Chronic Hiccups May Represent Another Side Effect from Chemotherapy in Patients With Cancer

Hiccups lasting for days, weeks or longer may be an underreported side effect of chemotherapy in patients with cancer, and more awareness — and an effective way to manage them — are needed, according to a recent survey.

Findings from the survey, which were published in the American Journal of Hospice and Palliative Medicine, also demonstrated hiccups may increase fatigue, anxiety and sleep disturbances among patients.

CURE® spoke with Heidi L. Wagner, chief operating officer of Meter Health, to learn more about the survey that she and her team conducted, why managing hiccups in patients with cancer is important and the importance of speaking up about potential side effects to cancer treatment.

CURE®: Can you go into a little bit into why hiccups are common in patients with cancer?

Wagner: We do kind of have a good sense of why (some patients) ended up with a bad case of hiccups.

Dr. Amina Jatoi from Mayo (Clinic) … she's done a lot of looking into why patients with cancer have hiccups, and the best thing that we can tell right now is we're not sure exactly why. But we do know that patients that are taking dexamethasone, which is often part of a chemo regimen, tend to have a higher incidence of hiccups. And since dexamethasone is very commonly used, we think that's part of the issue. But taking that out of the regimen is not an option.

How often do chronic hiccups occur?

(With this survey), we have focused, first and foremost, on patients with cancer, but it turns out that there are many, many health issues where hiccups are a side effect, so to speak. They're not just like when you and I get them; (these are) hiccups that last for days, weeks, sometimes even longer.

And then there also what's called intractable hiccups, which are those that that seemingly never go away, and a very, very, very, very small percentage of the population would experience them. … But in terms of other health conditions where patients end up getting hiccups, anything longer than 48 hours is considered problematic.

When some of these patients have chronic hiccups, is there a way to manage them?

We've convened a group of clinicians that are particularly interested in this, and we had an advisory board (meeting) last April. This is anecdotal, … but a lot of (patients) actually won't raise hiccups as being part of their issue. The physician that we spoke to said that they don't often — although they were going to start — really asking about it, because it's not something that's typically raised.

If you think about particularly oncology patients that are undergoing chemotherapy regimens, they have many things that they're worried about and don't feel well, so this isn't often something that gets raised to the physician’s consciousness. But when it is, there's a number of products that are used off-label to try and manage hiccups. Gabapentin is an example. There are a couple of (medications) that (oncologists) use, but basically, they're not very effective. One of our advisors said that we're, in essence putting them to sleep, we’re not really (controlling) the hiccups, we ended up dulling their senses — sedating them, that's the word that they used. There’s nothing effective. That's one of the things that came out in the survey.

That's why we wanted to do the survey, which is (to determine) how big of an issue is this really? And although I can't really give you any firm numbers yet on prevalence or incidence, we were more interested in finding out whether physicians were aware, and what was the burden on their patient population. What did they think of their existing remedies? What was their interest in something new that was specific for hiccups? Currently there's nothing on the market that is specifically for hiccups.

What do you think the findings from the survey add to the knowledge base? And how do you think they'll benefit patients?

I think our findings were somewhat confirmatory to what our gut views were. … We wanted to survey 100 health care providers, physicians, as well as nurses, nurse practitioners and physician assistants. And ultimately, we got 90.

I also was surprised at how many physicians actually responded; I assumed that more nurses and nurse practitioners (would respond) versus the physicians themselves. But that was not the case.

We had filters, so they basically had to have seen a fair number of patients within the last six months before they could go on to answer the questions because we wanted to make sure that their experience was relatively recent.

What was really interesting was that 89% of those surveyed agreed that hiccups can be a significant problem for (some) cancer patients; 82% overall agree that a new treatment option was needed.

When we were questioning about the burden of the hiccups to their actual patients, 68% felt that their patients had complained of stress and anxiety; 65% of fatigue; problem sleeping, that was about 61%.

But the thing that really struck me was that 78% of the respondents said that for those patients that had chemo-induced hiccups, it was as bad if not worse than chemo-induced nausea and vomiting. We don't even hesitate to try and address a patient's nausea and vomiting. That's considered awful; nobody wants that. But we're not addressing what is yet another pretty serious problem for them, and that's the hiccups.

From my perspective, I think that's a positive for patients. Anything that helps us elevate this in terms of awareness of hiccups as being problematic in this context. (This is also helpful for) our work going forward and using this to try and action some of these (into) clinical data to try and address this.

What advice would you give to patients who may be experiencing chemotherapy-induced hiccups?

I would hope that (patients) would start speaking up more so that this can become a better, more well-understood burden of their oncology treatment because (cancer teams) are motivated to treat other coincident issues. So we should be looking at this as well.

I'm really hopeful that that patients will start speaking up more about the burden.

We really do need (cancer clinicians) to understand that (findings from surveys like these are) not just (to inform) patients, but for the treatment community, that this is something that occurs relatively frequently and should be addressed.

This interview has been edited for clarity and conciseness

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