title: Nausea and vomiting after breast cancer surgery, and relationship with tumor receptor status.
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.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India. sumitrabakshi@yahoo.in
authors.forename: Sumitra Ganesh
authors.initials: SG
authors.lastname: Bakshi
authors.forename: Bipin
authors.initials: B
authors.lastname: Jibhkate
authors.forename: Raman
authors.initials: R
authors.lastname: Sareen
authors.forename: Rajan
authors.initials: R
authors.lastname: Badwe
mesh_terms: D001943:Breast Neoplasms / Q000378:metabolism* / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000209:etiology* / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
references.citation: Anesth Analg. 2007 Dec;105(6):1615-28, table of contents
references.pmid: 18042859
references.citation: Obstet Gynecol. 2003 Apr;101(4):639-44
references.pmid: 12681864
references.citation: Can J Anaesth. 1991 Apr;38(3):298-302
references.pmid: 1828016
references.citation: Breast Cancer. 2007;14(3):269-76
references.pmid: 17690503
references.citation: Acta Anaesthesiol Scand. 2002 Sep;46(8):921-8
references.pmid: 12190791
references.citation: Cancer Res. 1983 Aug;43(8):3534-8
references.pmid: 6861126
references.citation: Cancer. 1998 Aug 15;83(4):698-705
references.pmid: 9708933
references.citation: J Clin Pathol. 1989 Sep;42(9):902-5
references.pmid: 2551929
references.citation: Br J Cancer. 1990 Feb;61(2):298-302
references.pmid: 2138030
references.citation: Cancer. 2007 Nov 15;110(10):2222-9
references.pmid: 17932880
references.citation: Anesth Analg. 1999 Dec;89(6):1340-5
references.pmid: 10589605
references.citation: Am J Surg. 2006 Jun;191(6):767-72
references.pmid: 16720146