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Prophylaxis of acute chemotherapy-induced nausea and vomiting in children with cancer: What is the evidence?

Antonarakis, Emmanuel S., Evans, Jamie L., Heard, Gemma F., Noonan, Lucy M., Pizer, Barry L. and Hain, Richard D.W. 2004. Prophylaxis of acute chemotherapy-induced nausea and vomiting in children with cancer: What is the evidence? Pediatric Blood and Cancer 43 (6) , pp. 651-658. 10.1002/pbc.20138

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Abstract

BACKGROUND: Nausea and vomiting are preventable side effects of cancer chemotherapy for children. Antiemetics are essential, especially as treatment becomes more intensive. Many drugs are available, but adequate evidence-based recommendations are lacking. We aimed (1) to consider an evidence-based approach for pharmacological prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in children, and (2) to compare this approach with antiemetic prescribing in two paediatric oncology centres. PROCEDURE: Relevant publications (Medline, Embase, CancerLit:1966-2002) were critically evaluated using pre-defined criteria. Evidence-based statements summarising their findings were formulated, and evidence basis proposed. Current prescribing practice was then compared with this evidence basis in Welsh children under 16 receiving chemotherapy at Llandough Hospital, Cardiff or Alder Hey Children's Hospital, Liverpool between 1 January 2001 and 31 December 2001. RESULTS: Of 213 studies retrieved, 82 provided evidence. Our evidence basis recommends combination 5HT3-antagonist/corticosteroid for highly emetogenic chemotherapy, 5HT3-antagonist alone for moderate emetogenicity, and no antiemetic for other chemotherapy. Forty-four children in Cardiff (0.6-16.9 yrs) and 14 in Liverpool (0.8-16.2 yrs) were included in the audit. Differences in prescribing practice between the centres were not significant. In 109/159 (69%) of chemotherapy courses (35, 87 and 100% of high, moderate and low emetogenicity, respectively), antiemetics were selected in accordance with evidence basis. Seventy percent of prescribed doses were as evidence basis recommended. CONCLUSIONS: We present an evidence basis for prescribing prophylactic antiemetics to children undergoing chemotherapy. Prescribing practices in these two centres treating Welsh children were similar. Both differed from the evidence basis we propose. Deviations were greatest for regimens of high emetogenicity, where effective emetic control is most crucial.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
R Medicine > RJ Pediatrics
Additional Information: Full Text Sources John Wiley & Sons, Inc. Other Literature Sources Access more work from the authors - ResearchGate Medical Nausea - Genetic Alliance Vomiting - Genetic Alliance Cancer - MedlinePlus Health Information Cancer Chemotherapy - MedlinePlus Health Information Nausea and Vomiting - MedlinePlus Health Information
Publisher: Wiley-Blackwell
ISSN: 1545-5009
Date of Acceptance: 2 June 2004
Last Modified: 02 Nov 2015 09:43
URI: https://orca.cardiff.ac.uk/id/eprint/70555

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