B140
Antiemetic medication for prevention and treatment of chemotherapy induced nausea and vomiting in childhood
Robert Phillips1, Faith Gibson2, Shireen Gopaul3, Jean Craig4, Elizabeth Houghton5, Barry Pizer5
1Centre for Reviews and Dissemination, York, UK, 2UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK, 3The Leeds Teaching Hospital NHS Trust, UK, 4Institute of Child Health, University of Liverpool, UK, 5Royal Liverpool Children's Hospital NHS Trust, Liverpool, UK
Background.
Nausea and vomiting continue to be a problem for children undergoing treatment for malignancies, despite the advances in antiemetic therapies. Optimal paediatric dosing and scheduling of antiemetics remains uncertain. This results in inconsistencies and variation in prescribing, often underpinned by personal preference and experience as opposed to high quality evidence.
This systematic review examined pharmacological approaches to prevent or reduce anticipatory, acute and delayed symptoms of nausea and vomiting in children and young people who have cancer.
Method
This study was undertaken as a Cochrane Childhood Cancer Review [DOI: 10.1002/14651858.CD007786]. RCTs comparing pharmacological antiemetics and cannabinoids with active or placebo controls in children and young people (<18 years old) undergoing chemotherapy were included. Electronic database searches of CENTRAL, Medline, EMBASE, DARE, PsychINFO and LILACS were supplemented by examination of trial registries and major conference abstracts. Two researchers independently screened titles and abstracts, retrieving any disputed articles for detailed analysis. Data extraction for included studies was undertaken and checked independently. Further data and clarification of methods were frequently sought from the study authors. Data were entered on RevMan5. Crossover trials were analysed using paired data where possible. Synthesis was undertaken using a generic inverse-variance fixed-effect model where appropriate.
Results
844 articles were initially identified, with 68 being examined in detail. 28 studies were finally included in the review. These studies examined a wide range of different pharmacological antiemetics, using different doses and comparators, and reporting adverse events (25 studies), total control of acute emesis (22 studies) or nausea (13 studies). No study reported quality of life. A pooled analysis was undertaken in only three areas: cannabinoids vs. prochlorperazine (2 studies), the addition of dexamethasone to 5HT3 antagonists (2 studies), and for different doses of granisitron (3 studies). No other pooled analyses were possible.
Conclusion
Our knowledge of the effectiveness of antiemetics to prevent chemotherapy-induced nausea and vomiting in childhood is incomplete and imprecise
