Antipsychotic medication relieves chemo-related nausea
New research presented Wednesday highlights drugs to make cancer therapy easier but also underscores the difficulties that patients may encounter after treatment.
Joel Salcido for USA TODAY
Renee Nicholas, 37, had a double mastectomy after being diagnosed with cancer four years ago.
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A commonly used schizophrenia drug, Zyprexa, reduced the number of patients suffering from chemotherapy-related nausea and vomiting by more than half, according to a study of 80 patients presented in advance of the annual meeting of the American Society of Clinical Oncology.
The study focused on patients getting a heavy, triple-drug chemo combination, during which vomiting and nausea are very common, even among patients getting the best possible anti-nausea medications.
In the new study, led by Rudolph Navari of the Indiana University School of Medicine-South Bend, 68% of patients randomly assigned to be treated with a standard drug called Reglan, or metoclopramide, ended up vomiting, compared with 29% of those assigned to take Zyprexa, sold generically as olanzapine.
About 76% of those taking Reglan still became nauseated, compared with 33% of those taking Zyprexa, the study says. Patients took the drugs orally for three days, Navari says. While taking Zyprexa long-term can cause side effects, such as weight gain, doctors didn't note any major problems in patients taking this short dose, he says.
Nausea and vomiting are serious problems for many cancer patients, even causing some to stop taking their medications, says Sandra Swain, president-elect of ASCO. The group's annual meeting will take place June 1-4 in Chicago. For others, the side effects disrupt their lives and make it hard to work or take care of their families.
Swain says "this is a huge advance" that ranks alongside high-tech advances in drugs and so-called "targeted" therapies. "Even in this era of 'precision medicine,' we are still reminded that we need to improve the patient experience."
Chemotherapy causes nausea and vomiting in a different way than a stomach virus, says Andrew Putnam, an assistant professor of oncology and medicine at Georgetown Lombardi Comprehensive Cancer Center. Instead of upsetting the digestive tract, chemo activates the brain's "vomiting center," Putnam says. That's why an antipsychotic drug such as Zyprexa, which works on the brain, is able to help. He's recently tried prescribing it to his patients, with good results.
Breast cancer survivor Renee Nicholas, 37, says the nausea that accompanied her therapy was debilitating. "I tried every anti-nausea drug available," she says. "I even tried acupuncture once or twice a week."
Another study presented Wednesday, however, shows that doctors haven't made as much progress as they'd like.
Many primary care doctors — and even some oncologists — aren't informed about important health issues affecting cancer survivors, according to a study by Larissa Nekhlyudov of Harvard Medical School.
While cancer patients are typically seen by specialists during treatments, they often return to their family doctors or other generalists when they finish therapy, says Michael Link, ASCO's current president.
But finishing cancer therapy doesn't mean that patients are care-free, Link says. Cancer treatments can be highly toxic, saving lives at a punishing cost to the heart, bones and even the brain. Some therapies can push patients into early menopause, while others can cause new cancers.
Because patients are likely to be seen by their primary care doctors when these problems crop up, it's important that generalists know how to watch for these complications and monitor patients, Nekhlyudov says.
Her results show awareness was low:
• Only 15% to 17% of primary care doctors knew that a common type of chemo, cyclophosphamide, sold under the brand name Cytoxan, can cause premature menopause and second cancers.
• About 22% of primary care doctors knew that another drug, oxaliplatin, also sold as Eloxatin, can cause nerve problems and pain in the fingers and other extremities.
• About 27% knew that the drug paclitaxel, or Taxol, can cause these nerve problems as well.
• And 55% knew that the drug doxorubicin, or Adriamycin, can damage the heart muscle.
Yet even oncologists were unaware of some side effects, correctly identifying these complications 62% to 97% of the time, the study shows.
The study illustrates why it's important for every cancer patient to receive a treatment summary and survivorship plan when finishing active therapy, Link says. Those documents can concisely inform future doctors about which drugs, surgeries or radiation therapies patients have undergone, and which screening tests or other care they need to stay healthy. The study also reinforces the need to expand the use of electronic medical records to make sharing this information easier.
Nicholas, who was 33 when she was diagnosed with breast cancer, is thankful that her treatment went well but knows that she's at risk for future complications, such as heart problems related to her chemo and bone loss associated with another long-term breast cancer drug. And because she's so young, she has a long time ahead of her for problems to develop. Nicholas says she's grateful that her doctors monitor her so closely, checking her heart regularly and measuring her bone density once a year.
But overall, Nicholas says these are good problems to have, because they show she's survived a potentially lethal disease.
"This is really a problem created by our success," Link says. "There are now 12 million cancer survivors who are a testament to our success in cancer care."
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