Sugalski Aaron J, Grimes Allison C, Nuño Michelle M, Ramakrishnan Subhash, Beauchemin Melissa P, Robinson Paula D, Santesso Nancy, Walsh Alexandra M, Wrightson Andrea R, Yu Lolie C, Parsons Susan K, Sung Lillian, Dupuis L Lee
University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
Children's Oncology Group, Monrovia, California, USA.
Pediatr Blood Cancer. 2024 Nov;71(11):e31295. doi: 10.1002/pbc.31295. Epub 2024 Sep 5.
This study aimed to determine the proportion of patients receiving clinical practice guideline (CPG)-inconsistent care related to chemotherapy-induced vomiting (CIV) prophylaxis, and to describe the association between CPG-inconsistent care and site size. The association between delivery of CPG-inconsistent care and patient outcomes (CIV control, admission prolongation, and unplanned healthcare visits) was also described.
This was a retrospective study conducted at Children's Oncology Group (COG) National Cancer Institute Community Oncology Research Program (NCORP) sites. Eligible patients received highly (HEC) or moderately emetogenic chemotherapy (MEC) as inpatients from January 2014 through December 2015, and were previously enrolled in a COG study. The COG generated a patient list from which patients were randomly selected for chart review by participating sites. A central panel adjudicated CIV prophylaxis received as CPG-consistent or -inconsistent.
Twenty-four sites participated. Over half of patients received CPG-inconsistent CIV prophylaxis (HEC: 59/112, 52.6%; MEC: 119/215, 55.3%). The most common reasons for CPG-inconsistency were shortened duration of antiemetic administration or omission of dexamethasone. Site size was not found to be associated with CPG-inconsistent care delivery (HEC: adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.76-1.23; MEC: adjusted OR: 1.07; 95% CI: 0.92-1.24). Additionally, there was no statistically significant association between receipt of CPG-inconsistent care and patient outcomes.
Patients receiving MEC or HEC often received CPG-inconsistent CIV prophylaxis. Site size was not associated with receipt of CPG-inconsistent care. Future studies should evaluate strategies to improve CIV control among pediatric oncology patients including those aimed at improving CPG adherence.
本研究旨在确定接受与化疗引起的呕吐（CIV）预防相关的临床实践指南（CPG）不一致治疗的患者比例，并描述CPG不一致治疗与机构规模之间的关联。还描述了CPG不一致治疗的实施与患者结局（CIV控制、住院时间延长和非计划医疗就诊）之间的关联。
这是一项在儿童肿瘤学组（COG）国家癌症研究所社区肿瘤学研究项目（NCORP）机构开展的回顾性研究。符合条件的患者在2014年1月至2015年12月期间作为住院患者接受了高致吐性化疗（HEC）或中度致吐性化疗（MEC），且之前参加过COG研究。COG生成了一份患者名单，参与研究的机构从中随机选择患者进行病历审查。一个中央小组判定接受的CIV预防措施为符合或不符合CPG。
24个机构参与了研究。超过一半的患者接受了不符合CPG的CIV预防措施（HEC：59/112，52.6%；MEC：119/215，55.3%）。CPG不一致的最常见原因是止吐药给药时间缩短或地塞米松遗漏。未发现机构规模与不符合CPG的治疗实施相关（HEC：调整后的比值比[OR]：0.96，95%置信区间[CI]：0.76 - 1.23；MEC：调整后的OR：1.07；95% CI：0.92 - 1.24）。此外，接受不符合CPG的治疗与患者结局之间无统计学上的显著关联。
接受MEC或HEC的患者经常接受不符合CPG的CIV预防措施。机构规模与接受不符合CPG的治疗无关。未来的研究应评估改善儿科肿瘤患者CIV控制的策略，包括旨在提高CPG依从性的策略。
