L Lee Dupuis1, Roy N Tamura2, Kara M Kelly3, Jeffrey P Krischer4, Anne-Marie Langevin5, Lu Chen6, E Anders Kolb7, Nicole J Ullrich8, Olle Jane Z Sahler9, Eleanor Hendershot10,11, Ann Stratton12, Lillian Sung13, Thomas W McLean14. 1. Department of Pharmacy and Research Institute, The Hospital of Sick Children, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada. 2. Health Informatics Institute, University of South Florida, Tampa, Florida. 3. Department of Pediatrics, Roswell Park Cancer Institute and Division of Pediatric Hematology/Oncology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York. 4. Health Informatics Institute and College of Medicine, University of South Florida, Tampa, Florida. 5. Division of Pediatric Hematology/Oncology, University of Texas Health Science Centre at San Antonio, San Antonio, Texas. 6. Department of Information Sciences, City of Hope, Duarte, California. 7. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware. 8. Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts. 9. Pediatric Hematology/Oncology, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York. 10. Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada. 11. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. 12. Department of Cancer and Blood Disorders, Akron Children's Hospital, Akron, Ohio. 13. Department of Paediatrics, Division of Haematology/Oncology, The Hospital of Sick Children and Faculty of Medicine, University of Toronto, Toronto, Canada. 14. Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Abstract
BACKGROUND: Little is known regarding risk factors for chemotherapy-induced nausea (CIN) in pediatric patients. PROCEDURE: A secondary analysis was conducted of a previously published multicenter, prospective, randomized, single-blind, sham-controlled trial assessing the efficacy of acupressure in preventing CIN in pediatric patients receiving highly emetogenic chemotherapy. The primary outcome was nausea severity, self-reported using the Pediatric Nausea Assessment Tool. The relationships between acute and delayed nausea severity and patient- (sex, race, age, and cancer diagnosis) and treatment-related (chemotherapy, antiemetic prophylaxis, CIN, and vomiting control) factors were analyzed by a proportional odds generalized estimating equation approach. The acute phase started with administration of the first and continued for 24 hours after the last chemotherapy dose. The delayed phase started at the end of the acute phase and continued until the next chemotherapy block (maximum seven days). RESULTS: In the acute and delayed phases, 165 and 144 patients provided data for analysis, respectively. Nonwhite race was significantly associated with higher acute phase nausea severity (OR, 1.7; 95% CI, 1.1-2.6). Poor CIN control in the acute phase (OR, 16; 95% CI, 4.0-64.6), diagnosis of a cancer other than a central nervous system (CNS) tumor (OR, 2.5; 95% CI, 1.2-5.3), and cisplatin administration (OR, 3.7; 95% CI, 2.1-6.0) were significantly associated with higher delayed phase nausea severity. CONCLUSION: Acute phase CIN was associated with nonwhite race. Delayed phase CIN was associated with poor acute phase CIN control, diagnosis of non-CNS cancer, and receipt of cisplatin. These findings will inform future antiemetic trial design.
RCT Entities:
BACKGROUND: Little is known regarding risk factors for chemotherapy-induced nausea (CIN) in pediatric patients. PROCEDURE: A secondary analysis was conducted of a previously published multicenter, prospective, randomized, single-blind, sham-controlled trial assessing the efficacy of acupressure in preventing CIN in pediatric patients receiving highly emetogenic chemotherapy. The primary outcome was nausea severity, self-reported using the Pediatric Nausea Assessment Tool. The relationships between acute and delayed nausea severity and patient- (sex, race, age, and cancer diagnosis) and treatment-related (chemotherapy, antiemetic prophylaxis, CIN, and vomiting control) factors were analyzed by a proportional odds generalized estimating equation approach. The acute phase started with administration of the first and continued for 24 hours after the last chemotherapy dose. The delayed phase started at the end of the acute phase and continued until the next chemotherapy block (maximum seven days). RESULTS: In the acute and delayed phases, 165 and 144 patients provided data for analysis, respectively. Nonwhite race was significantly associated with higher acute phase nausea severity (OR, 1.7; 95% CI, 1.1-2.6). Poor CIN control in the acute phase (OR, 16; 95% CI, 4.0-64.6), diagnosis of a cancer other than a central nervous system (CNS) tumor (OR, 2.5; 95% CI, 1.2-5.3), and cisplatin administration (OR, 3.7; 95% CI, 2.1-6.0) were significantly associated with higher delayed phase nausea severity. CONCLUSION: Acute phase CIN was associated with nonwhite race. Delayed phase CIN was associated with poor acute phase CIN control, diagnosis of non-CNS cancer, and receipt of cisplatin. These findings will inform future antiemetic trial design.
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