CCLG guideline on the management of chemotherapy induced nausea and vomiting
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Executive Summary
The CCLG supportive care group have compiled this national framework document based on excellent international guidelines with the aim of providing a comprehensive overview which may be taken to standardize therapy across CCLG Centres for the management of chemotherapy induced nausea and vomiting.
The CCLG supportive care group have compiled this national framework document based on excellent international guidelines with the aim of providing a comprehensive overview which may be taken to standardize therapy across CCLG Centres for the management of chemotherapy induced nausea and vomiting.
Introduction
Chemotherapy-induced nausea and vomiting (CINV) are said to be the most documented distressing side-effects of childhood cancer treatment, potentially influencing compliance with future treatments if not managed appropriately (Wood et al. 2015). Managed incorrectly, they can lead to physical problems such as anorexia, malnutrition and dehydration, plus psychological complications that in turn may lead to anticipatory nausea and vomiting (Rodgers et al. 2012; Dewan, Singhal and Harit, 2010).
Nausea and vomiting are reflexes initiated by the body to expel toxic substances from the stomach and intestine (Navari, 2013). Emesis is co-ordinated by the vomiting Centre situated in the medulla which receives input from the chemoreceptor trigger zone (CTZ) found in the area postrema and is outside of the blood-brain barrier. It is simulated by circulating toxins or drugs such as chemotherapy. The CTZ possesses many 5HT₃ receptors, NK1 receptors and Dopamine receptors (D2). The vomiting Centre is stimulated by drugs, smells, sights, emotions etc. as well as G.I input. CINV may result from chemo or CSF fluid acting directly on the CTZ, in the vomiting Centre but chemotherapy may also induce the release of serotonin and substance P from cells within the gastric mucosa.
The different stages of CINV are acute (0-24hrs after 1st dose); delayed (24hrs-5 days post chemotherapy) and anticipatory (prior to the start of chemotherapy). Physiological differences exist in acute and delayed CINV. Acute is mediated by the neurotransmitter serotonin, whereas delayed is mediated by substance P. Therefore optimal management of CINV may require targeting the peripheral pathways with a 5HT₃ receptor antagonist and the central pathway with an NK1 receptor.
The provision of adequate preventative and responsive anti-nausea and vomiting therapies is key in all centres where children and treated with chemotherapy. The different centres have traditionally used their own guidelines, but not developed according to the recommendations of the NICE Guideline Methodology. An international collaboration, centred in the Canadian POGO group, developed a series of detailed evidence-based guidelines for the management of different phases of treatment-related nausea and vomiting. This document details the recommendations and explanatory notes where necessary to explain different decisions from the Canadian-led panel. The research and main linking explanations are found in the accompanying guideline documents.
Chemotherapy-induced nausea and vomiting (CINV) are said to be the most documented distressing side-effects of childhood cancer treatment, potentially influencing compliance with future treatments if not managed appropriately (Wood et al. 2015). Managed incorrectly, they can lead to physical problems such as anorexia, malnutrition and dehydration, plus psychological complications that in turn may lead to anticipatory nausea and vomiting (Rodgers et al. 2012; Dewan, Singhal and Harit, 2010).
Nausea and vomiting are reflexes initiated by the body to expel toxic substances from the stomach and intestine (Navari, 2013). Emesis is co-ordinated by the vomiting Centre situated in the medulla which receives input from the chemoreceptor trigger zone (CTZ) found in the area postrema and is outside of the blood-brain barrier. It is simulated by circulating toxins or drugs such as chemotherapy. The CTZ possesses many 5HT₃ receptors, NK1 receptors and Dopamine receptors (D2). The vomiting Centre is stimulated by drugs, smells, sights, emotions etc. as well as G.I input. CINV may result from chemo or CSF fluid acting directly on the CTZ, in the vomiting Centre but chemotherapy may also induce the release of serotonin and substance P from cells within the gastric mucosa.
The different stages of CINV are acute (0-24hrs after 1st dose); delayed (24hrs-5 days post chemotherapy) and anticipatory (prior to the start of chemotherapy). Physiological differences exist in acute and delayed CINV. Acute is mediated by the neurotransmitter serotonin, whereas delayed is mediated by substance P. Therefore optimal management of CINV may require targeting the peripheral pathways with a 5HT₃ receptor antagonist and the central pathway with an NK1 receptor.
The provision of adequate preventative and responsive anti-nausea and vomiting therapies is key in all centres where children and treated with chemotherapy. The different centres have traditionally used their own guidelines, but not developed according to the recommendations of the NICE Guideline Methodology. An international collaboration, centred in the Canadian POGO group, developed a series of detailed evidence-based guidelines for the management of different phases of treatment-related nausea and vomiting. This document details the recommendations and explanatory notes where necessary to explain different decisions from the Canadian-led panel. The research and main linking explanations are found in the accompanying guideline documents.
Methods
This guideline is a national framework document for local implementation. It relies on the work undertaken by the Canadian-led POGO group who developed three clinical practice guidelines for the prevention and management of chemotherapy-induced nausea and vomiting (CINV) in children.
The POGO group convened an international guideline panel to create a clinical practice guideline based on accepted best-practice methods (similar to those used by NICE). The group undertook a series of focused systematic reviews addressing management question in the prevention of CINV, and the treatment of breakthrough, refractory and anticipatory CINV. They then summarized this evidence and debated it, placing it in clinical context and developing recommendations. The guidelines were then subject to international stakeholder review before publication.
Now all phases of the management have been completed, the CCLG Supportive Care group has undertaken to summarize and contextualize in a UK framework to provide an up to date framework for local guidelines to be developed from. This involved the summarizing of the guidelines, discussion of the recommendations made within a UK licensing context, and providing a summary guide as an example for use. Recommendations were then circulated via the CCLG Guideline Development Group panel and feedback incorporated.
The CCLG Group noted that each centre may have subtle variations on their interpretation of the evidence, some driven by local commissioning or drug procurement processes, which make cost-effectiveness decisions different and the local guideline marginally different. The CCLG Group were also vey mindful of the necessarily poor quality of evidence that underlies the banding of drugs into emetogenic potential. Such data in children are drawn from small studies, often confounded by expectation and prophylactic antiemetics. As such, centre variations may occur. Centres with experience and disagreement with a classification system (such as the POGO system) are encouraged to publish their experience to support the advancement of the knowledgebase.
This guideline is a national framework document for local implementation. It relies on the work undertaken by the Canadian-led POGO group who developed three clinical practice guidelines for the prevention and management of chemotherapy-induced nausea and vomiting (CINV) in children.
The POGO group convened an international guideline panel to create a clinical practice guideline based on accepted best-practice methods (similar to those used by NICE). The group undertook a series of focused systematic reviews addressing management question in the prevention of CINV, and the treatment of breakthrough, refractory and anticipatory CINV. They then summarized this evidence and debated it, placing it in clinical context and developing recommendations. The guidelines were then subject to international stakeholder review before publication.
Now all phases of the management have been completed, the CCLG Supportive Care group has undertaken to summarize and contextualize in a UK framework to provide an up to date framework for local guidelines to be developed from. This involved the summarizing of the guidelines, discussion of the recommendations made within a UK licensing context, and providing a summary guide as an example for use. Recommendations were then circulated via the CCLG Guideline Development Group panel and feedback incorporated.
The CCLG Group noted that each centre may have subtle variations on their interpretation of the evidence, some driven by local commissioning or drug procurement processes, which make cost-effectiveness decisions different and the local guideline marginally different. The CCLG Group were also vey mindful of the necessarily poor quality of evidence that underlies the banding of drugs into emetogenic potential. Such data in children are drawn from small studies, often confounded by expectation and prophylactic antiemetics. As such, centre variations may occur. Centres with experience and disagreement with a classification system (such as the POGO system) are encouraged to publish their experience to support the advancement of the knowledgebase.
CCGL Group
The adaptation group consisted of: Dr Bob Phillips, Prof Faith Gibson, Mr. Pritesh Patel, Mrs. Eloise Neumann, Dr Amy Mitchell, Dr Geoff Shenton, Mrs. Ghazala Javid and Dr Hugh Bishop.
The adaptation group consisted of: Dr Bob Phillips, Prof Faith Gibson, Mr. Pritesh Patel, Mrs. Eloise Neumann, Dr Amy Mitchell, Dr Geoff Shenton, Mrs. Ghazala Javid and Dr Hugh Bishop.
Recommendations
OVER-RIDING PRINCIPLES
Children and young people about to undertake chemotherapy should have their chemotherapy assessed for emetogenicity
Balancing the use of antiemetic against the chance of the chemotherapy causing problems is a key principle. A number of systems have been proposed; for this guideline the POGO-developed system will be used. It divides chemotherapy into four strata:
Children and young people should have their symptoms of nausea and vomiting assessed
There are a range of assessment tools for nausea and vomiting (see ‘References’). These guidelines strongly advise using them within practice in order to improve patient care. No clear data supports the use of any one system over another, and with varied age ranges two scales may be preferred.
Children and young people about to undertake chemotherapy should have their emetogenicity-assessed treatment prescribed prior to chemotherapy, adapted to their own personal experience
While the evidence underpinning ‘personalisation’ of therapy is weak, it is common practice to use higher-level antiemetic’s when a child or young person has experienced problems with nausea and/or vomiting previously. Good control is felt to reduce the chances of anticipatory, and breakthrough/refractory, nausea and vomiting in subsequent courses.
The source guidance expresses a preference for palonosetron in many areas. While this is based on current RCTs, the panel were concerned about the possible effects of recency bias (where more positive results are published more quickly) and the lack of clear cost-effectiveness. Combined with the weak evidence for the superiority of any other 5HT3 antagonist against any other, we recommendation the use of a 5HT3 antagonist (ondansetron) as in the 2012 guideline.
OVER-RIDING PRINCIPLES
Children and young people about to undertake chemotherapy should have their chemotherapy assessed for emetogenicity
Balancing the use of antiemetic against the chance of the chemotherapy causing problems is a key principle. A number of systems have been proposed; for this guideline the POGO-developed system will be used. It divides chemotherapy into four strata:
- Highly emetogenic chemotherapy (HEC) includes very highly emetogenic chemotherapy
- Moderately emetogenic chemotherapy (MEC)
- Low emetogenicity chemotherapy
- Minimal emetogenicity
Children and young people should have their symptoms of nausea and vomiting assessed
There are a range of assessment tools for nausea and vomiting (see ‘References’). These guidelines strongly advise using them within practice in order to improve patient care. No clear data supports the use of any one system over another, and with varied age ranges two scales may be preferred.
Children and young people about to undertake chemotherapy should have their emetogenicity-assessed treatment prescribed prior to chemotherapy, adapted to their own personal experience
While the evidence underpinning ‘personalisation’ of therapy is weak, it is common practice to use higher-level antiemetic’s when a child or young person has experienced problems with nausea and/or vomiting previously. Good control is felt to reduce the chances of anticipatory, and breakthrough/refractory, nausea and vomiting in subsequent courses.
The source guidance expresses a preference for palonosetron in many areas. While this is based on current RCTs, the panel were concerned about the possible effects of recency bias (where more positive results are published more quickly) and the lack of clear cost-effectiveness. Combined with the weak evidence for the superiority of any other 5HT3 antagonist against any other, we recommendation the use of a 5HT3 antagonist (ondansetron) as in the 2012 guideline.
Prophlaxis
Prophlaxis: Very highly emetogenic chemotherapy
For children and young people receiving very highly emetogenic chemotherapy a combination of 5HT3 Antagonist (Ondansetron), Dexamethasone and Aprepitant should be prescribed unless there us a contraindication.
Contraindications include:
For children and young people receiving very highly emetogenic chemotherapy with a contraindication to Aprepitant a combination of 5HT3 antagonist (Ondansetron) and Dexamethasone should be prescribed unless there is a contraindication.
Contraindications include:
For children and young people receiving very highly emetogenic chemotherapy with a contraindication to Aprepitant and Dexamethasone receive A) Ondansetron or B) 5HT3 antagonist (Ondansetron) and levomepromazine or C) 5HT3 antagonist (Ondansetron) and Metoclopramide or D) 5HT3 antagonist (ondansetron) and Nabilone in adolescents.
Prophlaxis: Highly emetogenic chemotherapy
For children and young people receiving emetogenic chemotherapy a combination of 5HT3 antagonist (Ondansetron) and Dexamthasone. Aprepitant should be prescribed at step 2 or 3 unless there is a contraindication.
Contraindications include:
For children and young people receiving highly emetogenic chemotherapy with a contradiction to Aprepitant a combination of 5HT3 antoganoist (Ondansetron) and Dexamethasone should be prescribed unless there is a contraindication.
Contraindications include:
For children and young people receiving highly emetongenic chemotherapy with a contraindication to Aprepitant and Dexamethasone receive A) 5HT3 Antagonist (Ondansetron) OR B) 5HT3 antagonist (Ondansetron) and Levomepromazine or C) 5HT3 antagonist (Ondansetron) and Metoclopromide Or D) 5HT3 antagonist (Ondansetron) and Nabilone in adolescents.
This group in particular have very weak evidence to guide a selection of therapies and require further research.
Prophlaxis: Moderately emetogenic chemotherapy
For children and young people receiving moderately emetogenic chemotherapy a combination of 5HT3 antagonist (Ondansetron) and Dexamethasone should be prescribed unless there is a contraindication.
Contraindications include:
For children and young people receiving moderately emetogenic chemotherapy with a contraindication to Dexamethasone a combination of 5HT3 antagonist and Aprepitant should be prescribed unless there is a contraindication.
Contraindications include:
For Children and young people receiving moderately emetogenic chemotherapy with a contraindication to Aprepitant and Dexamethasone receive A) Ondansetron or B) 5HT3 Antagonist (Ondansetron) and Levomepromazine or C) 5HT3 antagonist (ondansetron) and Metoclopramide or D) 5HT3 antagonist (Ondansetron) and Nabilone in adolescents.
Prophlaxis: Low emetogenic chemotherapy
For children and young people receiving moderately emetogenic chemotherapy a 5HT3 antagonist (onsansetron) should be prescribed.
Prophlaxis: Minimally Emetogenic chemotherapy
For children and young people receiving minimally emetogenic chemotherapy no routine prophylaxis should be prescribed.
Prophlaxis: Very highly emetogenic chemotherapy
For children and young people receiving very highly emetogenic chemotherapy a combination of 5HT3 Antagonist (Ondansetron), Dexamethasone and Aprepitant should be prescribed unless there us a contraindication.
Contraindications include:
- Age < 6 months (Aprepitant, see table 4)
- Contraindication to dexamethasone (e.g. steroids included in treatment protocol). Refer to table 4.
- Drug interaction with Aprepitant. Refer to table 4.
For children and young people receiving very highly emetogenic chemotherapy with a contraindication to Aprepitant a combination of 5HT3 antagonist (Ondansetron) and Dexamethasone should be prescribed unless there is a contraindication.
Contraindications include:
- Contraindication to dexamethasone (e.g. steroids included in treatment protocol)
For children and young people receiving very highly emetogenic chemotherapy with a contraindication to Aprepitant and Dexamethasone receive A) Ondansetron or B) 5HT3 antagonist (Ondansetron) and levomepromazine or C) 5HT3 antagonist (Ondansetron) and Metoclopramide or D) 5HT3 antagonist (ondansetron) and Nabilone in adolescents.
Prophlaxis: Highly emetogenic chemotherapy
For children and young people receiving emetogenic chemotherapy a combination of 5HT3 antagonist (Ondansetron) and Dexamthasone. Aprepitant should be prescribed at step 2 or 3 unless there is a contraindication.
Contraindications include:
- Age < 6 months (aprepitant, refer to table 4)
- Contraindication to dexamethasone (e.g. steroids included in treatment protocol). Refer to table 4.
- Drug interaction with aprepitant. Refer to table 4.
For children and young people receiving highly emetogenic chemotherapy with a contradiction to Aprepitant a combination of 5HT3 antoganoist (Ondansetron) and Dexamethasone should be prescribed unless there is a contraindication.
Contraindications include:
- Contraindication to dexamethasone (e.g. steroids included in treatment protocol)
For children and young people receiving highly emetongenic chemotherapy with a contraindication to Aprepitant and Dexamethasone receive A) 5HT3 Antagonist (Ondansetron) OR B) 5HT3 antagonist (Ondansetron) and Levomepromazine or C) 5HT3 antagonist (Ondansetron) and Metoclopromide Or D) 5HT3 antagonist (Ondansetron) and Nabilone in adolescents.
This group in particular have very weak evidence to guide a selection of therapies and require further research.
Prophlaxis: Moderately emetogenic chemotherapy
For children and young people receiving moderately emetogenic chemotherapy a combination of 5HT3 antagonist (Ondansetron) and Dexamethasone should be prescribed unless there is a contraindication.
Contraindications include:
- Contraindication to dexamethasone (e.g. steroids included in treatment protocol). See table 4.
For children and young people receiving moderately emetogenic chemotherapy with a contraindication to Dexamethasone a combination of 5HT3 antagonist and Aprepitant should be prescribed unless there is a contraindication.
Contraindications include:
- Age < 6 months
- Drug interaction with Aprepitant, see table 4
For Children and young people receiving moderately emetogenic chemotherapy with a contraindication to Aprepitant and Dexamethasone receive A) Ondansetron or B) 5HT3 Antagonist (Ondansetron) and Levomepromazine or C) 5HT3 antagonist (ondansetron) and Metoclopramide or D) 5HT3 antagonist (Ondansetron) and Nabilone in adolescents.
Prophlaxis: Low emetogenic chemotherapy
For children and young people receiving moderately emetogenic chemotherapy a 5HT3 antagonist (onsansetron) should be prescribed.
Prophlaxis: Minimally Emetogenic chemotherapy
For children and young people receiving minimally emetogenic chemotherapy no routine prophylaxis should be prescribed.
Nausea & Vomiting
Breakthrough Nausea or Vomiting
Breakthrough refers to the reoccurrence of significant nausea or vomiting after a period of acceptable control. Should a child or young person experience this, a ‘next level up’ approach to prophylaxis should be strongly considered on subsequent cycles.
For children and young people receiving moderate, low or minimal emetogenic chemotherapy, escalation of treatment to the next highest level of intensity should be undertaken.
For children or young people receiving highly emetogenic chemotherapy, addition of A) Levomepromazine or B) Metoclopromide or C) Lorazepam (See table 3 below) to the treatment should be considered.
Refractory Nausea or Vomiting
Refractory refers to the continuation of significant nausea or vomiting without a period of acceptable control. Should a child or young person experience this, a ‘next level up’ approach to prophylaxis should be strongly considered on subsequent cycles.
For children and young people receiving moderate, low or minimal emetogenic, escalation or treatment to the next highest level of intensity should be undertaken.
For children and young people receiving highly emetogenic chemotherapy, consider substitution of Ondansetron for an alternative 5HT3 antagonist, for example Granisetron (Licenced IV/oral for children and patches for older children as per BNF)
For children and young people receiving highly emetogenic chemotherapy, who have previously been considered to have a contraindication to Apprepitant, re-visiting that decision is strongly recommended.
For children and young people who continue to suffer refractory nausea and / or vomiting, addition of A) Levomepromazin Infusion instead of bolus injection or B) Lorazepam or C) Acupressure to the treatment should be considered.
Other alternative agents and approaches have been used. For example, hyoscine patches can be used for subsequent courses for refractory emesis failing to respond to other rescue therapy, applied the night before chemotherapy is due (at least 12 hours prior to chemotherapy). Others may use nabilone for refractory cinv for adolescents. Some data suggest the use of olanzapine; this is subject to ongoing study in North America.
Anticipatory Nausea or Vomiting
Anticipatory refers to significant nausea or vomiting prior to the delivery of chemotherapy. Research in this area is particularly weak. Lorazepam is used with good effect in centres. Refer to dosing information below in table 4. Some centers use ondansetron and / or levomepromazine up to 24hrs prior to chemotherapy.
For children and young people who develop anticipatory nausea and/or vomiting, psychological interventions such as hypnosis or systematic desensitization may be offered.
For children ad young people who develop anticipatory nausea and/or vomiting, low dose Lorazepam refer to table 4, may be prescribed the day before, and from the first day of chemotherapy.
Delayed Nausea & Vomiting
The above regimens are intended to prevent both acute and delayed nausea and vomiting. If additional agents are required, then Aprepitant (cisplatin based regimens), Granisetron and Nabilone (adolescents) can be used.
Breakthrough Nausea or Vomiting
Breakthrough refers to the reoccurrence of significant nausea or vomiting after a period of acceptable control. Should a child or young person experience this, a ‘next level up’ approach to prophylaxis should be strongly considered on subsequent cycles.
For children and young people receiving moderate, low or minimal emetogenic chemotherapy, escalation of treatment to the next highest level of intensity should be undertaken.
For children or young people receiving highly emetogenic chemotherapy, addition of A) Levomepromazine or B) Metoclopromide or C) Lorazepam (See table 3 below) to the treatment should be considered.
Refractory Nausea or Vomiting
Refractory refers to the continuation of significant nausea or vomiting without a period of acceptable control. Should a child or young person experience this, a ‘next level up’ approach to prophylaxis should be strongly considered on subsequent cycles.
For children and young people receiving moderate, low or minimal emetogenic, escalation or treatment to the next highest level of intensity should be undertaken.
For children and young people receiving highly emetogenic chemotherapy, consider substitution of Ondansetron for an alternative 5HT3 antagonist, for example Granisetron (Licenced IV/oral for children and patches for older children as per BNF)
For children and young people receiving highly emetogenic chemotherapy, who have previously been considered to have a contraindication to Apprepitant, re-visiting that decision is strongly recommended.
For children and young people who continue to suffer refractory nausea and / or vomiting, addition of A) Levomepromazin Infusion instead of bolus injection or B) Lorazepam or C) Acupressure to the treatment should be considered.
Other alternative agents and approaches have been used. For example, hyoscine patches can be used for subsequent courses for refractory emesis failing to respond to other rescue therapy, applied the night before chemotherapy is due (at least 12 hours prior to chemotherapy). Others may use nabilone for refractory cinv for adolescents. Some data suggest the use of olanzapine; this is subject to ongoing study in North America.
Anticipatory Nausea or Vomiting
Anticipatory refers to significant nausea or vomiting prior to the delivery of chemotherapy. Research in this area is particularly weak. Lorazepam is used with good effect in centres. Refer to dosing information below in table 4. Some centers use ondansetron and / or levomepromazine up to 24hrs prior to chemotherapy.
For children and young people who develop anticipatory nausea and/or vomiting, psychological interventions such as hypnosis or systematic desensitization may be offered.
For children ad young people who develop anticipatory nausea and/or vomiting, low dose Lorazepam refer to table 4, may be prescribed the day before, and from the first day of chemotherapy.
Delayed Nausea & Vomiting
The above regimens are intended to prevent both acute and delayed nausea and vomiting. If additional agents are required, then Aprepitant (cisplatin based regimens), Granisetron and Nabilone (adolescents) can be used.
Discharge Medication
For very high and high emetogenic regimes, ensure patients are discharged on at least 3 days of anti-emetics.
For very high and high emetogenic regimes, ensure patients are discharged on at least 3 days of anti-emetics.
References
Source guidelines:
POGO Guidelines for the management of chemotherapy induced nausea and vomiting. http://www.pogo.ca/healthcare/practiceguidelines/
References to tools:
Baxter, A., Watcha, M., Baxter, W., Leong, T. and Wyatt, M. (2011) Development and Validation of a Pictorial Nausea Rating Scale for Children. Pediatrics, 127(6), pp.1542–1549.
Dupuis, L.L., Taddio, A., Kerr, E., Kelly, A. and MacKeigan, L. (2006) Development and Validation of the Pediatric Nausea Assessment Tool for Use in Children Receiving Antineoplastic Agents. Pharmacotherapy, 26(9), pp.1221-1231.
Rhodes, V. and McDaniel, R. (1999) The Index of Nausea, Vomiting, and Retching: A New Format of the Index of Nausea and Vomiting. Oncology Nursing Forum, 26(5), pp.889-894.
Wood, J.M., Chapman, K. and Eilers, J.(2011) Tools for Assessing Nausea, Vomiting, and Retching. Cancer Nursing, 34(1), E14-E24.
Other references:
Dewan, P., Singhal, S. and Harit, D. (2010) Management of Chemotherapy-Induced Nausea and Vomiting. Indian Pediatrics, 47, pp. 149-155.
Kraukauer , E.L., Zhu, A.X., Bounds, B.C., Sahani, D., McDonald, K.R., and Brachfel, E. (2005) Case 6-2005: A 58- Year Old Man with Esophageal Cancer and Nausea and Vomiting and Intractable Hiccups. New England Journal of Medicine, 352(8), pp.817-825.
Navari, R. (2013) Management of Chemotherapy-Induced Nausea and Vomiting: Focus on Newer Agents and New Uses for Older Agents. Drugs, 73, pp.249-262.
Rodgers, C., Norville, R., Taylor, O., Poon, C., Hesselgrave, J., Gregurich, M. and Hockenberry, M. (2012) Children’s Coping Strategies for Chemotherapy-Induced Nausea and Vomiting. Oncology Nursing Forum, 39(2), pp.202-209.
Wood, M., Hall, L., Hockenberry, M. and Borinstein, S. (2015) Improving Adherence to Evidence-Based Guidelines for Chemotherapy-Induced Nausea and Vomiting. Journal of Pediatric Oncology Nursing, 32(4), pp.195 –20.
Source guidelines:
POGO Guidelines for the management of chemotherapy induced nausea and vomiting. http://www.pogo.ca/healthcare/practiceguidelines/
References to tools:
Baxter, A., Watcha, M., Baxter, W., Leong, T. and Wyatt, M. (2011) Development and Validation of a Pictorial Nausea Rating Scale for Children. Pediatrics, 127(6), pp.1542–1549.
Dupuis, L.L., Taddio, A., Kerr, E., Kelly, A. and MacKeigan, L. (2006) Development and Validation of the Pediatric Nausea Assessment Tool for Use in Children Receiving Antineoplastic Agents. Pharmacotherapy, 26(9), pp.1221-1231.
Rhodes, V. and McDaniel, R. (1999) The Index of Nausea, Vomiting, and Retching: A New Format of the Index of Nausea and Vomiting. Oncology Nursing Forum, 26(5), pp.889-894.
Wood, J.M., Chapman, K. and Eilers, J.(2011) Tools for Assessing Nausea, Vomiting, and Retching. Cancer Nursing, 34(1), E14-E24.
Other references:
Dewan, P., Singhal, S. and Harit, D. (2010) Management of Chemotherapy-Induced Nausea and Vomiting. Indian Pediatrics, 47, pp. 149-155.
Kraukauer , E.L., Zhu, A.X., Bounds, B.C., Sahani, D., McDonald, K.R., and Brachfel, E. (2005) Case 6-2005: A 58- Year Old Man with Esophageal Cancer and Nausea and Vomiting and Intractable Hiccups. New England Journal of Medicine, 352(8), pp.817-825.
Navari, R. (2013) Management of Chemotherapy-Induced Nausea and Vomiting: Focus on Newer Agents and New Uses for Older Agents. Drugs, 73, pp.249-262.
Rodgers, C., Norville, R., Taylor, O., Poon, C., Hesselgrave, J., Gregurich, M. and Hockenberry, M. (2012) Children’s Coping Strategies for Chemotherapy-Induced Nausea and Vomiting. Oncology Nursing Forum, 39(2), pp.202-209.
Wood, M., Hall, L., Hockenberry, M. and Borinstein, S. (2015) Improving Adherence to Evidence-Based Guidelines for Chemotherapy-Induced Nausea and Vomiting. Journal of Pediatric Oncology Nursing, 32(4), pp.195 –20.
Appendix
Figure 1: Site of actions of anti-emetics
Figure 1: Site of actions of anti-emetics
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Document Version:
1.0 Lead Authors: Dr Bob Phillips, Prof Faith Gibson, Mr. Pritesh Patel, Mrs. Eloise Neumann, Dr Amy Mitchell, Dr Geoff Shenton, Mrs. Ghazala Javid and Dr Hugh Bishop |
Approving Network:
Wessex Oncology Network Date of Approval: 10/2021 Review Due:
10/2024 |
PIER Contact |
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