Improving Guideline-Congruent Care for Chemotherapy-Induced Nausea and Vomiting Prophylaxis in Pediatric Oncology Patients

• Published in: JCO oncology practice Vol. 18; no. 3; p. e412
• Main Authors: Diorio, Caroline, Vardaro, Julie, Wei, Yahui, Mauro, Jane, Croy, Colleen, Oranges, Katelyn E, Flanagan, Lindsay, Reilly, Anne F, Bailey, L Charles, Jubelirer, Tracey, Elgarten, Caitlin W, Freedman, Jason L
• Format: Journal Article
• Language: English
• Published: United States 01.03.2022
• Subjects: Antiemetics - pharmacology; Antiemetics - therapeutic use; Antineoplastic Agents; Aprepitant - adverse effects; Child; Humans; Nausea - chemically induced; Nausea - drug therapy; Nausea - prevention & control; Neoplasms - complications; Neoplasms - drug therapy; Vomiting - chemically induced; Vomiting - drug therapy; Vomiting - prevention & control
• ISSN: 2688-1535
• DOI: 10.1200/OP.21.00476

Chemotherapy-induced nausea and vomiting (CINV) is a very common side effect of pediatric cancer therapy. High-quality, evidence-based, pediatric-specific guidelines for prophylaxis and treatment of CINV are available. At many centers, guideline-concordant care is uncommon. We formed a multidisciplinary quality improvement team to implement guideline-concordant care for CINV prophylaxis at our center. We present the results following the first year of our interventions. We planned and implemented a multipronged approach in three key phases: (1) developing and publishing an acute CINV prophylaxis pathway, (2) education of providers, and (3) updating the computerized provider order entry system. We used iterative, sequential Plan-Do-Study-Act cycles and behavioral economic strategies to improve adherence to guideline-concordant CINV prophylaxis. We focused on aprepitant usage as a key area for improvement. At the beginning of the study period, < 50% of patients were receiving guideline-concordant CINV prophylaxis and < 15% of eligible patients were receiving aprepitant. After 1 year, more than 60% of patients were receiving guideline-concordant care and 50% of eligible patients were receiving aprepitant. We describe the development and implementation of a standardized pathway for prevention of acute CINV in pediatric oncology patients. With a multidisciplinary, multifaceted approach, we demonstrate significant improvements to guideline-congruent CINV prophylaxis.