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Delayed nausea and vomiting in children receiving antineoplastics
L L Dupuis1, R Lau, M L Greenberg
1Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. lee.dupuis@sickkids.on.ca
Insights
Delayed nausea and vomiting from antineoplastic agents are less common in children than adults. Routine antiemetic use during the delayed phase may not be necessary for all pediatric patients.
Area of Science:
- Pediatric Oncology
- Clinical Pharmacology
- Patient Symptom Management
Background:
- Delayed nausea and vomiting (N&V) following antineoplastic therapy in children are not well-characterized.
- Understanding the prevalence and management of delayed N&V is crucial for improving pediatric cancer care.
Purpose of the Study:
- To describe the incidence of delayed nausea and vomiting in children receiving antineoplastic agents.
- To document the antiemetic drug therapies used for prevention or management of delayed N&V in this population.
Main Methods:
- Prospective study of children receiving antineoplastic agents.
- Daily recording of emetic episodes and self-assessed nausea for children (>3 years).
- Assessment of daily diet and antiemetic use during acute and delayed phases.
Main Results:
- 79% of 174 antineoplastic cycles were not associated with delayed vomiting.
- Delayed vomiting was more frequent with cisplatin, carboplatin, cyclophosphamide, multi-day therapy, or acute vomiting.
- Moderate to severe nausea occurred on 58% of study days; 93% of days without antiemetics were vomit-free.
Conclusions:
- Delayed nausea and vomiting appear less prevalent in pediatric patients compared to adults.
- Routine prophylactic antiemetic administration during the delayed phase may not be universally indicated.
Background:
The nature and prevalence of delayed antineoplastic-induced nausea and vomiting have not been well-described in children. This study describes the extent of delayed nausea and vomiting in children receiving antineoplastic agents as well as the drug therapies initiated in an attempt to prevent or manage it.
Procedure:
All children receiving antineoplastics were eligible for study entry. The date and time of each emetic episode were recorded on each day antineoplastics were given and for 3 days thereafter. Nausea was self-assessed daily by children who were older than 3 years and were not developmentally delayed. Diet was also assessed daily. The emetic response, median nausea rating and median diet achieved were described.
Results:
The emetic response of 124 children who received 174 antineoplastic cycles was evaluated. Most cycles (137/174;79%) were not associated with delayed vomiting. Cycles which included cisplatin, carboplatin, or cyclophosphamide; involved antineoplastic therapy given over 2 or more consecutive days; or were accompanied by vomiting during the acute phase were associated with a significantly higher incidence of delayed vomiting. Moderate to severe nausea was reported on 58% (267/459) of study days. No antiemetics were given on most study days (412/522;79%); nevertheless, most of the study days (381/412;93%) which were unaccompanied by antiemetic support during the delayed phase were completely free from vomiting. Antiemetics were most often given as single agents (ondansetron: 54 study days; dimenhydrinate: 17 study days; dexamethasone: 6 study days). Diet was largely unaffected during the study period.
Conclusions:
Antineoplastic-induced delayed nausea and vomiting may be less prevalent in children than in adults. Routine antiemetic administration during the delayed phase may not be warranted in all patients. Med Pediatr Oncol 2001;37:115-121.