Guideline for the Prevention and Management of Chemotherapy Induced Nausea and Vomiting in Children with Cancer

The recommendations in this guideline are adapted to the local context from the C17 endorsed Pediatric Oncology Group of Ontario (POGO) Guideline for the Prevention of Acute Nausea and Vomiting due to Antineoplastic Medication in Pediatric Cancer Patients, the POGO Guideline for Classification of the Acute Emetogenic Potential of Antineoplastic Medication in Pediatric Cancer Patients, and the POGO Guideline for the Prevention and Treatment of Anticipatory Nausea and Vomiting due to Chemotherapy in Pediatric Cancer Patients. The full versions of the guidelines which include the systematic reviews are available at: http://www.pogo.ca/healthcare/practiceguidelines
 

The APPHON/ROHPPA guideline utilized these systematic reviews and adapted the information for use in the Atlantic Provinces.  The APPHON/ROHPPA guideline provides   recommendations on the management of nausea and vomiting in children being treated for cancer or chemotherapy induced nausea and vomiting (CINV). The guideline will include the management of acute, delayed, anticipatory, breakthrough and refractory CINV. This guideline will also categorize antiemetic therapy based on the emetogenic potential of chemotherapy agents. The Pediatric Oncology Group of Ontario (POGO) has classified chemotherapy agents based on their emetogenic potential. This guideline will not include a review of alternative methods of nausea control nor will it make recommendations as it is felt the evidence in this area is not sufficient. 

Definitions
Nausea and vomiting assessment
Non-pharmacologic Management
  • Dietary Concerns
Pharmacologic Management
  • Antiemetic management
  • Route of Administration for Antiemetic Agents
  • Duration of Antiemetic Administration
  • Management of Antiemetic Failure
  • Other considerations
The following 3 algorithms provide tools for the healthcare provider to determine how to manage chemotherapy induced nausea and vomiting (CINV) in children with cancer. The algorithms have been adapted from the 2012 POGO guidelines for the Prevention of Acute Nausea and Vomiting due to Antineoplastic Medication.
 
  • APPHON/ROHPPA Prevention and management of CINV in Pediatric Cancer Patients - Low and Minimal Emetogenic Risk
  • APPHON/ROHPPA - Prevention and management of CINV in Pediatric Cancer Patients - Moderate Emetogenic Risk
  • APPHON/ROHPPA - Prevention and management of CINV in Pediatric Cancer Patients – High Emetogenic Risk
 

The supportive care guidelines have been developed by appropriate Atlantic Provinces health professional specialists (physicians, pharmacists, nurses and other health professionals) using evidence-based or best practice references.  Format and content of the guidelines will change as they are reviewed and revised on a periodic basis.  Care has been taken to ensure accuracy of the information.  However, any physician or health professional using these guidelines will be responsible for verifying doses, and administering medications and care according to their own institutional formularies and policies and acceptable standards of care.

Guideline for Classification of the acute emetogenic potential of Antineoplastic medication in pediatric cancer patient Guideline
 
APPHON has adotped the POGO Guideline for Classification of the acute emetogenic potential of Antineoplastic medication in pediatric cancer patient guideline.  This POGO guideline provides physicians, nurses, pharmacists and other health care providers who care for children aged 1 month to 18 years who are receiving antineoplastic medication with an approach to assess the emetogenic potential of antineoplastic regimens. The scope of this guideline is limited to the assessment of antineoplastic therapy emetogenicity in the acute phase (within 24 hours of administration of an antineoplastic agent). Its scope does not include anticipatory, breakthrough or delayed phase antineoplastic-induced nausea and vomiting (AINV), or nausea and vomiting that is related to radiation therapy, disease, co-incident conditions or end-of-life care. In addition, this guideline is most applicable to children who are naïve to antineoplastic therapy and who are about to receive their first course of antineoplastic therapy. In the case of children who have received antineoplastic medication in the past, estimation of the emetogenic potential of the antineoplastic regimen to be given incorporates both the recommendations of this guideline and an assessment of the child’s previous experience with AINV.
 
This guideline represents the first of a series of guidelines to address the need for, and the selection of, antiemetic prophylaxis and intervention in children with cancer receiving antineoplastic therapy. These guidelines will lead to improvements in the supportive care of children with cancer by offering a standardized, evidence-based approach to the prophylaxis of AINV, optimization of AINV control and provision of cost-effective antiemetic prophylaxis. 
 
The complete guideline and a summary version are available at:
 
 
 

Directives pour la gestion des nausées et des vomissements

Les nausées et les vomissements peuvent commencer immédiatement après l’administration de la chimiothérapie ou être différés jusqu’à 12 heures, selon le ou les agents chimiothérapeutiques. Les nausées et les vomissements surviennent parfois avant le début de la chimiothérapie, cela est appelé nausées et vomissements « anticipés » : la relaxation et la distraction peuvent aider à les contrôler.

  • Gestion non pharmacologique
  • Gestion pharmacologique

Les lignes directrices relatives aux soins de soutien du ROHPPA ont été élaborées par des professionnels de la santé des provinces atlantiques à partir de références fondées sur des observations factuelles ou des pratiques exemplaires. Le format et le contenu des lignes directrices varieront, car ils font régulièrement l’objet d’examens et de révisions. On a pris soin de s’assurer que l'information est juste. Cependant, tout médecin ou professionnel de la santé ayant recours à ces lignes directrices sera tenu de vérifier les doses, d'administrer les médicaments et de fournir les soins en respectant les formulaires, les politiques et les normes de diligence acceptables de leur établissement.

 Link to 2001 APPHON/ROHPPA French translated Nausea & Vomiting Guideline (2015 version to be translated)