am J Surg. 2006;191:767–72.

    Article  PubMed  Google Scholar 

  6. Shousha S, Coady AT, Stamp T, James KR, Alaghband-Zadeh J. Oestrogen receptors in mucinous carcinoma of the breast: an immunohistological study using paraffin wax sections. J Clin Pathol. 1989;42:902–5.

    Article  PubMed  CAS  Google Scholar 

  7. Apfel C, Roewer N, Korttila K. How to study postoperative nausea and vomiting. Acta Anaesthesiol Scand. 2002;46:921–8.

    Article  PubMed  CAS  Google Scholar 

  8. Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, Hooper VD, Kovac AL, Kranke P, Myles P, Philip BK, Samsa G, Sessler DI, Temo J, Tramer MR, Kolk CV, Watcha M. Society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2007;105(6):1615–28.

    Article  PubMed  Google Scholar 

  9. Sharma S, Tandon VR, Mahajan A. Menopausal symptoms in urban women. JK Sci. 2007;9(1):13–7.

    Google Scholar 

  10. Pujol P, Daures JP, Thezenas S, Guilleux F, Rouanet P, Grenier J. Changing estrogen and progesterone receptor patterns in breast carcinoma during the menstrual cycle and menopause. Cancer. 1998;83(4):698–705.

    Article  PubMed  CAS  Google Scholar 

  11. Yang KP, Samaan NA. Reduction of estrogen receptor concentration in MCF-7 human breast carcinoma cells following exposure to chemotherapeutic drugs. Cancer Res. 1983;43:3534–8.

    PubMed  CAS  Google Scholar 

  12. Oktem O, Oktay K. Quantitative assessment of the impact of chemotherapy on ovarian follicle reserve and stromal function. Cancer. 2007;110(10):2222–8.

    Article  PubMed  CAS  Google Scholar 

  13. Bernstein L, Ross RK, Pike MC, Brown JB, Henderson BE. Hormone levels in older women: a study of post-menopausal breast cancer patients and healthy population controls. Br J Cancer. 1990;61:298–302.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We would like to thank Ms Rohini Hawaldar for all her help with the analysis of these data.

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Authors and Affiliations

  1. Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India

    Sumitra Ganesh Bakshi, Bipin Jibhkate & Raman Sareen

  2. Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India

    Rajan Badwe

  3. 1102, Gloriosa, Prin N.M. Kale Marg, Agar Bazar, Dadar, Mumbai, 400028, India

    Sumitra Ganesh Bakshi

Authors
  1. Sumitra Ganesh Bakshi
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  2. Bipin Jibhkate
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  3. Raman Sareen
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  4. Rajan Badwe
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Corresponding author

Correspondence to Sumitra Ganesh Bakshi.

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Bakshi, S.G., Jibhkate, B., Sareen, R. et al. Nausea and vomiting after breast cancer surgery, and relationship with tumor receptor status. J Anesth 26, 187–195 (2012). https://doi.org/10.1007/s00540-011-1274-5

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  • DOI: https://doi.org/10.1007/s00540-011-1274-5

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