A survey of antiemetic use in children with cancer

Pediatric oncologists within Pediatric Oncology Group institutions were surveyed to determine current antiemetic practices for children receiving chemotherapy and the basis for those practices. A mean severity rating for associated nausea and vomiting was calculated and used to rank 31 chemotherapeutic agents commonly used in the treatment of childhood cancer. Antiemetics were used 17%, 79%, and 98% of the time for chemotherapeutic agents with mild, moderate, or severe associated nausea and vomiting, respectively. A median of one, two, and three antiemetics were used for mild, moderate, and severe agents, respectively. Antihistamines and phenothiazines were the drugs most commonly used for agents causing mild or moderate nausea and vomiting, and metoclopramide hydrochloride/antihistamines with lorazepam and/or corticosteroids were used most often for chemotherapeutic agents causing severe nausea and vomiting. Most oncologists based their choice of antiemetics on personal experience. Current literature addressing the treatment of nausea and vomiting in children receiving chemotherapy, as reviewed here, does not always support the present clinical practices.