PEG-aspariginase is a backbone chemotherapy agent in pediatric acute lymphoblastic leukemia and in some non-Hodgkin lymphoma therapies. Nurses lack standardized guidelines for monitoring patients receiving PEG-asparaginase and for educating patients/families about hypersensitivity reaction risks. An electronic search of six databases using publication years 2000–2015 and multiple professional organizations and clinical resources was conducted. Evidence sources were reviewed for topic applicability. Each of the final 23 sources was appraised by two team members. The GRADE system was used to assign a quality and strength rating for each recommendation. Multiple recommendations were developed: four relating to nurse monitoring of patients during and after drug administration, eight guiding hypersensitivity reaction management, and four concerning patient/family educational content. These strong recommendations were based on moderate, low, or very-low quality evidence. Several recommendations relied upon generalized drug hypersensitivity guidelines. Additional research is needed to safely guide PEG-asparaginase monitoring, hypersensitivity reaction management and patient/family education. Nurses administering PEG-asparaginase play a critical role in the early identification and management of hypersensitivity reactions.
The administration of chemotherapy to children with cancer is a high-risk process that must be performed in a safe and consistent manner with high reliability. Clinical trials play a major role in the treatment of children with cancer; conformance to chemotherapy protocol requirements and accurate documentation in the medical record are critical. Inconsistencies in the administration and documentation of chemotherapy were identified as opportunities for errors to occur. A major process improvement was initiated to establish best practices for nurses who administer chemotherapy to children. An interdisciplinary team was formed to evaluate the current process and to develop best practices based on current evidence, protocol requirements, available resources, and safety requirements. The process improvement focused on the establishment of standardized and safe administration techniques, exact administration times, and consistent electronic documentation that could easily be retrieved in medical record audits. Quality improvement tools including SBAR (Situation, Background, Assessment, Recommendation), process mapping, PDSA (Plan, Do. Study, Act) cycles, and quality metrics were used with this process improvement. The team established best practices in chemotherapy administration to children that have proven to be safe and reliable. Follow-up data have demonstrated that the project was highly successful and improved accuracy, patient and nurse safety, and effectiveness of chemotherapy administration.
Hemorrhagic cystitis is a known complication of cyclophosphamide, an anti-neoplastic agent used to treat a variety of oncologic diseases in children. Hydration can prevent hemorrhagic cystitis; however, use varies in clinical practice. A team was assembled to develop evidence-based practice recommendations to address the following question: in a population of children with cancer, what is the appropriate pre and post hydration for the administration of different dose levels of intravenous cyclophosphamide to prevent bladder toxicity? The purpose was to identify the appropriate rate, duration and route of hydration to prevent bladder toxicity with low, intermediate and high dose cyclophosphamide. After a systematic search of the literature, 15 pieces of evidence were evaluated and used. There is a moderate level of quality evidence related to hydration for high dose cyclophosphamide and very low quality evidence related to intermediate or low dose cyclophosphamide. Three general recommendations were made for hydration associated with cyclophosphamide. There is a need for further research related to the prevention of bladder toxicity in children with cancer receiving cyclophosphamide.
Background: Chemotherapy-induced nausea and vomiting can adversely affect patients' health and quality of life. Guidelines recommend prophylactic antiemetic regimens according to the emetogenic potential of anti-tumor therapies. However, these recommendations are not for patients receiving high-dose myeloablative regimens prior to stem cell transplant (SCT). Current guidelines do not recommend a specific antiemetic regimen for patients receiving highdose chemotherapy prior to SCT due to a lack of evidence. At VCUHS, the standard of care in patients receiving high-dose melphalan prior to SCT was an antiemetic regimen consisting of ondansetron + dexamethasone. Due to perceived poor nausea and vomiting control, the standard of care was changed in August of 2012 to a three-drug regimen containing aprepitant. Following this change in practice, this project was undertaken for the primary objective of determining the effectiveness of an antiemetic regimen containing aprepitant compared to the previous standard of care in patients receiving high-dose melphalan prior to autologous SCT. Methods: This retrospective observational review compared patients who received the previous antiemetic standard of care to those who received the three-drug regimen containing aprepitant prior to autologous SCT with high-dose melphalan conditioning at VCUHS between April 2010 and April 2013. The primary outcome measure was overall nausea control (NC), defined as no episodes of documented emesis and 2 uses of rescue antiemetics in the overall phase (D-2 to D+2) with no additional scheduled antiemetics. Results: 114 patients were included in the analysis. The rate of overall NC was not significantly different between the two groups [treatment difference-1%, 95% CI-19 to 18]. However, the mean number of episodes of emesis was significantly lower in the aprepitant group than in the control group in the acute (0 vs. 0.2, p ¼ 0.012), delayed (0.3 vs. 1.3, p < 0.001), and overall period (0.3 vs. 1.4, p < 0.001). Also, fewer patients in the aprepitant group required additional scheduled antiemetics (3% vs. 36%, p ¼ 0.011) than patients in the control group. There were no significant differences in length of stay or time to neutrophil engraftment. Conclusions: The addition of aprepitant failed to demonstrate a statistically significant benefit in terms of overall NC when compared to the previous antiemetic standard of care in patients receiving high-dose melphalan prior to autologous SCT. This lack of benefit and lower than expected rates of overall NC were attributed to aggressive pre-emptive rescue antiemetic use and additional doses of scheduled ondansetron in the control group. However, this analysis did find that aprepitant reduces episodes of emesis and use of additional scheduled antiemetics in patients receiving high-dose melphalan prior to autologous SCT.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.