Holdsworth Mark T, Raisch Dennis W, Frost Jami
Department of Pharmacy and Pediatrics, College of Pharmacy, University of New Mexico, Albuquerque, 87131, USA.
Cancer. 2006 Feb 15;106(4):931-40. doi: 10.1002/cncr.21631.
To the authors' knowledge there is little information available regarding the effectiveness of standard antiemetic therapy among cancer patients who receive emetogenic chemotherapy in clinical practice, especially in the pediatric population. The current study was undertaken to determine the effectiveness of standard antiemetic interventions among children receiving emetogenic chemotherapy.
The authors conducted a retrospective review of antiemetic surveys for children who received emetogenic chemotherapy. Patients and/or their parents were surveyed for acute and delayed nausea and emesis after each course of emetogenic chemotherapy. The survey consisted of validated measures of the severity of nausea and emesis. Complete protection (CP) rates were calculated for each chemotherapy regimen during both the acute and delayed phases and also by gender and age group (ages birth-3 yrs, 4-11 yrs, and 12-20 yrs). Antiemetic therapy consisted of intravenous ondansetron administered once daily during chemotherapy either alone (for moderately emetogenic chemotherapy) or in combination with dexamethasone (for severely emetogenic chemotherapy).
In total, 224 different patients completed 1256 surveys. CP from both acute and delayed nausea and emesis was more likely in the children ages birth-3 years than in older children. For moderately emetogenic regimens, nausea and emesis in the acute and delayed phases were controlled well. Among severely emetogenic chemotherapy regimens, 7 of 12 different regimen types had CP rates < 50% in either the acute phase or the delayed phase. CP rates were particularly low for cisplatin-based and cyclophosphamide-based regimens.
Nausea and emesis remain significant problems among children who receive emetogenic chemotherapy. CP rates were associated significantly with patient age, and higher rates were observed among very young children.
据作者所知，关于在临床实践中接受致吐性化疗的癌症患者，尤其是儿科患者中标准止吐疗法的有效性，几乎没有可用信息。本研究旨在确定接受致吐性化疗的儿童中标准止吐干预措施的有效性。
作者对接受致吐性化疗的儿童的止吐调查进行了回顾性分析。在每个疗程的致吐性化疗后，对患者和/或其父母进行急性和延迟性恶心及呕吐的调查。该调查包括对恶心和呕吐严重程度的有效测量。计算每个化疗方案在急性和延迟阶段以及按性别和年龄组（出生至3岁、4至11岁和12至20岁）的完全保护（CP）率。止吐治疗包括在化疗期间每天静脉注射一次昂丹司琼，单独使用（用于中度致吐性化疗）或与地塞米松联合使用（用于重度致吐性化疗）。
共有224名不同患者完成了1256次调查。出生至3岁的儿童比年龄较大的儿童更有可能在急性和延迟性恶心及呕吐方面获得完全保护。对于中度致吐性方案，急性和延迟阶段的恶心和呕吐得到了很好的控制。在重度致吐性化疗方案中，12种不同方案类型中的7种在急性或延迟阶段的CP率<50%。基于顺铂和基于环磷酰胺的方案的CP率特别低。
在接受致吐性化疗儿童中，恶心和呕吐仍然是严重问题。CP率与患者年龄显著相关，在非常年幼的儿童中观察到更高的CP率。
