Comparative effectiveness research in antineoplastic-induced nausea and vomiting control in children

Abstract

Antineoplastic-induced nausea and vomiting (AINV) is one of the most distressing adverse effects experienced by adult and pediatric patients receiving antineoplastic agents. Despite this, evidence of the efficacy and safety of antiemetic interventions in children is limited, and prevention and treatment approaches vary widely between centers. The purpose of this review is: first, to describe the barriers to comparative antiemetic effectiveness research in AINV control in children; second, to highlight limitations of the currently available pediatric AINV evidence; third, to summarize and discuss comparative effectiveness research specific to AINV control in children, with a focus on agents recommended in evidence-based guidelines developed for acute phase AINV control; and finally, to offer guidance regarding future comparative effectiveness research in this field.

Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy‐Induced Nausea and Vomiting in Children With Cancer

“…In a systematic review and meta‐analysis, weight gain and sedation (78% [95% confidence interval (CI): 63 to 95%] and 48% [95% CI: 35 to 67%], respectively) were commonly associated with the use of olanzapine in children less than 13 years old . Extrapyramidal symptoms (EPS) and electrocardiograph abnormalities were reported less frequently (9% [95% CI: 4 to 21%] and 14% [95% CI: 7 to 26%], respectively).…”

“…Therefore systematic reviews evaluating the safety of metoclopramide [5] and prochlorperazine [6] were undertaken, and an existing systematic review of the safety of olanzapine [7] in children was considered by the panel. Primary studies reported separately for patients ࣘ18 years of age or the mean or median age pf participants was ࣘ18 years; iii.…”

“…[7] Extrapyramidal symptoms (EPS) and electrocardiograph abnormalities were reported less frequently (9% [95% CI: 4 to 21%] and 14% [95% CI: 7 to 26%], respectively). Most adverse effects associated with olanzapine use were of minor clinical significance; no fatalities attributable to olanzapine were identified.…”

Guideline concordant care for prevention of acute chemotherapy-induced nausea and vomiting in children, adolescents, and young adults

“…[8][9][10][11] Although some patients receiving prophylaxis still experience CINV, studies show that administering prophylactic regimens concordant with published guidelines significantly reduces and controls symptoms for patients receiving moderately emetogenic or highly emetogenic chemotherapy (MEC; HEC). [12][13][14] Despite rigorously-developed guidelines and availability of effective medications to prevent and treat CINV in pediatric cancer patients, the prescription of antiemetic medications in this population varies widely. One study found that 78% of sites self-reported a standardized approach to prophylaxis.…”