Children Receiving Cancer Chemotherapy Research Articles

Nutritional Status, Eating Behaviors, and Gastrointestinal Symptom Cluster Among Children Receiving Cancer Chemotherapy in Thailand: A Descriptive Study

Background: Most children undergoing chemotherapy for cancer experience gastrointestinal (GI) tract symptoms that affect their eating habits, nutritional status, and quality of life (QOL). Previous research on the connections between these factors has primarily focused on Western countries. As a result, there is limited understanding of these issues among Thai children. Objective: To describe GI symptoms, eating, nutritional status, and QOL for Thai children with cancer. Methods: This descriptive study used multiple methods. Quantitative data were collected through (1) standardized measures of GI symptoms and QOL and (2) extraction of medical history and clinical data from the child’s medical records, then analyzed using descriptive statistics. Qualitative data were collected with semistructured interviews with each child, then their parent, and analyzed using a directed content analysis. Results: Sixteen child-parent dyads participated in this study. Most children exhibited reduced food intake and weight loss, primarily attributed to GI symptoms and environmental factors. Underreporting of symptoms was identified, contributing to suboptimal symptom management. Clinician-recommended low-bacterial diets posed challenges to maintaining children’s food intake. Additionally, hospital food with repetitive menus and plain flavors was generally undesirable for children during hospitalization. Conclusions: Multifaceted factors influencing the nutritional status and QOL of children with cancer within the unique care context of Thailand were identified. Implications for Practice: The study findings inform the development of multi-level interventions targeting to optimize eating, nutritional status, and QOL for children with cancer. What is Foundational: The model, informed by cultural considerations, could be adapted for research in other countries with distinctive cultures.

Safety of Procalcitonin Guided Early Discontinuation of Antibiotic Therapy among Children Receiving Cancer Chemotherapy and Having Low-Risk Febrile Neutropenia: A Randomized Feasibility Trial (ProFenC Study)

In low-risk febrile neutropenia (LR-FN), the safety of early discontinuation of empiric antibiotics without marrow recovery is not well established. This study aimed to evaluate the safety of procalcitonin (PCT) guided early discontinuation of antibiotics in LR-FN. In this trial, children with LR-FN with an afebrile period of at least 24 h, sterile blood culture, and negative/normalized PCT were randomized at 72 h of starting antibiotics into two groups: intervention arm and standard arm. The antibiotics were stopped in the intervention arm regardless of absolute neutrophil count (ANC), while in the standard arm, antibiotics were continued for at least 7 days or until recovery of ANC (>500/mm3). The primary objective was to determine the treatment failure rates, and the secondary objective was to compare the duration of antibiotics and all-cause mortality between the two arms. A total of 46 children with LR-FN were randomized to either the intervention arm (n = 23) or the standard arm (n = 23). Treatment failure was observed in 2/23 (8.7%) of patients in the intervention arm compared to 1/23 (4.3%) in the standard arm [RR: 2 (95% CI: 0.19–20.6); p = 0.55]. The median duration of antibiotics in the intervention arm and standard arm were 3 days vs 7 days (P= <0.001). There was no mortality in this study. PCT-guided early discontinuation of empirical antibiotics in LR-FN is feasible. There was no significant difference observed in treatment failure between the early discontinuation of antibiotics vs standard therapy. The total duration of antibiotic exposure was significantly lesser in the discontinuation arm. Further, larger multicenter studies are needed to confirm the finding of this study.

Erratum to: Population pharmacokinetics of piperacillin in febrile children receiving cancer chemotherapy: the impact of body weight and target on an optimal dosing regimen.

BACKGROUND The β-lactam antibiotic piperacillin (in combination with tazobactam) is commonly chosen for empirical treatment of suspected bacterial infections. However, pharmacokinetic variability among patient populations and across ages leads to uncertainty when selecting a dosing regimen to achieve an appropriate pharmacodynamic target. OBJECTIVES To guide dosing by establishing a population pharmacokinetic model for unbound piperacillin in febrile children receiving cancer chemotherapy, and to assess pharmacokinetic/pharmacodynamic target attainment (100% fT > 1×MIC and 50% fT > 4×MIC) and resultant exposure, across body weights. METHODS Forty-three children admitted for 89 febrile episodes contributed 482 samples to the pharmacokinetic analysis. The typical doses required for target attainment were compared for various dosing regimens, in particular prolonged infusions, across MICs and body weights. RESULTS A two-compartment model with inter-fever-episode variability in CL, and body weight included through allometry, described the data. A high CL of 15.4 L/h (70 kg) combined with high glomerular filtration rate (GFR) values indicated rapid elimination and hyperfiltration. The target of 50% fT > 4×MIC was achieved for an MIC of 4.0 mg/L in a typical patient with extended infusions of 2-3 (q6h) or 3-4 (q8h) h, at or below the standard adult dose (75 and 100 mg/kg/dose for q6h and q8h, respectively). Higher doses or continuous infusion were needed to achieve 100% fT > 1×MIC due to the rapid piperacillin elimination. CONCLUSIONS The licensed dose for children with febrile neutropenia (80 mg/kg q6h as a 30 min infusion) performs poorly for attainment of fT>MIC pharmacokinetic/pharmacodynamic targets. Given the population pharmacokinetic profile, feasible dosing regimens with reasonable exposure are continuous infusion (100% fT > 1×MIC) or prolonged infusions (50% fT > 4×MIC).

Population pharmacokinetics of piperacillin in febrile children receiving cancer chemotherapy: the impact of body weight and target on an optimal dosing regimen.

BackgroundThe β-lactam antibiotic piperacillin (in combination with tazobactam) is commonly chosen for empirical treatment of suspected bacterial infections. However, pharmacokinetic variability among patient populations and across ages leads to uncertainty when selecting a dosing regimen to achieve an appropriate pharmacodynamic target.ObjectivesTo guide dosing by establishing a population pharmacokinetic model for unbound piperacillin in febrile children receiving cancer chemotherapy, and to assess pharmacokinetic/pharmacodynamic target attainment (100% fT > 1×MIC and 50% fT > 4×MIC) and resultant exposure, across body weights.MethodsForty-three children admitted for 89 febrile episodes contributed 482 samples to the pharmacokinetic analysis. The typical doses required for target attainment were compared for various dosing regimens, in particular prolonged infusions, across MICs and body weights.ResultsA two-compartment model with inter-fever-episode variability in CL, and body weight included through allometry, described the data. A high CL of 15.4 L/h (70 kg) combined with high glomerular filtration rate (GFR) values indicated rapid elimination and hyperfiltration. The target of 50% fT > 4×MIC was achieved for an MIC of 4.0 mg/L in a typical patient with extended infusions of 2–3 (q6h) or 3–4 (q8h) h, at or below the standard adult dose (75 and 100 mg/kg/dose for q6h and q8h, respectively). Higher doses or continuous infusion were needed to achieve 100% fT > 1×MIC due to the rapid piperacillin elimination.ConclusionsThe licensed dose for children with febrile neutropenia (80 mg/kg q6h as a 30 min infusion) performs poorly for attainment of fT>MIC pharmacokinetic/pharmacodynamic targets. Given the population pharmacokinetic profile, feasible dosing regimens with reasonable exposure are continuous infusion (100% fT > 1×MIC) or prolonged infusions (50% fT > 4×MIC).

がん化学療法に伴い子どもが体験する悪心・嘔吐の症状マネジメント : IASMの概念を用いた介入研究

がん化学療法に伴い子どもが体験する悪心・嘔吐の症状マネジメント : IASMの概念を用いた介入研究

Anticoagulation Therapy for Thrombotic Events in Paediatric Cancer Patients with Low Platelet Counts

Background Thrombocytopenia is common in children receiving cancer chemotherapy. In addition, children with cancer are also at increased risk of acute thrombotic events (TE). When these two complications occur simultaneously, TE management with anticoagulants (ACT) poses a unique challenge, as ACT use in thrombocytopenic patients increases their bleeding risk. Current guidelines provide only best practice recommendations on how to manage this treatment conundrum, and even these recommendations vary on optimal management due to the lack of evidence to guide treatment. To date, no systematic literature review summarizing the available paediatric data on treatment of TE in the presence of thrombocytopenia has been conducted. The aim of our systematic review was to summarize the data available to evaluate the safety of ACT for management of TE in paediatric oncology patients during periods of thrombocytopenia. Methods We systematically searched MEDLINE and EMBASE from the OVID platform from inception to April 15th 2016 for studies that included children aged less than 18 years with diagnosis of cancer complicated by an objectively confirmed TE, whose anticoagulation therapy was complicated by a period of thrombocytopenia (as defined by the study author). We included all study designs. Two authors (LB and AA) screened the data at title then full-text level to select eligible studies. Disputes were arbitrated by a third author (UA) until a consensus was reached. Our primary outcome was haemorrhagic complications, categorized as minor or major according to paediatric ISTH criteria. Bleeding episodes were divided according to anticoagulation intensity (age-appropriate, agent-specific full dose vs. half-dose, as per CHEST guidelines) and degree of thrombocytopenia (i.e. severe &lt;/=50 x109/L, moderate 51-99 x109/L, mild &gt;/=100 x109/L). Our secondary outcome was the identification of platelet transfusion triggers according to degree of anticoagulation intensity. Results Our search yielded 244 articles, of which 13 were screened at a full text level. Four manuscripts were selected for inclusion, as follows: case report (n=1), case series (n=2), and prospective cohort study (n=1). Details of included studies are described inTable 1 and patient information in table 2. The studies included 39 patients with malignancies, of which the most common were acute lymphoblastic leukaemia (n=13), CNS malignancies (n=6), non-hodgkinlymphoma(n=4). All patients had venous TE. Type and regimen of ACT, and author definitions of thrombocytopenia and bleeding were variable. Thirty-five patients received low-molecular weight heparin (LMWH), of whom 33 received therapeutic dose, and no dose was recorded for two. Three patients received unfractionated heparin (UFH) with antithrombin(AT) supplementation; however, UFH wasstopped in periods of low platelet counts, and one received a reduced dose UFH. According to our definition, 36/39 (92.3%) experienced severe thrombocytopenia, 1 (2.6%) developed moderate thrombocytopenia, platelet count was not stated in 2(5.1%). Using the ISTH bleeding criteria, one patient (2.6%) developed major bleeding, and seven (17.9%) developed minor bleeding (n=2 intestinal bleeding, n=5 injection site/port bleeding). Only one study reported our secondary outcome, which used a platelet transfusion trigger of &lt;40x109/L if receiving therapeutic LMWH and &lt;20x109/L if receiving prophylactic LMWH. Given the heterogeneity, we were unable to statistically aggregate any data. Discussion The results of this systematic review highlight the paucity of high-quality data to assess the use and safety of ACT for TE in paediatric cancer patients during periods of thrombocytopenia. We identified only observational studies- one prospective and three retrospective in design. These studies included very few patients (total n=39), and had variable patients, disease and treatment-related factors. Evidence-based recommendations cannot be generated to guide an optimal ACT management in such situations. Further research using standardized definitions is needed to identify optimal strategies for treating thrombotic events during periods of thrombocytopenia. Such research will help on the development of evidence-based clinical practice guidelines to improve patient care. Disclosures Brandão: Boehringer Ingelheim: Consultancy.

To Determine the Role of Procalcitonin in Febrile Neutropenic Episodes of Children Undergoing Treatment for Childhood Cancers

Background: Infections are major cause of morbidity and mortality in children receiving cancer chemotherapy particularly when they are neutropenic, mainly due to immune deficiency. Between 48-60% neutropenic patients with fever have an underlying infection which can often be life threatening. Before putting the child on empiric antimicrobial regimes for FN, it is essential to know the spectrum of locally prevalent pathogens and their susceptibility patterns. Often these children don’t manifest fever even in presence of infection and fever may be present in neutropenic patients receiving chemotherapy even in the absence of infection. Present diagnostic tools available for diagnoses in FN are often not so robust and do not differentiate between various classes of organisms causing these infections. Procedure: Blood culture is time consuming and negative blood culture does not exclude bacteremia, which leads to the empirical use of broad-spectrum antibiotic treatment in pediatric patients with neutropenia, even where signs of infection are absent. We propose to evaluate the role of PCT, as a sensitive marker to evaluate pediatric oncology patients presenting with FN. Results: Blood-culture was positive in 18.05% of the patients, with majority of patients having gram-negative bacterial infections. On comparison with the focus of infection, high PCT and CRP values were obtained in patients with pulmonary infection than in extra-pulmonary infections. In our study the sensitivity of PCT was high upto 73.3% at a cut-off of ≥0.25 ng/ml for ruling out bacteremia, when compared to blood culture and CRP in our patients. Conclusion: The PCT value is certainly helpful in guiding the physicians in clinical decisions and thus the better approach towards the management of pediatrics oncology patients with FN.

Assessment of hepatitis B immunization status after antineoplastic therapy in children with cancer

BACKGROUND AND OBJECTIVES:Hepatitis B is a disease that is preventable with vaccination. Antibody levels after vaccination may be affected by suppression of the immune system due to cancer therapy. Children with cancer have a high risk of hepatitis B virus (HBV) infection. We aimed to assess the pretreatment immunization status against HBV infection and the rate of continuity of immunization after therapy in children with cancer.DESIGN AND SETTING:Retrospective case review of patients treated from 2004 to 2008.PATIENTS AND METHODS:We reviewed the medical records of patients treated in the departments of pediatric hematology and oncology and collected data on immunization history and hepatitis B serology. Anti-HBs antibody titers were compared before and after treatment.RESULTS:This study included 159 (99 males, 60 females) children who had a serologic examination. Antineoplastic therapy had been given for acute leukemia (n=66), non-Hodgkin lymphoma (n=27), Hodgkin lymphoma (n=20), and solid tumors (n=46). Fifty-one patients had not been immunized against HBV prior to the therapy; HBV serology was negative in 49 of these patients and HBsAg was positive in 2 patients. Anti-HBs antibody positivity was present in 99 of 108 patients with an immunization history, whereas no vaccination response was present in 9 patients. The titer of anti-HBs antibody was decreased below the protection level in 33 (33%) patients with positive anti-HBs antibody, whereas the protection level was found to be maintained in 66 (67%) patients. The most significant decrease (63.6%) was observed in leukemia patients. Posttreatment HBsAg and HBV DNA positivity was detected in two of the patients with negative pretreatment serology, whereas no HBV infection developed in the group with positive anti-HBs antibody.CONCLUSIONS:This study demonstrated the importance of routine childhood vaccination in reducing the risk of HBV infection in patients with cancer.

Presumptive treatment for malaria is not justified in children receiving cancer chemotherapy

Predominant etiologies of febrile neutropenia (FN) during the course of cancer chemotherapy include infections with bacteria, fungi, and viruses. Infection with malarial parasite is a possibility in regions that are endemic for malaria. Over-diagnosis and over-treatment of malaria is increasingly being recognized as a serious concern in malaria endemic regions. Aim was to determine the incidence of malarial infection in episodes of FN in children receiving chemotherapy for malignant disorders. Children, with malignant disorders, on chemotherapy, who fulfilled the definition of FN were enrolled prospectively. Standard microscopy, quantitative buffy coat, and antigen detection (OptiMAL) were performed in each episode of FN. One hundred episodes of FN involving 82 children were investigated. The age ranged from 2 to 13 years (mean: 5.8 ± 2.8). Eighty-one episodes were in children with acute lymphoblastic leukemia, 15 in acute myeloid leukemia, and remaining 4 in other malignancies. Evidence for malaria was not found in any case by any of the three methods. Malaria was not found to be a causative agent for FN in children with various malignant disorders, in a region with low endemicity for malaria. Presumptive administration of antimalarials in children with FN is unjustified. Pediatric oncologists constantly face the challenge of managing febrile illnesses in immunocompromised patients. Those practicing in malaria endemic regions can effectively exploit diagnostic tools for malaria for a rational decision.

Antiemetic activity of ginger in childrenreceiving cancer chemotherapy

Objective: To evaluate the antiemetic effect of ginger versus metoclopramide in children receiving cancer chemotherapy. Methods: A sample of 50 patients aged 6 – 14 years attending the Haematooncology unit in Ibn Al – Atheer Children's Teaching Hospital in Mosul city and receiving chemotherapy for their malignancies were included. They were randomly subdivided into 2 groups and received different types of treatment including ginger and metoclopramide. Results: The study showed that cancer was more common in female than in male with male to female ratio 0.85/1. Acute lymphoblastic leukemia was the most common type of cancer and constituted 60% of the cases and it revealed that response rate was higher in those treated by ginger compared to metoclopramide (72% and 32% respectively); response was found to be higher in males than in females (86.6% and 50% respectively). Conclusions: Nausea and vomiting are common problems in children receiving chemotherapy. Ginger (Zingiber officinale) appears to be promising in controlling these problems.

Meta-analysis: Effect of Prophylactic Hematopoietic Colony-Stimulating Factors on Mortality and Outcomes of Infection

Benefits of prophylactic hematopoietic colony-stimulating factors (CSFs) in adults and children receiving cancer chemotherapy or undergoing stem-cell transplantation (SCT) are unclear. To determine whether prophylactic CSFs decrease mortality, infections, and febrile neutropenia more than does placebo or no therapy in patients with cancer and in patients undergoing SCT. Electronic searches of Ovid MEDLINE and EMBASE from inception until April 2007 and of the Cochrane Central Register of Controlled Trials until the second quarter of 2006. We selected 148 trials that were reported in any language that randomly assigned patients to CSFs or to either placebo or no therapy. Prophylactic CSFs were given concurrently with or after initiation of chemotherapy. Two reviewers independently extracted data onto standardized forms. Short-term all-cause mortality appeared to be similar between the prophylactic CSF and the control groups (7.6% vs. 8.0%; relative risk, 0.95 [95% CI, 0.84 to 1.08]; absolute risk reduction, 0.4% [CI, -0.5% to 1.4%]). Risks for infection-related death with CSFs and placebo or no therapy were 3.1% and 3.8%, respectively (relative risk, 0.82 [CI, 0.66 to 1.02]; absolute risk reduction, 0.8% [CI, 0.0% to 1.5%]). Use of CSFs reduced the following more than did placebo or no therapy: documented infections (median rate, 38.9% vs. 43.1%; rate ratio, 0.85 [CI, 0.79 to 0.92]), microbiologically documented infections (median rate, 23.5% vs. 28.6%; rate ratio, 0.86 [CI, 0.77 to 0.96]), and episodes of febrile neutropenia (median rate, 25.3% vs. 44.2%; rate ratio, 0.71 [CI, 0.63 to 0.80]). Trial designs, including assessments of infections, and participants were heterogeneous. Estimates of mortality effects were imprecise. Prophylactic CSFs may have little or no effect on mortality but do decrease rates of infection in patients receiving cancer chemotherapy or those undergoing SCT.

Lack of effect of prophylactic hematopoeitic colony stimulating factors in cancer patients and stem cell transplant recipients on short term survival: A meta-analysis of randomized trials

6605 Background: Previous randomized trials and meta-analyses have failed to determine with certainty whether prophylactic hematopoietic colony-stimulating factors (CSFs) influence survival in adults and children receiving cancer chemotherapy or undergoing stem cell transplantation (SCT). The primary objective was to determine whether prophylactic CSFs improve short-term overall survival. Secondary objectives were to determine whether prophylactic CSFs affected infection-related mortality, documented infections, microbiologically documented infections or febrile neutropenia. Methods: We performed electronic searches of OVID Medline from 1966 to November 2006; EMBASE from 1980 to November 2006; and the Cochrane Central Register of Controlled Trials until the second quarter, 2006. We included studies if there was randomization between CSFs and placebo/no therapy; CSFs were given concurrently with or following initiation of chemotherapy in the prophylactic setting; and chemotherapy/conditioning regimen or supportive care were not planned to be systematically different between study arms. From 4,019 reviewed titles and abstracts, 145 studies were included. Independent extraction was performed by two observers using a standardized data collection sheet. Results: Prophylactic CSFs did not affect short-term overall survival, with a relative risk (RR) of 1.00 (95% confidence interval [CI] 0.99 to 1.01; P=.9). This result was consistent across different patient populations (including patient age and underlying disease) and study characteristics. The effect of prophylactic CSFs on infection-related mortality was less clear (RR 0.83, 95% CI 0.67 to 1.03; P=.09). Intervention did reduce documented infections (rate ratio 0.85, 95% CI 0.78 to 0.92; P&lt;.00001), microbiologically documented infections (rate ratio 0.85, 95% CI 0.75 to 0.95; P=.004) and febrile neutropenia (rate ratio 0.70, 95% CI 0.62 to 0.79; P&lt;.00001). Conclusions: Prophylactic CSFs do not improve short-term overall survival but are associated with decreased rates of infection. Decision-making around this intervention should be based upon further exploration of costs, preferences and quality of life. No significant financial relationships to disclose.

COMPARISON OF ACCELERATED AND RAPID SCHEDULES FOR MONOVALENT HEPATITIS B AND COMBINED HEPATITIS A/B VACCINES IN CHILDREN WITH CANCER

The aim of this study was to determine the efficacy of immunization against hepatitis A and B infections with “rapid” or “accelerated” schedules in children with cancer receiving chemotherapy. Fifty-one children were recruited to receive either vaccination schedule, in the “rapid vaccination schedule”; hepatitis B (group I) or combined hepatitis A/B vaccines (group III) were administered at months 0, 1, 2, and 12; in the “accelerated vaccination schedule,” hepatitis B (group II) or combined hepatitis A/B (group IV) vaccines were administered on days 0, 7, 21, and 365 intramuscularly. The seroconversion rates at months 1 and 3 were 35.7 and 57.1% in group I and 25 and 18.8% in group II, respectively. Group I developed higher seroconversion rates at month 3. In group III the seroconversion rates for hepatitis B at months 1 and 3 were 54.5 and 60% and in group IV 50 and 70%, respectively. For hepatitis A, the seroconversion rates at months 1 and 3 were 81.8 and 90% in group III and 80 and 88.9% in group IV, respectively. The accelerated vaccination schedule seems to have no advantage in children receiving cancer chemotherapy except for high antibody levels at month 1. In conclusion, the accelerated vaccination schedules are not good choices for cancer patients. The combined hepatitis A/B vaccine is more effective than monovalent vaccine in cancer patients, which probably can be explained by an adjuvant effect of the antigens. The seroconversion of hepatitis A by the combined hepatitis A/B vaccination is very good in cancer patients.

Inpatient versus outpatient management of low-risk pediatric febrile neutropenia: measuring parents' and healthcare professionals' preferences.

Our primary objective was to describe and compare parents' and healthcare professionals' strength of preference scores for outpatient oral antibiotic relative to inpatient parenteral antibiotic treatment for low-risk febrile neutropenic children. Our secondary objective was to identify predictors of strength of preference for oral outpatient treatment. Respondents were parents of children receiving cancer chemotherapy, and pediatric oncology healthcare professionals. First, the inpatient and outpatient options were described, and the respondent indicated their initially preferred option. The respondent next ranked how important seven factors (including "fear/anxiety" and "comfort") were in making their initial choice. The threshold technique was then used to elicit the respondent's strength of preference score for oral outpatient, relative to parenteral inpatient management. There were 75 parent and 42 healthcare-professional respondents. There was no significant difference (P =.08) in the proportions of parents (40 of 75; 53%) and healthcare professionals (30 of 42; 71%) who initially would choose outpatient management. For parents, stronger preference for oral outpatient therapy was associated with higher anticipated quality of life for the parent and child at home relative to hospital, lower importance rank for "fear/anxiety," and higher importance rank for "comfort." Conversely, for professionals, only lower importance rank for "fear/anxiety" was associated with higher strength of preference scores for outpatient oral antibiotic management. Only 53% of parents would choose outpatient oral antibiotic management for low-risk febrile neutropenia. Predictors of strength of preference scores for outpatient oral antibiotic relative to inpatient parenteral antibiotic treatment differed between parent and professional respondents.

COMPARISON OF TROPISETRON AND GRANISETRON IN THE CONTROL OF NAUSEA AND VOMITING IN CHILDREN RECEIVING COMBINED CANCER CHEMOTHERAPY

Tropisetron and granisetron are selective serotonin (5-HT 3 ) antagonists that have been proven effective in the prevention of nausea and vomiting in adults and children receiving cancer chemotherapy. This prospective, randomised study was designed to compare the efficacy of the two agents in the prevention of vomiting and nausea in children receiving highly emetogenic chemotherapy for various malignancies. A total of 51 children (mean age: 7.7 - 4.8 year) were studied in 133 chemotherapy cycles. In 66 chemotherapy cycles, the children received tropisetron as an antiemetic agent in a dose of 0.2 mg/kg/24 h intravenously and, in 67 cycles, they received granisetron 40 w g/kg/24 h intravenously before cytotoxic drug administration during the days they received chemotherapy. The response per 24 h of chemotherapy was defined as complete (no nausea and vomiting), partial (1-4 events of vomiting and/or nausea), and failure (more than 4 events o fvomiting and/or nausea). Efficacy of antiemetic therapy was evaluatedas acute (Day 1) and overall was based on the worst day during the chemotherapy. Complete control of acute vomiting was achieved in 74% of tropisetron and 88% of granisetron patients ( P = 0.04), and complete control of acute nausea in 56% and 82% respectively ( p = 0.002). Overall response by means of complete control of both vomiting and nausea during the whole therapy period was 29% of tropisetron group and 55% of granisetron group ( p = 0.007). The statistical analysis (depending on the emetogenicity of the chemotherapy cycles) showed increased efficacy of granisetron in highly (grade 3) emetogenic chemotherapy cycles ( p = 0.002), whereas there was no differencein the very highly emetogenic cycles ( p = 0.7). Also, granisetron was found to be more effective than tropisetron, especially in patients heavier than 25 kg ( p = 0.02). The adverse reactions were few and mild. There were no differences in the tolerability of the two antiemetic therapy modalities. In conclusion, granisetron was found to be more effective than tropisetron in controlling nausea and vomiting in children receiving highly emetogenic chemotherapy. This increased antiemetic efficacy of granisetron might have been related to maximal dose differences according to body weight.

Commentary on "Treatments that work in pediatric psychology: Procedure-related pain".

that many children under the age of 6 years had difficulty mastering the skills involved in progressive muscle relaxation, imagery, and deep breathing. Consequently, modified cognitive-behavioral strategies, such as distraction, may be more appropriate for preschool children. Additional modifications may be needed for children with other special needs, such as motor or cognitive disabilities. We also know very little about the long-term outcome of cognitive-behavioral interventions for procedural pain. It is admirable that several of the studies that were cited in this review presented long-term outcome data. In actuality, however, we have only published data demonstrating continued benefits of treatment after the complete withdrawal of cognitive-behavioral therapy for a handful of children! Powers et al. (1993) documented the longest follow-up period, with three children maintaining reductions in behavioral distress for 1 to 6 months postintervention. In the remaining studies that included follow-up behavioral observations, Blount et al. (1994), Dahlquist et al. (1985), and Jay et al. (1985) documented that distress reductions maintained for one to two sessions for a total of eight children. Thus, the question of whether children actually can continue to effectively use cognitive-behavioral coping strategies for months or years following the completion of psychological treatment remains to be answered. We currently are in the process of analyzing 6to 12-month followup data from an NCI-funded longitudinal study of cognitive behavioral treatment of children receiving cancer chemotherapy. Our preliminary data suggest that virtually all children responded posiJournal of Pediatric Psychology, Vol. 24, No. 2, 1999, pp. 153–154

ONDANSETRON AND TROPISETRON IN THE CONTROL OF NAUSEA AND VOMITING IN CHILDREN RECEIVING COMBINED CANCER CHEMOTHERAPY

Ondansetron (Zofron, Glaxo) and tropisetron (Navoban, Sandoz) are selective serotonin (5HT ) 3 antagonists that have proven very effective in the prevention of vomiting and nausea in adults and children receiving cancer chemotherapy. This study compared the efficacy of the two agents in the prevention of vomiting and nausea in children receiving chemotherapy for solid tumors and blood malignancies. A total of 23 children were studied in 205 chemotherapeutic cycles (116 oneday regimens and 89 multiple-day regimens). In 102 chemotherapeutic cycles the children received ondansetron as an antiemetic agent in a dose of 5 mg/m 2 30 min before chemotherapy was given and then 4 mg/m 2 every 8 h IV (group A) and in 103 cycles they received tropisetron in one dose of 0.2 mg/kg 24 h 1 IV (max dose 5 mg) 30 min before cytotoxic drugs administration every day they received chemotherapy (group B). The response was defined as complete in the absence of nausea and vomiting per 24 h of chemotherapy, as partial given the presence of 1-4 events of vomiting and/or nausea less than 5 h per 24 h, and as failure if there were more than 4 events of vomiting and/or nausea for more than 5 h per 24 h of chemotherapy. The response of the two groups was studied independently and depending on the degree of emetogenicity of the chemotherapeutic agents, which were divided into mildly, moderately, and highly emetogenic. The comparison of the two groups not taking into consideration the emetogenicity of the chemotherapeutic agents showed that ondansetron was more effective in 1-day regimens ( P = . 023 ), whereas the two agents were equally effective in multiple-day regimens ( P = . 2 ). The statistical analysis depending on the emetogenicity of the chemotherapeutic agents showed increased efficacy of ondansetron in mild ( P = . 017 ) and moderately emetogenic chemotherapeutic agents, whereas there was no difference in the highly emetogenic drug group. Ondansetron is found to be more effective than tropisetron in controlling acute nausea and vomiting in children receiving mild and moderately emetogenic chemotherapeutic drugs, although there is no difference in the efficacy of both antiemetic agents when highly emetogenic drugs are administered.

Circadian rhythm of body temperature in children receiving cancer chemotherapy

Circadian rhythm of body temperature in children receiving cancer chemotherapy

Circadian Rhythm of Body Temperature in Children Receiving Cancer Chemotherapy

Circadian Rhythm of Body Temperature in Children Receiving Cancer Chemotherapy

Prospective Study of Lactose Absorption During Cancer Chemotherapy

SummaryChemotherapy is a recognized cause of morphological alterations to the proximal intestine. Lactose malabsorption, the functional consequence of a small intestinal enzymatic derangement, has been shown to play an important role in causing gastrointestinal symptoms in subjects receiving chemotherapy. To establish a rational basis for the exclusion of lactose from the diet and to reduce the risk of developing gastrointestinal symptoms, we conducted a study of lactose absorption in 20 children during cancer chemotherapy. Because lactose is an important nutritional sugar, the tolerance of lactose provided by yogurt was examined. Lactose absorption was investigated by a hydrogen breath test (BT) after oral ingestion of milk (250 ml) containing physiological doses of lactose (12 g). The effect of yogurt supplementation was also tested by BT after meals of yogurt (450 g) also containing physiological doses of lactose (12.1 g). In 11 children, lactose malabsorption was detected by BT during the study before any gastrointestinal symptom revealed this status. Of these 11 children, no gastrointestinal discomfort developed in five receiving a lactose‐excluded diet. In contrast, in the six children not restricted in lactose intake, gastrointestinal symptoms were observed 4 to 13 weeks after lactose malabsorption was detected by BT. The findings of our study suggested the usefulness of dietary supplementation with yogurt, a lactose‐containing food, in children who developed lactose malabsorption. In fact, all lactose‐malabsorbent children showed good lactose absorption and tolerance when tested by yogurt BT. Furthermore, a yogurt‐supplemented diet was also successful in three subjects initially recognized as lactose intolerant. In conclusion, the data presented have important implications in reducing the risk of developing gastrointestinal symptoms in children receiving cancer chemotherapy.