Acute chemotherapy-induced nausea and vomiting in children with cancer: Still waiting for a common consensus on treatment

Abstract

Chemotherapy-induced nausea and vomiting (CINV) is one of the most common treatment side-effects, and remains a significant concern, in children undergoing chemotherapy. Although adult patients receive chemotherapy regimens combined with appropriate standardized antiemetic treatment, children can receive markedly varying antiemetic treatments. A narrative review of CINV was performed regarding CINV definition, scoring system, prevention and treatment, specifically focussing on studies conducted with paediatric oncology patients. The review highlighted a lack of rigorously developed CINV scoring systems and standardized CINV pharmacological treatment for paediatric oncology patients. Different scoring systems were found to identify potential risk factors for CINV associated with the use of several different antiemetic drugs, however, few studies have been performed in children undergoing chemotherapy. Thus, CINV remains a distressing and partially controlled side-effect in the paediatric patient population. To reduce emesis and improve quality of life in paediatric oncology patients, standardized antiemetic treatment may be preferred, using a unique CINV scoring system that accounts for the emetogenic level of the chemotherapy regimen adopted and the children’s clinical characteristics.

Systematic review of the effectiveness of complementary and alternative medicine on nausea and vomiting in children with cancer: a study protocol

“…The two most commonly reported symptoms are nausea and vomiting 3. Nausea is a subjective experience characterised by a feeling of impending vomiting,5 whereas vomiting is defined as retching and expulsion of the stomach’s contents through the mouth accompanied by shivering and salivation 5. A previous study indicated that these two symptoms affected up to 70% of children undergoing chemotherapy 6.…”

“…The aetiology of nausea and vomiting in children with cancer is multifactorial,9 but it is generally believed to be largely related to chemotherapy, which is the most common type of treatment for childhood cancer 5. Chemotherapeutic agents circulating in the blood stimulate the chemoreceptor trigger zone and result in acute nausea and vomiting 10.…”

“…Those exposed to whole-brain radiation are similarly at risk because of increased intracranial pressure due to tissue swelling 16. Other causes of nausea and vomiting include anaesthesia given for surgery,17 analgesics (particularly opioids)18 and anxiety and emotional responses 5…”

“…Nausea and vomiting cause serious disruptions in patients’ daily function and quality of life during cancer treatment 3–5. These two symptoms can also contribute to additional clinical problems, such as weight loss and cachexia 19.…”

“…They also issued a guideline to provide a consensus for healthcare professionals on how these two symptoms can be managed using a pharmacological approach 6. However, these two symptoms remain a significant clinical concern for children with cancer 5. This concern might be due to healthcare professionals’ perception that nausea and vomiting are solely biological problems as well as the heavy reliance of these professionals on pharmacological treatment for symptom management 46.…”