Predictors of Control of Chemotherapy-Induced Nausea and Vomiting; experience from a tertiary oncology center in Pakistan

Abstract

Background: CINV is a known distressful symptom in pediatric cancer patients. In a resource-limited setting, insight regarding CINV frequency and current practice can help optimize symptom control. Methods: Prospective study in the pediatric oncology daycare and inpatient services within a tertiary care hospital over 6 months. Patient demographics, chemotherapy and antiemetic regimen details were recorded. Frequency of acute nausea, vomiting and nausea severity for each session was recorded using a self-report questionnaire. Primary outcome was complete control (CC) (defined as no acute nausea or vomiting). Secondary outcomes included nausea severity and antiemetic prescription patterns. Results: A total of 61 (median age 7 years, 45.9% girls) patients received chemotherapy over 265 visits (85 single-day, 56 blocks). Inpatient sessions were more frequently of high emetogenicity (47.8% of 138 sessions) and most daycare sessions moderately emetogenic (79.5% of 127). Overall CC was 65.7%, significantly better for inpatients (73.2%, P<.009) and for sessions with weight-appropriate ondansetron dosing (p = 0.033). Odds of experiencing nausea (median severity 4) were higher in day care (OR 2.11, 95% CI 1.13-3.92) and lower (OR 0.25, 95% CI 0.09-0.72) when ondansetron dosing was weight-appropriate. CC did not vary significantly with age or gender. Conclusion: The overall CC rate was 65%, and was significantly higher for inpatients, highly emetogenic regimens, and when appropriate ondansetron dosing was used. This study identified gaps in our antiemetic practice, with moderately emetogenic sessions failing to receive guideline-recommended antiemetics, correlating with significantly lower complete control for daycare sessions.