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Guideline concordant care for prevention of acute chemotherapy-induced nausea and vomiting in children, adolescents, and young adults

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Abstract

Purpose

Prescribing guideline-recommended anti-emetics is an effective strategy to prevent CINV. However, the rate of guideline-concordant care is not well-understood. The purpose of this study was to describe the proportion of pediatric, adolescent, and young adult patients receiving HEC or MEC who received guideline-concordant antiemetic prophylaxis for acute CINV and to identify potential predictors of guideline-concordant antiemetic prophylaxis.

Methods

Using electronic health record data from 2016 through 2018, a retrospective single-institution cohort study was conducted to investigate how often patients less than 26 years of age receiving moderately or highly emetogenic chemotherapy receive guideline-concordant prophylaxis for acute CINV. Guideline-concordant care was defined according to guidelines from the Pediatric Oncology Group of Ontario for patients < 18 years and the American Society of Clinical Oncology for those ≥ 18 years. Independent variables included: sex, age, insurance status, race, ethnicity, cancer type, chemotherapy regimen, clinical setting, chemotherapy emetogenicity, and patient location. Predictors of receiving guideline-concordant care were determined using multiple logistic regression.

Results

Of 180 eligible patients, 65 (36.1%) received guideline-concordant care. In multivariable analysis, being treated in adult oncology setting (aOR 14.3, CI95 5.3–38.6), with a cisplatin-based regimen (aOR 3.5, CI951.4–9.0), solid tumor diagnosis (aOR 2.2, CI95 1.0–4.8), and commercial insurance (aOR 2.4, CI95 1.1–5.2) were associated with significantly higher likelihood of receiving guideline-concordant care.

Conclusions

Multi-level factors were associated with receiving guideline concordant care for prevention of CINV in children, adolescents, and young adults receiving emetogenic chemotherapy. These findings can inform current efforts to optimize implementation strategies for supportive care guidelines.

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Funding

M.B. was supported by the Reducing Health Disparities through Informatics (RHeaDI) training grant (T32NR007969) funded by NINR, the Training Program in Cancer-Related Population Sciences (NCI T32 CA094061), and a Doctoral Degree Scholarship in Cancer Nursing, DSCN-18-068-01, from the American Cancer Society. R.S. was supported by the National Institute of Nursing Research of the National Institutes of Health under award number K24NR018621. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. School of Nursing, Columbia University, New York, NY, 10032, USA

    Melissa Beauchemin & Rebecca Schnall

  2. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, 10032, USA

    Melissa Beauchemin & Dawn L. Hershman

  3. Columbia University Mailman School of Public Health, 722 W. 168th Street 7th Floor, New York, NY, 10032, USA

    Melissa Beauchemin

  4. The Hospital for Sick Children, Toronto, Canada

    Lillian Sung & L. Lee Dupuis

  5. Department of Biomedical Informatics, Columbia University, New York, NY, 10032, USA

    Chunhua Weng

  6. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada

    L. Lee Dupuis

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  1. Melissa Beauchemin
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Correspondence to Melissa Beauchemin.

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Beauchemin, M., Sung, L., Hershman, D.L. et al. Guideline concordant care for prevention of acute chemotherapy-induced nausea and vomiting in children, adolescents, and young adults. Support Care Cancer 28, 4761–4769 (2020). https://doi.org/10.1007/s00520-020-05310-6

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