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. 

DOI Link

Purpose & Patient Population

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

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline  
 
PROCESS OF DEVELOPMENT: A search of multiple databases and grey literature was completed to identify current recommendations in other guidelines. The AGREE system was used to evaluate the guidelines. A panel then discussed the information for the development and adaptation of recommendations.
 
SEARCH STRATEGY:
  • DATABASES USED: MEDLINE, EMBASE, Cochrane collaboration, AMED, CINAHL, ProQuest Dissertation Abstracts, and Health and Psychosocial Instruments
  • KEYWORDS: Appendices were provided for detailed search terms per database.
  • INCLUSION CRITERIA: Full-text publication, evaluated an intervention for anticipatory CINV, and patients per study arm were at least 10 cases
  • EXCLUSION CRITERIA: Language other than English

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Pediatrics 

Results Provided in the Reference

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.

Guidelines & Recommendations

Reports of the prevalence of anticipatory CINV varied from 0%–59% after the advent of 5HT3 use, and the prevalence of anticipatory nausea was higher than that of vomiting. Dexamethasone often was not given for highly emetic chemotherapy, and studies did not evaluate the relationships between CINV control and anticipatory CINV. Recommendations for interventions included the following:
  • Control of acute and delayed CINV should be optimized to minimize the risk of developing anticipatory CINV.
  • Psychological interventions such as hypnosis or desensitization may be offered to children.
  • Lorazepam at 0.04–0.08 mg/kg at bedtime the night before chemotherapy and once the next day prior to chemotherapy administration may be used for prevention or treatment.

Limitations

Evidence was weak, and the optimal dosing of medications for pediatric patients was not clear.

Nursing Implications

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.