Sleep protects against chemotherapy induced emesis

Abstract

BACKGROUND.We present a clinical trial to assess the hypothesis that chemotherapy related acute emesis is reduced when drugs are delivered while the patient is sleeping. METHODS.Adults without previous sleep disturbances or vomit inducing conditions who were going to receive their first courses of 100 mg/mz cisplatin were included. We reduced antiemetic prophylaxis consisting of ondansetron and dexamethasone in subsequent groups of patients. RESULTS.Twenty-one individuals were needed to decrease the antiemetic prophylaxis to zero. Significant vomiting was observed only when prophylaxis was abolished but not in previous steps employing negligible doses of prophylaxis. CONCLUSIONS.Our data show that when cisplatin is administered during sleep, the reduction of antiemetic prophylaxis is not followed by the expected increase in emetic toxicity. This antiemetic property of sleep is, as far as we know, unassessed in a controlled way. Further study of the clinical utility of this method in the prevention of chemotherapy related emesis is indicated.

Systematic review of sleep disorders in cancer patients: can the prevalence of sleep disorders be ascertained?

“…When selecting participants for studies, potentially important inclusion and exclusion criteria for sleep were rarely addressed. For example, only 19.7% ( n = 50) of the studies reviewed excluded for previous sleep disorder or current treatment of sleep disorders.…”

“…The 254 articles were mainly from the United States (n = 145, 57.5%) [3-7, 10-12, 14, 31-162], United Kingdom/Europe (n = 43, 16.9%) [8,, and Canada (n = 25, 9.8%) [16,. Very few were published during the 1980s (n = 4, 1.6%) [78,82,128,135] or 1990s (n = 16, 7.1%) [10,14,43,46,50,56,95,104,110,115,121,189,199,208,212,229], with most published in 2000 or later (n = 233, 91.3%) [3-8, 11, 12, 15, 16, 31-42, 44-49, 51-55, 57-75, 77, 79-81, 83-85, 87-94, 96-103, 105-109, 111-114, 116-120, 122-127, 129-134, 136-188, 190-198, 200-207, 209-211, 213-228, 230-269]. Quantitative descriptive studies were most common (n = 186, 73.6%), [3-8, 11, 12, 14-16, 31, 32, 34, 37, 38, 40, 43-46, 48-50, 54-63, 67-76, 78, 80, 82, 84-101, 103-108, 110-116, 118-123, 126, 129, 130, 132, 133, 135-140, 142-146, 148, 150, 151, 154, 155, 158-160, 162, 163, 165, 168-171, 173-177, 181-185, 188, 191, 194-199, 202-209, 211, 213-215, 217-221, 223, 224, 227-233, 235, 237, 239-243, 245-249, 251-255, 257, 259, 260, 263, 265-269] followed by intervention studies (n = 58, 22.8%), [35, 36, 38, 39, 41, 42, 47, 51-53, 64, 65, 77, 81, 83, 102, 109, 113, 117, 124, 127, 128, 131, 134, 141, 147, 149, 153, 156, 157, 161, 164, 167, 172, 178-180, 186, 187, 189, 190, 193, 201, 210, 216, 222, 225, 226, 234, 238, 244, 250, 256, 258, 261, 262, 264] qualitative studies (n = 7, 2.8%) [66,79,152,166,192,200,…”

“…Very few were published during the 1980s ( n = 4, 1.6%) or 1990s ( n = 16, 7.1%) , with most published in 2000 or later ( n = 233, 91.3%) …”

How do we manage patients with refractory or breakthrough emesis?

“…Complete remission was observed in 90% and 80% of the patients, respectively, during the first and second propofol-assisted cycles [12]. This observation can be connected with the fact that patients treated during their sleep are much less prone to nausea and vomiting [13].…”

Consensus regarding multiple day and rescue antiemetic therapy

“…Lorazepam is the drug that has most frequently been used in this way, especially in the pre-setron era. In a recent paper describing a study in which cisplatin was administered during sleep [6], prophylactic antiemetic treatment consisted of dexamethasone and ondansetron. In a phase I-like setting, antiemetic treatment was reduced in various steps in those patients who slept.…”