Integration of a nausea and vomiting assessment tool into antineoplastic management of pediatric oncology patients

Abstract

Background Antineoplastic-induced nausea and vomiting (AINV) is a treatment-related issue that can have significant negative influences on the cancer patient’s quality of life. Assessment of nausea is challenging in children as few studies include the perception of nausea as an outcome, and the severity is rarely evaluated with the use of a validated instrument. We describe our experience of integrating an AINV tool into patient care at the Alberta Children’s Hospital. Procedure: The Pediatric Nausea Assessment Tool (PeNAT) was adapted to create a standardized tool that could be used by the clinical pharmacists for AINV assessment. From February to August 2017, 74 patients receiving 217 cycles of highly or moderately emetogenic chemotherapy (HEC or MEC) were eligible to use the AINV tool. Patients that completed the AINV tool were contacted to complete a satisfaction survey. Results AINV tool uptake was low: 47 (22%) eligible chemotherapy cycles utilized the tool (24 (32%) and 23 (16%) cycles of HEC and MEC, respectively, ( p < 0.01)). Ifosfamide-containing cycles received the highest nausea ratings, with nausea severity correlated with agent emetogenicity. Mean nausea rating was 2.07 versus 1.76 for patients receiving HEC or MEC, respectively. Clinical pharmacists performed 1.24 AINV interventions per day. Patient satisfaction with AINV care overall was high; however, 51% of patients indicated that the tool led to no changes in nausea symptoms. Conclusions AINV tool uptake was low with limited value in improving outcomes. Incorporation of nausea assessment into the electronic health record and potential use of a mobile application may improve uptake.

Translation of the Pediatric Nausea Assessment Tool (PeNAT) Into Spanish and Evaluating Understandability Among Spanish-Speaking Hispanic American Children and Adolescents Receiving Chemotherapy

“…McKinnon and Jupp (2019) report mixed success when the PeNAT was used as a clinical tool. Barriers included the low rate of families being offered the PeNAT by clinical pharmacists, the onerous nature of a paper-based tool, and perceptions by clinicians, patients, and parents that nausea, even when identified, cannot be prevented or improved.…”

Assessment and management of nausea and vomiting in cancer survivors

“…Integration into the EHR may be benefi cial for real-time assessment and personalized interventions. 31 Th e Children's Oncology Group has endorsed evidencebased guidelines for the management of CINV in pediatric patients with cancer. 32 Older adults with cancer.…”

“…The Pediatric Nausea Assessment Tool (PeNAT) is an example of a validated tool that may benefit pediatric oncology practice. Integration into the EHR may be beneficial for real-time assessment and personalized interventions 31. The Children's Oncology Group has endorsed evidence-based guidelines for the management of CINV in pediatric patients with cancer 32…”

Pediatric oncology provider perspectives and patient/family perceptions of chemotherapy‐induced nausea and vomiting management: Experiences at an academic medical center

“…A single-institution study implementing a CINV assessment tool used by clinical pharmacists found that though only 22% of eligible chemotherapy cycles used the tool, patients were highly satisfied with their CINV care overall. 10…”