Flank, J., & Dupuis, L.L. (2014). Comparative effectiveness research in antineoplastic-induced nausea and vomiting control in children. Journal of Comparative Effectiveness Research, 3, 185–196.

DOI Link

Purpose

STUDY PURPOSE: To describe the obstacles for antineoplastic-induced nausea and vomiting (AINV) control in children; to illustrate limitations in the evidence for pediatric AINV control; to describe comparative effectiveness research for pediatric AINV control in the acute phase; and to provide recommendations for additional comparative research in pediatric CINV control

TYPE OF STUDY: General semisystematic review

Search Strategy

DATABASES USED: MEDLINE, EMBASE, Cochrane Center Register of Controlled Trials, Allied and Complementary Medicine, Health Technology Assessment, NHS Economic Evaluation Database, and the Cumulative Index to Nursing and Allied Health Literature database.

KEYWORDS: Antiemetics, antineoplastic-induced nausea and vomiting, chemotherapy-induced nausea and vomiting, comparative effectiveness research, guidelines, and pediatrics

INCLUSION CRITERIA: Full-text publications; English or French languages; pediatric data reported separately; emetogenicity of the antineoplastic therapy was determined; an explicit or implicit definition of complete acute AINV response was provided; the complete acute AINV response rate was reported as a percentage or proportion; the use of a 5HT3 receptor antagonist plus a corticosteroid along with reported dosages and routes; used the Pediatric Oncology Group of Ontario (POGO) guideline references

EXCLUSION CRITERIA: The use of aprepitant in a study, adults, and studies published before November 2011

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 71

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The references from the POGO guidelines were eliminated, and one duplicate article was identified, resulting in 69 references to be screened. Of these, 64 were excluded, leaving five full-text articles to be examined. All five of these articles were excluded based on the criteria for inclusion. No studies for inclusion resulted.

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 0
TOTAL PATIENTS INCLUDED IN REVIEW = 134 pediatric patients
KEY SAMPLE CHARACTERISTICS: A 5HT3 receptor antagonist was used as the antiemetic; age range of 0.5–18 years

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

APPLICATIONS: Pediatrics

Results

Two studies addressed the comparative pediatric evidence related to the selection of a 5HT3 receptor antagonist. One study found a complete control rate of nausea and vomiting of 30% with tropisetron (8 out of 27) and 32% with granisetron (7 out of 22). The other study found a complete control rate of 61% with granisetron (20 out of 33) and 45.5% (15 out of 33) with ondansetron. Three other studies showed improved control of AINV when a corticosteroid was used with a 5HT3 receptor antagonist versus an antiemetic alone in patients receiving highly emetogenic chemotherapy (HEC). Another comparison between the use of IV versus oral 5HT3 receptor antagonists found equivalent effectiveness when used for HEC or moderately emetogenic chemotherapy (MEC).

Conclusions

Because of inconsistencies in the the research studies' methodologies related to pediatric AINC, there were few comparative effectiveness research (CER) examples. The evidence available to support guidelines is of low quality, and many research gaps exist. Barriers related to CER in pediatric AINV include patient factors, discrepancies related to research design, and definitions of complete control, outcomes, and outcome measures.

Limitations

Insufficient evidence to develop comprehensive guidelines or for CER for AINV control in pediatric patients

Nursing Implications

Research related to pediatric AINV control is very limited and lacks in quality for comparison. The conclusions ascertained from this article were that children who used a corticosteroid with a 5HT3 receptor antagonist experienced increased efficacy of AINV control, and both IV and oral routes of these drugs have similar efficacy when used with HEC and MEC.

Legacy ID

5443