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Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada

PURPOSE: People with cancer face an elevated risk of infection and severe sequelae from COVID-19. Dexamethasone is commonly used for antiemetic prophylaxis with systemic therapy for cancer. However, dexamethasone is associated with increased risk of viral and respiratory infections, and causes lymph...

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Autores principales: Grant, Robert C., Rotstein, Coleman, Liu, Geoffrey, Forbes, Leta, Vu, Kathy, Lee, Roy, Ng, Pamela, Krzyzanowska, Monika, Warr, David, Knox, Jennifer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324309/
https://www.ncbi.nlm.nih.gov/pubmed/32601854
http://dx.doi.org/10.1007/s00520-020-05588-6
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author Grant, Robert C.
Rotstein, Coleman
Liu, Geoffrey
Forbes, Leta
Vu, Kathy
Lee, Roy
Ng, Pamela
Krzyzanowska, Monika
Warr, David
Knox, Jennifer
author_facet Grant, Robert C.
Rotstein, Coleman
Liu, Geoffrey
Forbes, Leta
Vu, Kathy
Lee, Roy
Ng, Pamela
Krzyzanowska, Monika
Warr, David
Knox, Jennifer
author_sort Grant, Robert C.
collection PubMed
description PURPOSE: People with cancer face an elevated risk of infection and severe sequelae from COVID-19. Dexamethasone is commonly used for antiemetic prophylaxis with systemic therapy for cancer. However, dexamethasone is associated with increased risk of viral and respiratory infections, and causes lymphopenia, which is associated with worse outcomes during COVID-19 infections. Our purpose was to minimize dexamethasone exposure during antiemetic prophylaxis for systemic therapy for solid tumors during the COVID-19 pandemic, while maintaining control of nausea and emesis. METHODS: We convened an expert panel to systematically review the literature and formulate consensus recommendations. RESULTS: No studies considered the impact of dexamethasone-based antiemetic regimens on the risk and severity of COVID-19 infection. Expert consensus recommended modifications to the 2019 Cancer Care Ontario Antiemetic Recommendations. CONCLUSION: Clinicians should prescribe the minimally effective dose of dexamethasone for antiemetic prophylaxis. Single-day dexamethasone dosing is recommended over multi-day dosing for regimens with high emetogenic risk excluding high-dose cisplatin, preferably in combination with palonosetron, netupitant, and olanzapine. For regimens with low emetogenic risk, 5-HT(3) antagonists are recommended over dexamethasone.
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spelling pubmed-73243092020-06-30 Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada Grant, Robert C. Rotstein, Coleman Liu, Geoffrey Forbes, Leta Vu, Kathy Lee, Roy Ng, Pamela Krzyzanowska, Monika Warr, David Knox, Jennifer Support Care Cancer Original Article PURPOSE: People with cancer face an elevated risk of infection and severe sequelae from COVID-19. Dexamethasone is commonly used for antiemetic prophylaxis with systemic therapy for cancer. However, dexamethasone is associated with increased risk of viral and respiratory infections, and causes lymphopenia, which is associated with worse outcomes during COVID-19 infections. Our purpose was to minimize dexamethasone exposure during antiemetic prophylaxis for systemic therapy for solid tumors during the COVID-19 pandemic, while maintaining control of nausea and emesis. METHODS: We convened an expert panel to systematically review the literature and formulate consensus recommendations. RESULTS: No studies considered the impact of dexamethasone-based antiemetic regimens on the risk and severity of COVID-19 infection. Expert consensus recommended modifications to the 2019 Cancer Care Ontario Antiemetic Recommendations. CONCLUSION: Clinicians should prescribe the minimally effective dose of dexamethasone for antiemetic prophylaxis. Single-day dexamethasone dosing is recommended over multi-day dosing for regimens with high emetogenic risk excluding high-dose cisplatin, preferably in combination with palonosetron, netupitant, and olanzapine. For regimens with low emetogenic risk, 5-HT(3) antagonists are recommended over dexamethasone. Springer Berlin Heidelberg 2020-06-30 2020 /pmc/articles/PMC7324309/ /pubmed/32601854 http://dx.doi.org/10.1007/s00520-020-05588-6 Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Article
Grant, Robert C.
Rotstein, Coleman
Liu, Geoffrey
Forbes, Leta
Vu, Kathy
Lee, Roy
Ng, Pamela
Krzyzanowska, Monika
Warr, David
Knox, Jennifer
Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada
title Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada
title_full Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada
title_fullStr Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada
title_full_unstemmed Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada
title_short Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada
title_sort reducing dexamethasone antiemetic prophylaxis during the covid-19 pandemic: recommendations from ontario, canada
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324309/
https://www.ncbi.nlm.nih.gov/pubmed/32601854
http://dx.doi.org/10.1007/s00520-020-05588-6
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