Intraoperative dexamethasone improves survival of cancer patients

Cancer patients have improved survival if given dexamethasone during tumour removal surgery—especially those with breast, ovary, uterus or cervical cancer. Dexamethasone is commonly administered at the start of surgery to prevent nausea and vomiting, but recent studies have suggested it may play a role in slowing some types of tumour growth, said Dr. Maximilian Schaefer, assistant professor of anaesthesia at Harvard Medical School. He spoke at the Anesthesiology 2021 annual meeting and presented findings of a large retrospective study comparing 90-day survival between patients given surgical dexamethasone to those who did not. “Ours is the first large study to show that for a wide variety of cancers where the immune system does not play a major role, the positive effects (of dexamethasone) seem to predominate,” he said. Read: Can dogs really help detect cancer? The drug is not given to everyone, it depends on whether the patient is considered to be at risk of nausea and vomiting post-surgery. “It’s at the discretion of the anesthesiologist, and sometimes other antiemetics are used instead,” Dr. Schaefer told the Medical Post in an interview. A previous study he coauthored in 2018 found intraoperative use of dexamethasone was associated with improved survival in pancreatic cancer patients. Other studies have suggested the drug has antitumour activity and is used as a chemotherapeutic agent mostly in hematological malignancies. “It is mostly in in vitro studies that show that dexamethasone might inhibit tumour growth, or can inhibit tumour and cancer growth,” but that it may help cancer patients is a compelling concept, he said. The drug also suppresses parts of the immune system, which could also potentially influence cancer growth. The researchers hypothesized that intraoperative dexamethasone would decrease mortality in patients undergoing cancer surgery. The study looked at a wide variety of cancers. Dexamethasone was not continued after surgery. Data pertaining to patients who underwent surgery for the removal of any type of solid malignancy were attained from the Beth Israel Deaconess Medical Center (between 2005 and 2020) and the Massachusetts General Hospital (between 2007 and 2015). The primary outcome was mortality within 90 days after surgery. Data for 74,058 adult patients were used. A total of 25,178 (34.0%) of the patients received intraoperative dexamethasone with a mean dose of 7.0 mg. Of this group, 25.7% were male, had an average age of 56 years, and average duration of surgery of 152 minutes. Of this group, 209 (0.83%) died within 90 days after surgery. A total of 48,880 patients did not receive intraoperative dexamethasone. This group consisted of more men, 46.4%, had an average age of 63 years, and a shorter average duration of surgery at 95 minutes. There were also more patients with a history of hypertension (40% compared to 25.1% in the dexamethasone group). Of this group, 3.2% (1,543) died within 90 days of surgery. Dr. Schaefer noted that patients who are usually given dexamethasone are younger with longer surgery times. Being female and a non-smoker are considered increased risk factors for nausea and vomiting. The researchers adjusted for patient demographics, comorbidities, intraoperative factors as well as preoperative steroid administrations and chemotherapies. Even with these adjustments, intraoperative administration of dexamethasone was associated with a statistically significantly greater decreased risk of 90-day mortality when compared to the no-dexamethasone patients, Dr. Schaefer said. Age was taken into account in the analyses, and when younger age was adjusted for, those who received the drug still had a 21% reduced risk of dying within one year after surgery. The effect of improved 90-day survival was greatest in patients who underwent surgery for non-immunogenic cancers, primarily sarcomas, and cancers of the breast, uterus, ovary, esophagus, pancreas, thyroid, bones and joints. Dexamethasone interacts with the immune system, and it is known that for certain types of tumor, the control of the tumor growth by the immune system may be important. “What dexamethasone does for the immune system is it suppresses it. So, for these types of tumours, where the immune system is important, this might outbalance the effect—the direct suppressive effect on the tumour,” he said. “We looked into the differential effect in what we call immunogenic and non-immunogenic tumors. We saw that only in patients where the immune system is not important to control cancer growth, that dexamethasone had an effect on the mortality outcome,” he said. Patients with other types of cancers were otherwise comparable between the dexamethasone and no-dexamethasone groups. More studies need to be conducted looking at specific cancers and tumour types, he said. “Interesting data and compelling because dexamethasone is inexpensive and readily available,” said Dr. Erin Powell, a medical oncologist and associate professor of medicine at Memorial University. She was not involved in the study, but also noted that “this is not a randomized study and more investigation is needed.”

Intraoperative dexamethasone improves survival of cancer patients

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