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Pediatric Chemotherapy-Induced Nausea and Vomiting Follow-up

  • Author: Reuven J Schore, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
 
Updated: Sep 16, 2015
 

Further Outpatient Care

See the list below:

  • Ensure episodes of emesis are well controlled prior to discharge.
  • Monitor serum laboratory levels in the ambulatory setting and correct for abnormalities of fluid and electrolyte status due to vomiting.
  • Educate patients and caregivers on mechanisms of rehydration and the importance of oral hydration during chemotherapy and following periods of vomiting.
  • Verify patients and caregivers are able to maintain proper nutritional status for patients at home. Provide nutrition supplements as needed.
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Further Inpatient Care

See the list below:

  • Monitor serum laboratory values and correct for abnormalities of fluid and electrolyte status due to episodes of chemotherapy-induced vomiting.
  • Monitor and supplement nutritional needs as appropriate for the child’s age.
  • Monitor the patient’s weight loss, if the patient is not able to maintain oral intake.
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Inpatient & Outpatient Medications

See the list below:

  • Antiemetic prophylaxis should always be initiated prior to administration of emetogenic chemotherapy.
  • If infusions are administered in an ambulatory setting, provide patients and caregivers with appropriate prescriptions and instructions prior to initiation of emetogenic chemotherapy.
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Complications

Complications of chemotherapy-induced nausea and vomiting may include the following:

  • Patient discomfort
  • Electrolyte imbalance
  • Dehydration
  • Poor nutrition
  • Prolonged hospitalizations
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Prognosis

See the list below:

  • Selection and modification of appropriate antiemetic therapy based on emetogenic potential of chemotherapy scheduled, prior patient experience, and patient risk factors increase the opportunity for administration of chemotherapy without emetic complications.
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Patient Education

See the list below:

  • Importance of adequate hydration
  • Adherence to schedules antiemetic regimen
  • Maintaining chemotherapy treatments as scheduled
  • Diet modifications to decrease emesis risk
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Contributor Information and Disclosures
Author

Reuven J Schore, MD Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences; Attending Physician, Center for Cancer and Blood Disorders, Leukemia and Lymphoma Program, Division of Oncology, Children's National Medical Center

Reuven J Schore, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Received research grant from: Millennium Pharmaceuticals, Inc; Onyx Pharmaceuticals, Inc; Merck Inc<br/>Received income in an amount equal to or greater than $250 from: Baxalta Pharmaceuticals, Inc.

Coauthor(s)

Devona Williams, PharmD Pharmacy Clinical Specialist, Children's National Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA Executive Vice President, Chief Medical and Academic Officer, Renown Heath

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American College of Healthcare Executives, American Society of Pediatric Hematology/Oncology, Society for Pediatric Research

Disclosure: Nothing to disclose.

References
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Vomiting reflex.
Table. Emetogenic Risk of Intravenously Administered Antineoplastic Agents[2, 6]
Emetogenic Risk levelAntineoplastic AgentsAntiemetic Regimen
level 4 (High): More than 90% of patients who receive these agents experience nausea and vomiting.Carmustine, cisplatin, cyclophosphamide (>1500 mg/m2), dacarbazine, dactinomycin, mechlorethamine, streptozotocinSerotonin-receptor antagonist,



dexamethasone, and aprepitant



level 3 (Moderate): Nausea and vomiting occurs in 30-90% of patients who receive these agents.Carboplatin, cyclophosphamide (< 1500 mg/m2), cytarabine (>1 g/m2), daunorubicin, doxorubicin, epirubicin, idarubicin, ifosfamide, irinotecan, oxaliplatinSerotonin-receptor antagonist and dexamethasone
level 2 (Low): Nausea and vomiting occurs in 10-30% of patients who receive these agents.Bortezomib, cetuximab, cytarabine (< 1 g/m2), docetaxel, etoposide, fluorouracil, gemcitabine, methotrexate, mitomycin, mitoxantrone, paclitaxel, pemetrexed, topotecan, trastuzumabSerotonin-receptor antagonist
level 1 (Minimal): Less than 10% of patients who receive these agents experience nausea and vomiting.Bevacizumab, bleomycin, busulfan, 2-chlorodeoxyadenosine, fludarabine, rituximab, vinblastine, vincristine, vinorelbineNo antiemetic routinely administered*
*If antiemetic required for individual patients, may use a single dose of serotonin-receptor antagonist
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