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Support Care Cancer. 2020 Jan 23. doi: 10.1007/s00520-020-05310-6. [Epub ahead of print]

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

Author information

1
School of Nursing, Columbia University, New York, NY, 10032, USA. mmp2123@cumc.columbia.edu.
2
Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, 10032, USA. mmp2123@cumc.columbia.edu.
3
Columbia University Mailman School of Public Health, 722 W. 168th Street 7th Floor, New York, NY, 10032, USA. mmp2123@cumc.columbia.edu.
4
The Hospital for Sick Children, Toronto, Canada.
5
Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, 10032, USA.
6
Department of Biomedical Informatics, Columbia University, New York, NY, 10032, USA.
7
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
8
School of Nursing, Columbia University, New York, NY, 10032, USA.

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.

KEYWORDS:

AYA; Cancer; Guideline-concordant care; Implementation science; Pediatric

PMID:
31974769
DOI:
10.1007/s00520-020-05310-6

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