Guideline concordant care for prevention of acute chemotherapy-induced nausea and vomiting in children, adolescents, and
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ORIGINAL ARTICLE
Guideline concordant care for prevention of acute chemotherapy-induced nausea and vomiting in children, adolescents, and young adults Melissa Beauchemin 1,2,3
4
2
5
& Lillian Sung & Dawn L. Hershman & Chunhua Weng & L. Lee Dupuis
4,6
& Rebecca Schnall
1
Received: 17 October 2019 / Accepted: 14 January 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 Cancer . Guideline-concordant care . Implementation science . Pediatric . AYA
* Melissa Beauchemin [email protected] 1
School of Nursing, Columbia University, New York, NY 10032, USA
2
Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA
3
Columbia University Mailman School of Public Health, 722 W. 168th Street 7th Floor, New York, NY 10032, USA
4
The Hospital for Sick Children, Toronto, Canada
5
Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA
6
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
Background Symptom management for children, adolescents, and young adults with cancer
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