Dupuis, L., Robinson, P.D., Boodhan, S., Holdsworth, M., Portwine, C., Gibson, P., . . . Sung, L. (2014). Guideline for the prevention and treatment of anticipatory nausea and vomiting due to chemotherapy in pediatric cancer patients. Pediatric Blood and Cancer, 61, 1506–1512.
PURPOSE: To provide evidence to optimize the control of anticipatory chemotherapy-induced nausea and vomiting (CINV) in children receiving chemotherapy
TYPES OF PATIENTS ADDRESSED: Pediatric patients
693 practice guideline publications were retrieved. Nine guidelines were included and scored, including those from the American Society of Clinical Oncology, Multinational Association of Supportive Care in Cancer, European Society for Medical Oncology, and National Comprehensive Cancer Network. None were directly adapted because they were aimed at adult patients. 1,586 references were retrieved from database searches, and 11 studies met the inclusion criteria.
Evidence was weak, and the optimal dosing of medications for pediatric patients was not clear.
The strongest recommendation for anticipatory CINV was prevention, which necessitated maximum prevention and control of CINV when first initiated. Although newer antiemetics improved CINV outcomes, anticipatory nausea remains a problem. In general, the timeframe for evaluating anticipatory CINV is prior to the first chemotherapy administration although it also may occur daily with multiday treatment. The authors pointed to evidence from longitudinal studies that with administration of 5HT3 and dexamethasone, about a third of adults had anticipatory nausea and 6%–11% had anticipatory vomiting. Maximum CINV control initially needs to be the goal, and patients should be evaluated on an ongoing basis for anticipatory nausea prior to each chemotherapy administration as part of the assessment of adequate CINV control. More studies of pediatric patients for CINV are needed.