How to evaluate anti-emetic prophylaxis in chemotherapy-induced vomiting in children?

Objectives: Lack of specific schemes for chemotherapy-induced nausea and vomit in children may lead to inadequate management of emesis. In our unit we chose to adapt to our pediatricpopulation the same guidelines designed for adult patients, including combinations of ondansetron, dexamethasone and aprepitant. These schemes were applied to all patients according to administered chemotherapy and to age and weight of the child, and their effectiveness was assessed through medical record data and the opinions of parents and patients.Methods: Data collection was performed on patients aged between 3-17 years, who received chemotherapy for malignancy through October-December 2013. We considered data of nausea and vomiting reported in the nursing records and carried out, after informed consent, astructured interview to the parents, asking their opinion on the effectiveness of antiemetics. Finally, it was requested the child’s opinion by a visual-analog method (BRAF scale).Results: We evaluated 186 courses of chemotherapy with different degree of emetic risk: high, 23%, moderate, 34%, low, 33%, and very low 10%. Medical records showed a total control of nausea and vomiting in 72% of cases and absence of vomiting, with occasional episodes of nausea in 21%. Among parents, 87.6% rated the treatment as effective, while 11.8% considered it as not effective. Data collection concerning the BRAF scale showed that 80% of children selected the cartoons equivalent to a state of little or no nausea, without vomit.Conclusions: Our data indicate that nurses, parents and children expressed a concordant evaluation of effectiveness of the anti-emetic prophylaxis and, therefore, our method ofassessment appears sufficiently reliable. The schedule used was efficacious for 80% of patients; therefore efforts need to be pursued in order to improve stratification of patientsaccording to emetic risk and subsequent selective intensification of anti emetic strategy.