Prevalence of anticipatory nausea and vomiting in children undergoing cytotoxic chemotherapy for malignant disease - the SiCK2 (Sickness prior to Chemotherapy in Kids) study

IntroductionAnticipatory nausea and vomiting (ANV) is thought to be a conditioned response to nausea and vomiting experienced in previous chemotherapy cycles, and has a significant negative impact on quality of life for children having treatment for cancer. The prevalence of this aversive experience with current antiemetics remains uncertain.MethodsSelf-report questionnaires completed by patients and parents across seven sites in the UK. Nausea and vomiting symptoms 24 hours prior to commencing chemotherapy were assessed with the Pediatric Nausea Assessment Tool (PeNAT). Data were also collected on the patients’ age, sex, oncological diagnosis, and previous experience of chemotherapy induced nausea and vomiting. Correlation between demographic data, chemotherapy information and prior reported experience of chemotherapy related nausea and vomiting was under-taken using multiple ordinal regression.Results191 episodes of anticipatory nausea and vomiting status were returned. 34% of patients described severe or very severe anticipatory nausea and/or vomiting. The severity of anticipatory nausea and vomiting was predicted two factors related to prior chemotherapy: control of anticipatory (OR 0.23 95%CI 0.09 to 0.53) and acute/delayed (OR 0.37, 95% CI 0.16 to 0.83) nausea and vomiting, and one current factor, the administration of antiemetic medication prior to arrival at the hospital (OR 3.0, 95%CI 1.3 to 6.8).ConclusionsThis study re-enforces, disappointingly, the continued high prevalence of anticipatory nau-sea and vomiting in children about to receive chemotherapy. There is clearly a need to improve interventions for this rarely discussed aversive experience of childhood cancer. Its high prevalence suggests trials of interventions should be possible to power effectively, and develop interventions that are both acceptable and deliverable.

Nausea and vomiting

Nausea and vomiting are common and distressing symptoms of cancer and its treatments. Treatment-related nausea and vomiting are covered in depth, including pre-treatment assessment, the emetogenic level of chemotherapy drugs, and pharmacological management of chemotherapy-induced nausea and vomiting. An evidence-based treatment algorithm is described, covering the wide range of possible anti-emetics. Non-pharmacological options are also described. There is also a section on anticipatory nausea and vomiting. Nausea and vomiting in advanced cancer are covered separately. The multifactorial nature of this is discussed, with a focus on different anti-emetic regimes, as well as nursing management, including detailed assessment and ongoing nutritional and psychological support.