Delayed nausea and vomiting in children receiving antineoplastics

Authors

  • L. Lee Dupuis MScPhm, FCSHP,

    Corresponding author
    1. Department of Pharmacy, University of Toronto, Ontario, Canada
    2. Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
    • Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
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  • Robert Lau MB, BS, FRCPC,

    1. Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Mark L. Greenberg MB, ChB, FRCPC, FAAP

    1. Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
    2. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract

Background

The nature and prevalence of delayed antineoplastic-induced nausea and vomiting have not been well-described in children. This study describes the extent of delayed nausea and vomiting in children receiving antineoplastic agents as well as the drug therapies initiated in an attempt to prevent or manage it.

Procedure

All children receiving antineoplastics were eligible for study entry. The date and time of each emetic episode were recorded on each day antineoplastics were given and for 3 days thereafter. Nausea was self-assessed daily by children who were older than 3 years and were not developmentally delayed. Diet was also assessed daily. The emetic response, median nausea rating and median diet achieved were described.

Results

The emetic response of 124 children who received 174 antineoplastic cycles was evaluated. Most cycles (137/174;79%) were not associated with delayed vomiting. Cycles which included cisplatin, carboplatin, or cyclophosphamide; involved antineoplastic therapy given over 2 or more consecutive days; or were accompanied by vomiting during the acute phase were associated with a significantly higher incidence of delayed vomiting. Moderate to severe nausea was reported on 58% (267/459) of study days. No antiemetics were given on most study days (412/522;79%); nevertheless, most of the study days (381/412;93%) which were unaccompanied by antiemetic support during the delayed phase were completely free from vomiting. Antiemetics were most often given as single agents (ondansetron: 54 study days; dimenhydrinate: 17 study days; dexamethasone: 6 study days). Diet was largely unaffected during the study period.

Conclusions

Antineoplastic-induced delayed nausea and vomiting may be less prevalent in children than in adults. Routine antiemetic administration during the delayed phase may not be warranted in all patients. Med Pediatr Oncol 2001;37:115–121. © 2001 Wiley-Liss, Inc.

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