Dupuis, L., Sung, L., Molassiotis, A., Orsey, A., Tissing, W., & van de Wetering, M. (2017). 2016 updated MASCC/ESMO consensus recommendations: Prevention of acute chemotherapy-induced nausea and vomiting in children. Supportive Care in Cancer, 25, 323–331. 

DOI Link

Purpose & Patient Population

PURPOSE: To update the 2009 recommendations for the prevention of acute chemotherapy-induced nausea and vomiting (CINV)
 
TYPES OF PATIENTS ADDRESSED: Pediatric—aged 18 years or younger

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: Committee formed consisting of clinicians experienced in pediatric supportive cancer care and insuring representation from multidisciplinary and international members. The updated version of the Pediatric Oncology Group of Ontario guideline for the prevention of acute nausea and vomiting related to antineoplastic medication in pediatric oncology was used as a basis. A systematic literature search was completed. 
 
DATABASES USED: MEDLINE, Embase, CCTR, AMED, HTA, NHSEED, CINAHL
 
INCLUSION CRITERIA: Published studies, primary randomized studies in English or French, studies including children younger than aged 18 years, mixed studies of adults and children in which pediatric results were reported separately or median/mean age was 13 years or younger, CINV prophylaxis was evaluated over entire acute phase or over the first 24 hours after chemotherapy, emetogenicity of administered chemotherapy was determined, clear definition of complete acute CINV response, complete antiemetic regimen described, the complete acute CINV response rate expressed as a proportion, only the acute phase of CINV was addressed because of a paucity of evidence in other phases.
 
EXCLUSION CRITERIA: Not a randomized design; evaluation of dolesetron was included.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Pediatrics

Results Provided in the Reference

Over 21,000 citations were identified, 73 of which were screened. After exclusions, eight studies were included, which were published after 2009. Committee members revised the recommendations with interpretation differences resolved by consensus. Recommendations were brought before the full MASCC Antiemesis Committee. Recommendations were changed when 67% agreement was reached among the members.

Guidelines & Recommendations

Acute phase of high emetic risk chemotherapy (greater than a 90% risk for CINV)—prophylaxis to include a 5-HT3 antagonist plus dexamethasone plus aprepitant. Children who cannot receive dexamethasone should receive a 5-HT3 antagonist plus aprepitant. Children who cannot receive aprepitant should receive a 5-HT3 antagonist plus dexamethasone.
 
Acute phase of moderate emetic risk chemotherapy (30%–90% risk)—prophylaxis to include a 5-HT3 antagonist plus dexamethasone. If a child cannot receive dexamethasone, aprepitant should be given instead of dexamethasone.
 
Acute phase of low emetic risk chemotherapy (10%–30% risk)—prophylaxis with a 5-HT3 antagonist only
 
Acute phase of minimal emetic risk chemotherapy (less than 10% risk)—no prophylaxis recommended.
 
5-HT3 antagonists cited were granisetron, ondansetron, tropisetron, or palonosetron.

Limitations

  • Small number of children studied
  • Standard antiemetic prophylaxis differed among studies.
  • Lack of standardized definition of complete response
  • Lack of validated method to assess nausea
  • Lack of pediatric evidence related to the prevention of CINV

Nursing Implications

Standardized pediatric CINV guidelines were developed for only the acute phase of chemotherapy administration; no guidelines exist for the anticipatory or delayed phases.