Antonarakis, E.S., Evans, J.L., Heard, G.F., Noonan, L.M., Pizer, B.L., & Hain, R.D. (2004). Prophylaxis of acute chemotherapy‐induced nausea and vomiting in children with cancer: What is the evidence? Pediatric Blood and Cancer, 43, 651–658.
DOI Link
Purpose
STUDY PURPOSE: To review evidence for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in children and to compare this evidence to prescription practices
TYPE OF STUDY: General, semisystematic review
Search Strategy
DATABASES USED: MEDLINE, EMBASE, CancerLit, Cochrane Library, the NHS Centre for Reviews and Dissemination, the National Institute for Clinical Excellence, and Bandolier
KEYWORDS: Vomiting, nausea, chemotherapy, child, cancer, antiemetic, serotonin antagonists, phenothiazines, metoclopramide, butyrophenones, corticosteroids, and cannabinoids
INCLUSION CRITERIA: All articles published from the inception of each database through 2002
EXCLUSION CRITERIA: Not listed
Literature Evaluated
TOTAL REFERENCES RETRIEVED: 213
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: A table of evidence was assembled, and the articles were assigned a level of evidence as defined by the Bandolier system. Practice recommendations were listed and graded based on the Ecceles et al. system.
Sample Characteristics
- FINAL NUMBER STUDIES INCLUDED = 23
- TOTAL PATIENTS INCLUDED IN REVIEW = Not listed
- KEY SAMPLE CHARACTERISTICS: Pediatric patients receiving antiemetics for CINV
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Pediatrics
Results
Practice recommendations included (a) a combination a 5HT3 antagonist and corticosteroid treatment for highly emetogenic chemotherapy, (b) a 5HT3 antagonist alone for moderately emetogenic chemotherapy, and (c) no intervention for low emetogenic chemotherapy.
When comparing antiemetic prescription recommendations to prescription practices in selected samples of pediatric patients in the United Kingdom, 100% of the patients with low emetogenic chemotherapy received antiemetics in accordance with evidence-based recommendations, 87% for moderate emetogenic chemotherapy, and 35% for highly emetogenic chemotherapy. Overall, 69% of the chemotherapy regimens received antiemetic therapy in accordance with evidence-based recommendations. Of the 30% of antiemetic prescriptions outside practice recommendations, 25% of doses were lower than recommended and 5% were higher.
Conclusions
Based on published evidence, many pediatric patients may not be receiving appropriate antiemetic therapy. The patients who were most likely to not receive recommended antiemetic therapy were those receiving highly emetogenic chemotherapy, which put those patients at an increased risk for experiencing CINV.
Limitations
This study took place in the United Kingdom, which may have different medication availability and prescription practices than other locations.
Nursing Implications
In the pediatric population, antiemetic prescription practices may not be in line with published evidence. Current best-practice sources should be consulted to ensure pediatric patients are adequately medicated to prevent CINV.
Legacy ID
5438
