Predictors of antiemetic alteration in pediatric acute myeloid leukemia

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 1668 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.

Risk factors for chemotherapy‐induced nausea in pediatric patients receiving highly emetogenic chemotherapy

“…Thus, pediatric‐specific risk factors must be identified. Four pediatric studies have explored this topic . In 1988, LeBaron et al reported that among a group of 31 pediatric patients aged 5 to 18 years receiving chemotherapy, adolescents reported more severe nausea than younger children and females reported more nausea than males .…”

“…Again, nausea severity was determined by patient or by proxy report using a measure that had not been validated. Using a large multi‐institutional prescription database, Freedman et al evaluated factors associated with a change in antiemetic prophylaxis or of the administration of rescue antiemetic agents in 1668 hospitalized pediatric patients with acute myeloid leukemia receiving chemotherapy . The use of rescue antiemetic agents was considered to be a surrogate for CIN.…”

“…Four pediatric studies have explored this topic. [15][16][17][18] In 1988, LeBaron et al reported that among a group of 31 pediatric patients aged 5 to 18 years receiving chemotherapy, adolescents reported more severe nausea than younger children and females reported more nausea than males. 15 The method of nausea assessment used in this study, a rating scale from 0 to 10, was not validated.…”

Anxiety, pain, and nausea during the treatment of standard‐risk childhood acute lymphoblastic leukemia: A prospective, longitudinal study from the Children's Oncology Group

“…In comparison with very young children (1 month to 2 years), changes in antiemetic regimens were found to be more likely in children older than 9 years in a retrospective cohort study. 31 This may provide indirect evidence of a higher risk of CINV in older children but may also reflect the increased ability of older children to advocate for adequate antiemetic therapy. In our study, parents reported more nausea in older children.…”

Merging Children’s Oncology Group Data with an External Administrative Database Using Indirect Patient Identifiers: A Report from the Children’s Oncology Group

“…PHIS is an administrative database including data from 44 free-standing pediatric hospitals in the United States that are affiliated with the Children’s Hospital Association (CHA; Overland Park, KS; data management center). These hospitals represent most of the major metropolitan areas in the U.S. PHIS data have previously been used in over 300 peer-reviewed publications including studies of patients with AML from our group [ 7 – 13 ]. Oversight of PHIS data quality methods is a joint effort between CHA, Truven Health Analytics (data processing partner, Ann Arbor, MI), and participating hospitals.…”