Madeline Digges1, Akram Hussein1, Andrew Wilcock2, Gregory B Crawford3,4, Jason W Boland5, Meera R Agar6, Aynharan Sinnarajah7,8, David C Currow3,6,9, Miriam J Johnson5. 1. 1 Discipline of Palliative Care, School of Medicine, Flinders University , Adelaide, South Australia, Australia . 2. 2 Hayward House Specialist Palliative Care Unit, School of Clinical Oncology, University of Nottingham , Nottingham, England. 3. 3 Northern Adelaide Palliative Service , Northern Adelaide Local Health Network, Adelaide, South Australia, Australia . 4. 4 Discipline of Medicine, University of Adelaide , Adelaide, South Australia, Australia . 5. 5 Wolfson Palliative Care Research Centre, Hull York Medical School , University of Hull, Hull, England. 6. 6 IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney , Sydney, New South Wales, Australia . 7. 7 Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada . 8. 8 Palliative/End of Life Care, Alberta Health Services , Calgary, Alberta, Canada . 9. 9 Southern Adelaide Palliative Services , Adelaide, South Australia, Australia .
Abstract
BACKGROUND: Haloperidol is widely prescribed as an antiemetic in patients receiving palliative care, but there is limited evidence to support and refine its use. OBJECTIVE: To explore the immediate and short-term net clinical effects of haloperidol when treating nausea and/or vomiting in palliative care patients. DESIGN: A prospective, multicenter, consecutive case series. SETTING/ SUBJECTS: Twenty-two sites, five countries: consultative, ambulatory, and inpatient services. MEASUREMENTS: When haloperidol was started in routine care as an antiemetic, data were collected at three time points: baseline; 48 hours (benefits); day seven (harms). Clinical effects were assessed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE). RESULTS: Data were collected (May 2014-March 2016) from 150 patients: 61% male; 86% with cancer; mean age 72 (standard deviation 11) years and median Australian-modified Karnofsky Performance Scale 50 (range 10-90). At baseline, nausea was moderate (88; 62%) or severe (11; 8%); 145 patients reported vomiting, with a baseline NCI CTCAE vomiting score of 1.0. The median (range) dose of haloperidol was 1.5 mg/24 hours (0.5-5 mg/24 hours) given orally or parenterally. Five patients (3%) died before further data collection. At 48 hours, 114 patients (79%) had complete resolution of their nausea and vomiting, with greater benefit seen in the resolution of nausea than vomiting. At day seven, 37 (26%) patients had a total of 62 mild/moderate harms including constipation 25 (40%); dry mouth 13 (21%); and somnolence 12 (19%). CONCLUSIONS: Haloperidol as an antiemetic provided rapid net clinical benefit with low-grade, short-term harms.
BACKGROUND:Haloperidol is widely prescribed as an antiemetic in patients receiving palliative care, but there is limited evidence to support and refine its use. OBJECTIVE: To explore the immediate and short-term net clinical effects of haloperidol when treating nausea and/or vomiting in palliative care patients. DESIGN: A prospective, multicenter, consecutive case series. SETTING/ SUBJECTS: Twenty-two sites, five countries: consultative, ambulatory, and inpatient services. MEASUREMENTS: When haloperidol was started in routine care as an antiemetic, data were collected at three time points: baseline; 48 hours (benefits); day seven (harms). Clinical effects were assessed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE). RESULTS: Data were collected (May 2014-March 2016) from 150 patients: 61% male; 86% with cancer; mean age 72 (standard deviation 11) years and median Australian-modified Karnofsky Performance Scale 50 (range 10-90). At baseline, nausea was moderate (88; 62%) or severe (11; 8%); 145 patients reported vomiting, with a baseline NCI CTCAE vomiting score of 1.0. The median (range) dose of haloperidol was 1.5 mg/24 hours (0.5-5 mg/24 hours) given orally or parenterally. Five patients (3%) died before further data collection. At 48 hours, 114 patients (79%) had complete resolution of their nausea and vomiting, with greater benefit seen in the resolution of nausea than vomiting. At day seven, 37 (26%) patients had a total of 62 mild/moderate harms including constipation 25 (40%); dry mouth 13 (21%); and somnolence 12 (19%). CONCLUSIONS:Haloperidol as an antiemetic provided rapid net clinical benefit with low-grade, short-term harms.
Authors: Rudolph M Navari; Cameron M Pywell; Jennifer G Le-Rademacher; Patrick White; Andrew B Dodge; Costantine Albany; Charles L Loprinzi Journal: JAMA Oncol Date: 2020-06-01 Impact factor: 31.777