Evaluation of Adequacy of Control of Chemotherapy Induced Vomiting in Paediatric Patients With Cancer at Kenyatta National Hospital

Abstract

Background Chemotherapy-induced nausea and vomiting (CINV) is a common side effect associated with various chemotherapy regimens. To mitigate this phenomenon, several classes of antiemetics are recommended for use before and after chemotherapy administration. This includes agents like serotonin type 3 receptor antagonists (5-HT3RA’s), corticosteroids and neurokinin type 1 receptor antagonists (NK1RA’s). There is scanty information on CINV prophylaxis and level of control of vomiting in children with cancer in Kenyatta National Hospital. Objective The main aim was to assess the adequacy of control of vomiting in paediatric patients with cancer at Kenyatta National Hospital. Methodology A longitudinal study design was adopted. Universal sampling technique was used. Patients who satisfied the inclusion criteria were followed up prospectively up to 120 hours post chemotherapy to assess the incidence of vomiting. Complete response was used as the primary endpoint in assessing adequacy of control of emesis in the acute, delayed and overall follow up period. A structured questionnaire was used as the data collection and entry tool during the study period. Data was then analyzed using STATA version 13.0 software. Univariate analysis was done and presented as frequency tables. Bivariate analysis was done using Fisher’s exact as a test of significance. Binary logistic regression was done to assess the strengths of the association. The level of significance adopted in the analysis was 0.05. Results The study population age ranged from 5 to 12 years with a mean age of 8.4±2.3 years. There was male predominance 58 (65.9%). Overall, 86 (97.7%) study participants got acute emesis prophylaxis. In the acute vomiting phase 77 (87.5%) got ondansetron monotherapy as prophylaxis, 6 (6.8%) got granisetron monotherapy while 3 (3.4%) got ondansetron and dexamethasone combination. Two (2.3%) patients did not receive prophylaxis in the acute phase. In the delayed emesis phase 10 (11.4%) study participants got prophylaxis. Out of those, 3 (3.4%) got ondansetron and dexamethasone combination while 7 (8%) got ondansetron monotherapy. Rescue treatment was given to 13 (14.77%) out of 58 (65.9%) v patients who had at least one episode of emesis. Complete response in the acute, delayed and overall follow up period was 47 (53.41%), 49 (55.7%) and 30 (34.09%) respectively. Peak emesis was reported on the first day 41 (46.6%) and reduced gradually over the follow up period. Duration of chemotherapy was found to increase the risk of delayed emesis (OR 4.91 95%CI (1.66 – 14.57), p=0.004). Chemotherapy regimen composition affected risk of emesis; platinum based regimens increased the risk of emesis (OR 20.36 95%CI (1.52 – 272.98), p=0.023) while presence of a steroid in the chemotherapy regimen decreased risk of vomiting (OR 0.26 95%CI (0.09 – 0.75), p = 0.012). High emetogenic chemotherapy increased the risk of emesis (OR 3.30 95%CI (1.22 – 8.88), p = 0.018) compared with moderately and low emetogenic chemotherapy. Conclusion Management of acute and delayed emesis in children still remains a big challenge. There was poor compliance with local and international guideline recommendations for management of chemotherapy induced vomiting. Recommendations Further studies can should assess the reasons for poor adherence to current CINV management guidelines and address the challenges and gaps in practice.