Risk factors associated with nausea and vomiting in children with cancer receiving chemotherapy

Abstract

Introduction Despite treatment with antiemetic medications, nausea remains uncontrolled for many children receiving chemotherapy. One reason is that risk factors for nausea in children remain poorly explored. The purpose of this study was to identify risk factors for chemotherapy-induced nausea (CIN) in children. Methods Prospective, observational study including 101 children (median age 6.4 years, range 0.8–17.9) with cancer receiving moderately or highly emetogenic chemotherapy. Primary endpoints were complete control of acute and delayed CIN, defined as no nausea in the acute phase 0–24 h after chemotherapy and in the delayed phase starting after the acute phase and ending 5 days later. Multivariable analyses included age, sex, cancer type, susceptibility to motion sickness, chemotherapy duration, numbers of antiemetics, co-administration with opioids or tricyclic antidepressants, and previously uncontrolled nausea or vomiting. Results Acute CIN was associated with susceptibility to motion sickness (odds ratio [OR] 5.73, 95% confidence interval [CI] 1.36–33.7) and older age (OR 4.19, 95% CI 1.30–14.7), comparing age group 8–18 years with 0–3 years. Delayed CIN was associated with uncontrolled acute nausea or vomiting (OR 10.3, 95% CI 2.65–50.9), highly emetogenic chemotherapy (OR 8.26, 95% CI 1.17–76.8), and having a hematologic cancer type (OR 7.81, 95% CI 1.05–79.2). Conclusions Susceptibility to motion sickness and age can influence the risk of acute CIN. More research is needed on how best to integrate risk information in preventive antiemetic strategies. Sufficient acute nausea and vomiting control are crucial to prevent delayed CIN.

Anti-Emetics in Children Receiving Chemotherapy for Solid Tumors and Leukemia: Pharmacology and Optimization of Therapy for Nausea and Vomiting

“…Unlike what is seen in adults, no gender-based differences in the perception of CINV were identified [8,10]. Disease-specific analyses showed that children with hematological malignancies are more likely to experience delayed CINV compared to those with solid tumors, likely due to the variable use of steroids in this population in the actual treatment [8]. Multi-day chemotherapy protocols commonly used in children lead to longer acute-phase duration, which has been associated with poorer acute-phase CIV control, likely due to the overlap of different phases [3].…”

“…Among children, older age and susceptibility to motion sickness have been consistently identified as risk factors for acute CINV [7][8][9]. Unlike what is seen in adults, no gender-based differences in the perception of CINV were identified [8,10]. Disease-specific analyses showed that children with hematological malignancies are more likely to experience delayed CINV compared to those with solid tumors, likely due to the variable use of steroids in this population in the actual treatment [8].…”

“…Among children, older age and susceptibility to motion sickness have been consistently identified as risk factors for acute CINV [7][8][9]. Unlike what is seen in adults, no gender-based differences in the perception of CINV were identified [8,10].…”

Efficacy and safety of Aprepitant-containing triple therapy for the prevention and treatment of chemotherapy-induced nausea and vomiting: A meta-analysis

“…[4][5][6][7][8] Based on the incidence of vomiting caused by chemotherapy drugs, it is classified into 4 risk levels: high (≥90%), moderate (30-90%), low (10-30%), and minimal (<10%). [9,10] Given the intricate pathogenesis of CINV and significant inter-individual variations among patients, [11] a combination of drugs should be administered as a prophylactic measure against vomiting in patients undergoing moderate or highly emetic chemotherapy (MEC/HEC). [9,10,[12][13][14][15][16][17][18][19][20] The commonly used antiemetic drugs in clinics mainly include 5-HT 3 receptor antagonists (5-HT 3 RA), neurokinin-1 antagonists (NK-1 RA), glucocorticoids, dopamine receptor antagonists, and certain psychotropic drugs .…”

Comment on ‘risk factors associated with nausea and vomiting in children with cancer receiving chemotherapy’

“…The therapy works by adding dexamethasone for moderate emetogenic chemotherapy (MEC) for anti-emetic supportive care and, for highly emetogenic chemotherapy (HEC), adding of the NK 1 receptor antagonist, aprepitant, to this therapy. 2,3 This comment focuses on the risk factors for CIN in children which were studied by Eliasen et al 4 In their recent report in Journal of Oncology Pharmacy Practice, Eliasen et al found that susceptibility to motion sickness and age can influence the risk of acute CIN. Although the clinical relevance of Eliansen's study is clear, some methodological issues can be raised concerning the use of statistical modelling, and the choices made on the inclusion of risk factors in the analyses and the final conclusions.…”