Association of Chemotherapy Regimen Intensity and Use of Psychotropic Medications in Pediatric Oncology Patients.

OBJECTIVE: Pediatric oncology patients endure treatments that may include chemotherapy, surgery, radiation, and transplant. These treatment modalities often have an effect on a patient's mental health. To date, little is known or published about the association between certain cancer treatment regimens and the use of psychotropic medications. The goal of this study is to identify associations between the use of psychotropic medications in pediatric oncology patients in relation to the intensity of their oncologic treatment regimen. METHODS: A retrospective chart review was completed for pediatric oncology patients seen between the years of 2009 and 2019 with prescriptions and/or inpatient orders for specific psychotropic medications. The intensity of the oncologic regimen was categorized using the Intensity of Treatment Rating Scale (ITR-3) tool. Association between the intensity of therapy and use of psychotropic medications were compared using Pearson χ2 and Fisher exact tests as appropriate. RESULTS: There were 172 patients identified as having inpatient and/or outpatient orders for psychotropic medications during the study period. Ninety-one pediatric oncology patients were included in data analysis. It was found that psychotropic medications were used consistently in pediatric oncology patients despite a specific ITR-3 score. There were no statistically significant associations found when comparing ITR-3 scores to psychotropic medication use or to age at diagnosis. CONCLUSIONS: Significance was not obtained in this study; however, we found that psychotropic medications were used across the spectrum of diagnoses, age, and oncologic treatment intensity. This suggests that all pediatric oncology patients should be evaluated for psychiatric needs throughout their course of oncologic treatment.

Optimization of Vancomycin Dosing to Achieve Target Area Under the Curve in Pediatrics.

OBJECTIVE: Vancomycin dosing requirements to achieve a target area under curve/minimum inhibitory concentration (AUC/MIC) of 400 to 600 mg•hr/L have not been established in pediatrics. Dose modeling studies and recent guidelines suggest dosing higher than historical recommendations. This study examines dosing requirements to achieve target AUC/MIC in human pediatric patients. METHODS: This retrospective study includes 77 patients, aged 1 month to 18 years, at a single center, who received at least 2 days of intravenous vancomycin with a pharmacokinetic monitoring note and calculated AUC/MIC. Dosing to achieve target AUC/MIC was evaluated by age and indication. Nephrotoxicity was also assessed. RESULTS: The mean dose required to achieve target AUC/MIC for all patients was 67.7 mg/kg/day. Adjusting for age, the mean dose required to achieve target AUC/MIC of 400 to 600 mg•hr/L was found to be statistically significantly different among 3 age cohorts: 1 month to 5 years, 6 to 12 years, and 13 to 18 years [F(2,74) = 15.32, p < 0.001], with mean requirements of 79 ± 14.1, 65.6 ± 21.1, and 53.9 ± 17.1 mg/kg/day, respectively. Dosing requirements were also found to be statistically significantly different across indications [F(6,70) = 4.84, p < 0.001]. Acute kidney injury was identified in 5 patients (6.5%). CONCLUSIONS: The vancomycin dose required to achieve target AUC/MIC in pediatrics was significantly higher in younger pediatric patients and ranged from 53.9 to 79 mg/kg/day, confirming recent guideline recommendations. Doses can be further adjusted for indication. Nephrotoxicity rates remain low compared with historical rates with single trough monitoring.