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Vomiting Despite Adherence to Guidelines: Suboptimal Control of Vomiting in Pediatric Cancer Patients
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  • Rotem Fishel Ben-Kenan,
  • Lily Sandblom,
  • M'hamed Temkit,
  • Alexandra Walsh
Rotem Fishel Ben-Kenan
Phoenix Children's Hospital Center for Cancer and Blood Disorders
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Lily Sandblom
The University of Arizona College of Medicine Phoenix
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M'hamed Temkit
Phoenix Children's Hospital Center for Cancer and Blood Disorders
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Alexandra Walsh
Phoenix Children's Hospital Center for Cancer and Blood Disorders

Corresponding Author:awalsh@phoenixchildrens.com

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Abstract

Objective: Vomiting is a common and distressing acute side effect of chemotherapy, negatively impacting quality of life, nutritional status and the ability of patients to tolerate further treatment. Standardized guidelines have been developed for anti-emetic regimens to improve control of nausea and vomiting. We aimed to determine the benefit of adherence to clinical practice guidelines (CPGs) on complete control of vomiting during chemotherapy in newly diagnosed pediatric patients with cancer. Methods: An electronic dashboard of pediatric patients newly diagnosed with cancer at Phoenix Children’s Hospital between August 2019 and January 2021 and receiving their first cycle of chemotherapy was utilized to monitor chemotherapy regimen, anti-emetic medications and vomiting episodes. Blocks were classified as guideline inconsistent, guideline-consistent, or guideline-consistent PLUS if additional prophylactic anti-emetic medications were utilized. We identified patients with complete control of vomiting, defined as no vomiting and no additional anti-emetics needed. Results: Among 136 patients, 29% received guideline inconsistent care, 37% received guideline-consistent care, and 34% received guideline-consistent PLUS care. 48% achieved complete control of vomiting. Older patients (p<0.0001) and higher emetogenicity chemotherapy (p=0.0003) were more likely to receive guideline-consistent or guideline-consistent PLUS therapy. With guideline-consistent and consistent-PLUS grouped together, diagnosis also was associated with improved adherence to CPGs (p=0.022). Multivariate analysis showed that patients more likely to receive guideline-consistent care were of older age (OR 1.11, p=0.016) and solid tumor patients (OR 5.59, p=0.028). Conclusions: Despite high rates of CPG adherence, complete control of vomiting remains sub-optimal which highlights the need for novel and/or risk-adapted therapies.
23 Apr 2024Submitted to Pediatric Blood & Cancer
25 Apr 2024Assigned to Editor
25 Apr 2024Submission Checks Completed
29 May 2024Review(s) Completed, Editorial Evaluation Pending
29 May 2024Editorial Decision: Revise Major
20 Sep 2024Submission Checks Completed
20 Sep 2024Assigned to Editor
20 Sep 20241st Revision Received
20 Sep 2024Review(s) Completed, Editorial Evaluation Pending
21 Sep 2024Reviewer(s) Assigned
25 Sep 2024Editorial Decision: Accept