Phillips, R.S., Friend, A.J., Gibson, F., Houghton, E., Gopaul, S., Craig, J.V., & Pizer, B. (2016). Antiemetic medication for prevention and treatment of chemotherapy-induced nausea and vomiting in childhood. Cochrane Database of Systematic Reviews, 2, CD007786. 

DOI Link

Purpose

STUDY PURPOSE: To update a previous systematic review regarding the effectiveness and adverse events of pharmacologic interventions used to control anticipatory, acute, and delayed nausea and vomiting in children younger than 18 years who are preparing to receive chemotherapy

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: Studies were identified by searching CENTRAL, MEDLINE, EMBASE, LILACS, and PsycINFO. Conference proceedings from ASCO, the International Society of Pediatric Oncology, Multinational Association of Supportive Care in Cancer, and ISSI Science and Technology Proceedings Index dating to December 16, 2014 were also used. Trial registries dating to to December 2014 were used, and reference lists from other studies were screened for additional studies.  
 
INCLUSION CRITERIA: Study abstracts were screened for randomized controlled trials (RCTs) that compared a pharmacological antiemetic, cannabinoid, or benzodiazepine with placebo or any alternative active intervention in children younger than 18 years who had a diagnosis of cancer and were scheduled to receive chemotherapy.
 
EXCLUSION CRITERIA: No specific exclusion criteria were stated.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: Eight hundred forty-four potentially useful articles were originally identified. Of these, 67 were included for detailed screening (described below). 
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two authors independently extracted quality data from each RCT according to the criteria of concealment of treatment allocation, blinding of the care provider, blinding of the participants, blinding of the outcome assessor, random sequence generation, and incomplete outcome data. The potential for selective reporting of outcomes was partially assessed by checking the reported outcomes against the study methods stating where outcomes were collected. The reviewers assessed for other potential bias, such as those associated with publication, funding, researcher role, and drop-out rates for cross-over, multiphase trials. Discrepancies between review authors were resolved by consensus.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 34 studies were included—28 original reviews and 6 updates.
  • TOTAL PATIENTS INCLUDED IN REVIEW: 1,719 participants and 2,226 episodes
  • SAMPLE RANGE ACROSS STUDIES: Median sample: 30 with a range of 12–428 patients; episode range = 50.5 with a range of 20–428 patients
  • KEY SAMPLE CHARACTERISTICS: Not reported

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

APPLICATIONS: Pediatrics

Results

Thirty-four studies using a range of antiemetic regimens produced a variety of outcomes. The majority of quantitative data related to the complete control (CC) of acute vomiting (27 studies). Adverse events were reported in 29 studies and nausea outcomes in 16 studies. Two studies assessed the use of dexamethasone with 5-HT3 antagonists for CC of vomiting (pooled risk ratio [RR] = 2.03, 95% confidence interval [CI] [1.35, 3.04]). Three studies compared 20 mcg/kg granisetron with 40 mcg/kg for CC of vomiting (pooled RR = 0.93, 95% CI [0.8, 1.07]). Three studies compared granisetron and ondansetron for CC of acute nausea (pooled RR = 1.05, 95% CI [0.94, 1.17], two studies), acute vomiting (pooled RR = 2.26, 95% CI [2.04, 2.51], three studies), delayed nausea (pooled RR = 1.13, 95% CI [0.93, 1.38], two studies), and delayed vomiting (pooled RR = 1.13, 95% CI [0.98, 1.29], two studies). Narrative synthesis suggests that 5-HT3 antagonists are more effective than older antiemetic agents, even when these agents are combined with a steroid. Cannabinoids are probably effective but produce frequent side effects.

Conclusions

This review provides evidence that knowledge of the most effective antiemetics to prevent chemotherapy-induced nausea and vomiting in pediatrics is incomplete and additional research is needed. This review also indicates that 5-HT3 antagonists are effective in patients receiving emetogenic chemotherapy and that granisetron or palonosetron may be better than ondansetron. Adding dexamethasone improves control of vomiting, although the risk-benefit profile of adjunctive steroid remains uncertain.

Nursing Implications

Overall, the evidence related to the treatment of chemotherapy-induced nausea and vomiting in pediatric populations receiving emetogenic chemotherapy is lacking and requires additional research, and 5-HT3 medications have been shown to be effective in small studies.

Legacy ID

6033