Related Experiment Videos
Paradoxical effects of prophylactic phenothiazine antiemetics in children receiving chemotherapy
Insights
Prophylactic phenothiazine antiemetics did not reduce nausea and vomiting in children undergoing chemotherapy. In fact, these antiemetics were associated with increased symptom severity and duration, suggesting further research is needed.
Area of Science:
- Pediatric Oncology
- Pharmacology
Background:
- Nausea and vomiting are common side effects of chemotherapy in children.
- Phenothiazine antiemetics are frequently used to manage these symptoms.
Purpose of the Study:
- To evaluate the effectiveness of prophylactic phenothiazine antiemetics in reducing chemotherapy-induced nausea and vomiting (CINV) in pediatric patients.
- To compare symptom severity and duration with and without prophylactic antiemetic use.
Main Methods:
- A within-patient, matched-pairs study design was used for 23 children (ages 9-17).
- Each patient served as their own control, comparing chemotherapy courses with and without prophylactic phenothiazine antiemetics.
- The Wilcoxon matched-pairs, signed-ranks test was employed for statistical analysis.
Main Results:
- Significantly higher ratings for nausea severity (P < .004), vomiting severity (P < .02), and symptom bother (P < .001) were observed during courses with prophylactic antiemetics.
- Analysis of the last eight patients revealed a significantly longer duration of nausea (P < .05) and vomiting (P < .02) when antiemetics were administered prophylactically.
- No predictable reduction in symptoms was found; an increase was even suggested.
Conclusions:
- Prophylactic phenothiazine antiemetics may not effectively reduce CINV in pediatric patients.
- These agents might be associated with an exacerbation of nausea and vomiting symptoms.
- Further research is required to identify pediatric subgroups that may benefit from antiemetic interventions.
Abstract:
The effectiveness of prophylactic phenothiazine antiemetics on reduction of nausea and vomiting was assessed for 23 children (age, 9-17 years) who had intermittently received antiemetics (ie, for one course but not for another). Each patient was his own control and the courses with antiemetics were compared to the matched courses without antiemetics (Wilcoxon matched-pairs, signed-ranks test). In each case, the matched courses with and without antiemetics were temporally consecutive and equivalent for chemotherapeutic agents and dosages. Significantly higher ratings for severity of nausea (P less than .004), vomiting (P less than .02), and the extent to which these symptoms bothered patients (P less than .001) were found during courses with prophylactic antiemetics. Duration (in hours) of nausea and vomiting was analyzed for the last eight consecutive study patients; in eight of eight patients, a significantly longer duration of nausea (P less than .05) and vomiting (P less than .02) was found for the courses in which antiemetics were given prophylactically. This study suggests that prophylactic phenothiazine antiemetics do not predictably reduce children's nausea and vomiting and may even be associated with an increase in symptoms. Further studies in children are needed to determine which patients might benefit most from antiemetic intervention.