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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 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-HT3 antagonists are recommended over dexamethasone

Year of Publication: 2020
Contained in: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Vol. 28, No. 10 (2020), p. 5031-5036
All journal articles: Search for all articles in this journal
Language: English
Contributors: Grant, Robert C | Author
Rotstein, Coleman
Liu, Geoffrey
Forbes, Leta
Vu, Kathy
Lee, Roy
Ng, Pamela
Krzyzanowska, Monika
Warr, David
Knox, Jennifer
Full text access:
Electronic availability is being checked...
Links: Full Text (dx.doi.org)
Keywords: 7S5I7G3JQL
Antiemetic
COVID-19
Chemotherapy
Glucocorticoids
Journal Article
Supportive care
Additional Keywords: *Betacoronavirus
*Coronavirus Infections
*Pandemics
*Pneumonia, Viral
Antiemetics
Antineoplastic Agents
Dexamethasone
Humans
Nausea
Neoplasms
Ontario
Practice Guidelines as Topic
Vomiting
ISSN: 1433-7339
Note: Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Notes: Date Completed 01.09.2020
Date Revised 09.09.2020
published: Print-Electronic
Citation Status MEDLINE
Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
PMID:
    32601854
Physical Description: Online-Ressource
ID (e.g. DOI, URN): 10.1007/s00520-020-05588-6
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520 |a METHODS: We convened an expert panel to systematically review the literature and formulate consensus recommendations 
520 |a 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 
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