Effectiveness of Strategies for Preventing Acute Antineoplastic-Induced Nausea and Vomiting in Children with Acute Lymphoblastic Leukemia
Bibliographic record
Abstract
ABSTRACT Objective: To describe the antiemetic regimens prescribed for children receiving antineoplastic drugs for the treatment of acute lymphoblastic leukemia and the effectiveness of these regimens in preventing acute antineoplastic-induced nausea and vomiting. Evaluation of the extent of adherence to guidelines for selection of the antiemetic regimen was a secondary objective. Methods: All children (inpatients and outpatients) receiving antineoplastics for the treatment of acute lymphoblastic leukemia during the 12-week study period were eligible for the study. For each patient, age, diagnosis, antineoplastic protocol, antineoplastic agents prescribed, antiemetic agents prescribed, and time of administration of antineoplastic and antiemetic medications were recorded. The date and time of each emetic episode were recorded in a patient diary on each day that antineoplastics were given and for 3 days thereafter. Children 3 years of age and older were asked to assess the worst degree of nausea experienced. Diet and the presence of adverse effects were also assessed. The rate of response to the antiemetic regimen, the median nausea rating, and the median diet followed were described for antineoplastic agents of high, moderate, and low emetogenicity. The responses of children who experienced anticipatory nausea and vomiting were compared with those of children who did not experience anticipatory symptoms. Proportions were compared by means of a χ 2 test or a Z -test with an a priori level of significance of 5%. Results: Data on emetic response were collected and analyzed for 94 children receiving 133 cycles of therapy over a total of 168 days. Complete, major, and failed responses were observed on 128 (76%), 30 (18%), and 10 (6%) of the study days respectively. Most children who received moderately to highly emetogenic regimens received at least one close of ondansetron. Children who vomited or were nauseated were given no additional antiemetic support or were given additional doses of ondansetron, dexamethasone, or dimenhydrinate. Conclusion: The rate of complete response to the antiemetic regimen in this study was lower than that reported by other investigators. Adjustment of the emetogenicity classification, standardization of the antiemetic selection process, and development of effective management strategies for anticipatory and breakthrough nausea and vomiting will improve patients' experience. RESUME Objectif : Decrire les traitements antiemetiques prescrits chez les enfants qui recoivent des antineoplasiques pour combattre la leucemie lymphoblastique aigue, et l'efficacite de ces traitements pour la prevention des nausees et des vomissements graves dus aux antineoplasiques. L'evaluation de la mesure avec laquelle on adherait aux lignes directrices dans le choix du traitement antiemetique constituait un objectif secondaire. Methodes : Tous les enfants (hospitalises et ambulatoires) qui recevaient des antineoplasiques pour le traitement de leur leucemie lymphoblastique aigue au cours de la periode d'etude de 12 semaines etaient admissibles a cette etude. On a consigne l'âge, le diagnostic, le protocole d'administration des antineoplasiques, les antineoplasiques prescrits, les antiemetiques prescrits et l'heure d'administration des antineoplasiques et des antiemetiques. La date et l'heure de survenue de chacun des episodes de nausees et de vomissements ont ete consignees dans un journal quotidien du patient pour chacune des journees ou des antineoplasiques ont ete administres et durant les trois jours suivants. On a demande aux enfants de trois ans ou plus d'evaluer leurs pires episodes de nausees et de vomissements. Le regime alimentaire et la manifestation d'effets indesirables ont egalement ete evalues. Le taux de reponse au traitement antiemetique, la cote mediane des nausees, et le regime alimentaire moyen suivi ont ete decrits pour les antineoplasiques fortement, moyennement et faiblement emetogenes. Les reactions des enfants qui ont eprouve des nausees et des vomissements par anticipation ont ete comparees a celles des enfants qui n'ont pas eprouve de symptomes par anticipation. Les proportions ont ete comparees au moyen du test du chi carre ou du test Z avec un taux de signification a priori de 5 %. Resultats : les donnees sur les reponses aux traitements antiemetiques ont ete recueillies et analysees pour 94 enfants qui ont recu 133 seances therapeutiques au cours d'un total de 168 jours. La reponse etait complete, importante et inexistante durant 128 (76%), 30 (18 %), et 10 (6 %) jours, respectivement, sur le total des jours d'etude. La plupart des enfants qui ont recu un traitement antineoplasique fortement ou moyennement emetogene ont recu au moins une dose d'ondansetron. Les enfants qui ont eprouve des nausees ou des vomissements n'ont recu aucun antiemetique d'appoint ou ils ont recu de doses additionnelles d'ondanserron, des dexamethasone ou de dimenhydrinate. Conclusion: Le taux de reponse complete aux traitements antiemetiques au cours de cette etude etait plus faible que celui rapporte par d'autres chercheurs. Une correction de la classification de l'emetogenecite, la standardisation du processus de selection des antiemetiques, et l'elaboration de strategies de gestion efficaces des nausees et des vomissements par reaction d'anticipation et pertherapeutiques facilitera la vie des patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".