In the field of adult patients, the risk factors for discordance with antiemetic guideline (GL) are reported to be hematological malignancy, older age, and the use of low emetic risk chemotherapy. However, there are scarce reports in the field of pediatric or adolescent and young adult (AYA) patients. Therefore, we assessed the concordance with antiemetic GL in the field of pediatric and AYA patients who received chemotherapy.
Using the Diagnosis Procedure Combination system in Japan, we identified patients with cancer aged 30 years or younger from July 2010 to March 2016. Patients’ data included age, gender, diagnosis, anticancer drugs, and antiemetic drugs. We assessed the concordance with antiemetic GL of ASCO in patients of each emetic risk category. Furthermore, we assessed the risk factors for discordance with antiemetic GL, using logistic regression.
A total of 21,106 patients who underwent chemotherapy were included. We classified patients into the following 6 age categories: 0-2 yo (n = 2,480), 3-5 yo (n = 1,983), 6-11 yo (n = 2,782), 12-17yo (n = 3,495), 18-23 yo (n = 3,941) and 24-29 yo (n = 6,425). The median age was 16 (0-29) years old. The rate of concordance with GL in each emetic risk category was 18.2% in high risk (18 yo >, n = 2,531), 51.1% in high risk (18 yo ≤, n = 4130), 32.1% in moderate risk (n = 7,188), 52.0% in low risk (n = 5,806), and 51.6% in minimum risk (n = 1,451). In multivariate analysis, risk factors for discordance with antiemetic GL were high emetic risk chemotherapy, lower age (0-2 yo), hematological malignancies, and brain tumor.Table: 1802P
Risk factors for discordance with antiemetic guideline
|Odd ratio||95% CI||P Value|
|Age category||0-2 yo||1.71||1.55-1.89||<0.05|
|Emetic risk category||High||2.27||2.0-2.55||<0.05|
Our study identified substantial room for improvement in antiemetic practice and risk factors for discordance with antiemetic GL in pediatric and AYA patients. These identified risks are different from those in adult patients. Further investigation of the causes of this discordance is warranted, especially considering the unique background of this field.
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All authors have declared no conflicts of interest.