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Tamura K, Aiba K, Saeki T, Nakanishi Y, Kamura T, Baba H, Yoshida K, Yamamoto N, Kitagawa Y, Maehara Y, Shimokawa M, Hirata K, Kitajima M. Testing the effectiveness of antiemetic guidelines: results of a prospective registry by the CINV Study Group of Japan. Int J Clin Oncol 2015; 20:855-65. [PMID: 25681876 DOI: 10.1007/s10147-015-0786-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/17/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many cancer patients suffer from the common side effect of chemotherapy-induced nausea and vomiting (CINV). Guidelines recommend a combination of two prophylactic antiemetics for moderately emetogenic chemotherapy (MEC) and three for highly emetogenic chemotherapy (HEC) and certain MEC regimens. METHODS This multicenter, prospective, observational study analyzed data for 1,910 patients in Japan scheduled for MEC or HEC. Use of antiemetic prophylaxis in relation to type of chemotherapy, incidences of and risk factors for nausea, vomiting, and acute versus delayed CINV, and estimated incidence of CINV by staff were analyzed using Fisher's exact test and multivariate logistic regression. The patients recorded the incidence of CINV and severity of nausea by visual analogue scales daily for 7 days after receiving chemotherapy. RESULTS A total of 240 (20.1 %) HEC and 476 MEC patients (66.6 %) received 2 antiemetics, compared with 883 (73.9 %) and 200 (28.0 %), respectively, who received 3 antiemetics. Approximately 74 % of HEC and 95 % of MEC patients received antiemetic therapy in compliance with guidelines. Acute nausea and vomiting were well controlled, but high incidences of delayed nausea occurred in both HEC and MEC patients. Delayed vomiting (p < 0.0001) was significantly less frequent in patients receiving three compared with 2 antiemetics. Female sex was a major risk factor for CINV. Medical staff tended to overestimate the incidence of CINV. Among HEC regimens, the incidence of CINV and the degree of nausea on day 1 of anthracycline-cyclophosphamide combination therapy were higher than with a cisplatin-based regimen. CONCLUSIONS Adherence to antiemetic guidelines effectively controls vomiting but is less effective against delayed nausea in HEC and MEC patients. Identification of individual risk factors, such as female sex, will assist in the development of personalized treatments for CINV. More intensive antiemetic therapy or a different modality of prophylaxis should be considered for the control of acute CINV in an anthracycline-cyclophosphamide regimen.
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Affiliation(s)
- Kazuo Tamura
- Division of Medical Oncology, Hematology and Infectious Diseases, Department of Medicine, School of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoko, 814-0180, Japan.
| | - Keisuke Aiba
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toshiaki Saeki
- Breast Oncology Service, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Toshiharu Kamura
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1, Honjomachi, Chuo-ku, Kumamoto, Kumamoto, 860-0811, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University, 1-1 Yanagito, Gifu, Gifu, 501-1194, Japan
| | - Nobuyuki Yamamoto
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007, Nagaizumicho, Sunto-gun, Shizuoka, 411-0934, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Mototsugu Shimokawa
- Department of Cancer Information Research, National Hospital Organization Kyushu Cancer Center, 3-1-1, Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan
| | - Koichi Hirata
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1 W17, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Masaki Kitajima
- International University of Health and Welfare, 2600-1 Kitakanemaru, Ohtawara, Tochigi, 324-8501, Japan
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Freedman JL, Faerber J, Kang TI, Dai D, Fisher BT, Huang YS, Li Y, Aplenc R, Feudtner C. Predictors of antiemetic alteration in pediatric acute myeloid leukemia. Pediatr Blood Cancer 2014; 61:1798-805. [PMID: 24939039 PMCID: PMC4141025 DOI: 10.1002/pbc.25108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/28/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Better knowledge of patient and cancer treatment factors associated with nausea/vomiting (NV) in pediatric oncology patients could enhance prophylaxis. We aimed to describe such factors in children receiving treatment for acute myeloid leukemia (AML). METHODS Retrospective longitudinal cohort study of 1,668 hospitalized children undergoing treatment for AML from the Pediatric Health Information System database (39 hospitals, 1999-2010). Antiemetic alteration, which included switch (a change in prescribed 5-HT₃ receptor antagonists) and rescue (receipt of an adjunct antiemetic), were first validated and then used as surrogates of problematic NV. Logistic and negative binomial regression modeling were used to test whether patient characteristics were associated with problematic NV. RESULTS Increasing age is associated with greater odds of experiencing antiemetic switch and higher relative rate of antiemetic rescue. Within a treatment cycle, each consecutive inpatient chemotherapy day decreased the likelihood of requiring antiemetic alteration. Each consecutive inpatient-day post-chemotherapy was associated with decreased need for switch, but increased need for rescue. Subsequent cycles of AML therapy were associated with lower odds of antiemetic switch on both chemotherapy and non-chemotherapy days, a lower rate of antiemetic rescue on chemotherapy days, and an increased rate of rescue on non-chemotherapy days. CONCLUSION In pediatric patients with AML, increasing age is strongly associated with greater antiemetic alteration. Antiemetic alteration occurs early in treatment overall, and early within each admission. While additional cycles of therapy are associated with less alteration overall, there is persistent rescue in the days after chemotherapy, suggesting additional etiologies of NV in pediatric cancer patients.
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Affiliation(s)
- Jason L. Freedman
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, USA,Corresponding author: Jason L. Freedman, MD, MSCE, The Children’s Hospital of Philadelphia, 3501 Civic Center Boulevard, CTRB 10207, Philadelphia, PA 19104, Phone: 267-425-5822, Fax: 215-590-7544,
| | - Jennifer Faerber
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Tammy I. Kang
- Divisions of Oncology and Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Dingwei Dai
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Brian T. Fisher
- Division of Infectious Diseases/Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia/University of Pennsylvania, Philadelphia, USA
| | - Yuan-Shung Huang
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Yimei Li
- Division of Oncology/Center for Clinical Epidemiology & Biostatistics, The Children’s Hospital of Philadelphia/University of Pennsylvania, Philadelphia, USA
| | - Richard Aplenc
- Division of Oncology/Center for Clinical Epidemiology & Biostatistics, The Children’s Hospital of Philadelphia/University of Pennsylvania, Philadelphia, USA
| | - Chris Feudtner
- Division of General Pediatrics/Center for Pediatric Clinical Effectiveness/Center for Clinical Epidemiology & Biostatistics, The Children’s Hospital of Philadelphia/University of Pennsylvania, Philadelphia, USA
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