Related Experiment Video

Updated: Aug 14, 2025

Acupoint Application Combined with Acupressure as an Adjunctive Therapy for Chemotherapy-Induced Nausea and Vomiting

Acupoint Application Combined with Acupressure as an Adjunctive Therapy for Chemotherapy-Induced Nausea and Vomiting

Published on: June 21, 2024

Addressing adherence to guidelines on prevention of acute chemotherapy-induced nausea and vomiting in pediatric

Marija Kacar^1,2, Paula MacDonald³, Paul Gibson^3,4

¹Division of Solid Tumors, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.

Pediatric Blood & Cancer

|January 16, 2023

Insights

Improving adherence to pediatric clinical practice guidelines for chemotherapy-induced nausea and vomiting (CINV) prevention is crucial. Quality improvement interventions significantly increased guideline adherence in children receiving highly emetogenic chemotherapy (HEC).

Area of Science:

Pediatric Oncology
Clinical Quality Improvement
Pharmacology

Background:

Chemotherapy-induced nausea and vomiting (CINV) is a significant challenge in pediatric cancer care.
Existing pediatric clinical practice guidelines (CPG) for CINV prevention show low adherence rates.
Addressing CINV is essential for improving patient quality of life during cancer treatment.

Purpose of the Study:

To enhance adherence to CPG for acute CINV prevention in hospitalized pediatric patients.
To increase adherence from a baseline of 25% to over 70% for high (HEC) and moderately emetogenic chemotherapy (MEC) by June 2021.
To identify and overcome barriers to CINV guideline adherence.

Main Methods:

A quality improvement study was conducted at McMaster Children's Hospital.
Interventions included process mapping to identify barriers, staff education, formulary adjustments for anti-emetics, and a standardized CPG tool.
Guideline adherence was assessed via chart review of 270 inpatient chemotherapy administrations (131 pre-intervention, 139 post-intervention).

Main Results:

Overall guideline adherence for CINV prevention improved from 25% to 72% (p < .001).
Adherence significantly increased in the high emetogenic chemotherapy (HEC) group from 32% to 93% (p < .001).
Adherence in the moderately emetogenic chemotherapy (MEC) group improved from 13% to 34% (p = .015), with aprepitant use in HEC and ondansetron monotherapy in MEC being common non-adherence reasons.

Conclusions:

Quality improvement initiatives effectively enhanced adherence to CINV prevention guidelines, particularly for HEC.
Further efforts are needed to sustain interventions and improve adherence in the MEC group.
Targeted strategies are required to address specific barriers in different chemotherapy emetogenicity categories.

Read full analysis

Abstract

Background:

Chemotherapy-induced nausea and vomiting (CINV) is a distressing adverse effect in children receiving cancer treatment. There are evidence-based pediatric clinical practice guidelines (CPG) on chemotherapy emetogenicity and acute CINV prevention, but adherence to these guidelines is low.

Procedure:

A quality improvement-based study was conducted at McMaster Children's Hospital. The SMART aim was to increase adherence to guidelines on prevention of acute CINV in hospitalized patients receiving high (HEC) and moderately emetogenic chemotherapy (MEC) from baseline 25% to more than 70% by June 2021. Barriers were identified by process mapping, and a series of interventions were implemented.

Results:

Guideline adherence was assessed in 270 inpatient chemotherapy administrations (HEC, MEC). Data were collected on 131 charts pre interventions and 139 charts post interventions. Interventions included education, addition of guideline-recommended anti-emetics to the inpatient formulary, and implementation of a standardized CPG tool. Initial rates of total CINV guideline adherence were 25%, which improved to 72% post intervention (p < .001). In subgroup analysis, guideline adherence in the MEC group improved from 13% to 34% (p = .015), and in the HEC group from 32% to 93% (p < .001). The most common reason for nonadherence in the HEC group was failure to use aprepitant as anti-emetic, and in MEC was option for ondansetron monotherapy prophylaxis.

Conclusion:

Using quality improvement methodology, barriers to guideline adherence were identified and interventions implemented. Guideline adherence for prevention of CINV improved, particularly in the HEC group but less for the MEC group. Future steps will include sustainability of interventions and addressing adherence in the MEC group.

Keywords:

anti-emetics chemotherapy nausea pediatrics supportive care vomiting

More Related Videos

Author Spotlight: Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture

Author Spotlight: Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture

Published on: August 4, 2023

Guidelines for Elective Pediatric Fiberoptic Intubation

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

Related Concept Videos

Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists

Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists

Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy. SP binds and activates...

Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists

Chemotherapy-Induced Nausea and Vomiting: 5-HT₃ Receptor Antagonists

5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...

Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists

Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists

Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
Phenothiazines, such as prochlorperazine...

Chemotherapy-Induced Nausea and Vomiting: Cannabinoids

Chemotherapy-Induced Nausea and Vomiting: Cannabinoids

Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
Two synthetic agonists of THC,...

Nursing Ethical Principles II

Nursing Ethical Principles II

Ethical principles are essential in guiding nurses to fulfill their responsibilities, focusing on the quality of nursing care and decision-making. These principles, including autonomy, beneficence, non-maleficence, justice, and fidelity, shape the ethical framework within healthcare settings.
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...

Prevention of Further Absorption of Poison

Prevention of Further Absorption of Poison

In cases of acute poisoning, the primary objective is to prevent further absorption of the toxic substance into the body. Immediate interventions using various decontamination techniques targeting the gastrointestinal (GI) tract can achieve this. Decontamination is crucial to prevent poison from entering the systemic circulation, which involves washing affected areas with water and mild soap and removing contaminated clothing. Once external decontamination is done, attention must be turned to...

Articles linked to this work by shared authors, journal, and citation graph.

Multi-locus genome-wide association analysis of grain yield, plant height, panicle length, and flowering time in the Senegalese pearl millet [Pennisetum glaucum (L.) R. Br.] germplasm.

PloS one·2026

Upstream process optimization and its critical role in chimpanzee adenoviral vector clinical drug development: lessons learned from VRON-0200 manufacturing.

Frontiers in bioengineering and biotechnology·2026

Scaling up symptom screening for routine use in pediatric oncology: provincial implementation.

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer·2026

Characterization and validation of electronic medical record data for pharmacoepidemiologic research.

Frontiers in pharmacology·2026

Area-Based Marginalization and Incidence of Childhood Cancer.

JAMA network open·2026

VRON-0200 alone and in combination with investigational antivirals for participants with chronic hepatitis B virus infection receiving stable nucleos(t)ide therapy: a phase 1b, randomised, open-label, multicentre trial.

The Lancet. Microbe·2026

See all related articles