Introduction
Childhood cancer is the second leading cause of death by disease post infancy among children. The overall survival of the disease has greatly improved in the past few years1–3, which has been distinctly observed in case of acute lymphoblastic leukemia, the most common childhood cancer; its overall survival has increased drastically from 40% to 50% in the early 1970–1980s to over 90% in recent years4. This improvement has been attributed to incorporation of increasingly intense chemotherapeutic courses associated with a high incidence of adverse events such as chemotherapy-induced nausea and vomiting (CINV). Despite the presence of highly effective antiemetics regimens, CINV remains a cause of distress for patients with cancer, especially those undergoing highly emetogenic chemotherapy (HEC) regimens. CINV occurs in up to 70% of the pediatric population undergoing rigorous chemotherapy. Studies have suggested that nausea and vomiting can be associated with extended hospital stay and decreased patient satisfaction. CINV influences the quality of life of children and their parents.
Symptoms such as nausea are highly subjective and often difficult to assess in the pediatric population; conversely, vomiting is usually much easier to assess mainly as it is a tangible and objective symptom that can be counted for frequency and measured for severity. Children lack the ability to describe how they feel or adequately rate their nausea severity and are often prescribed antiemetic medication as needed and may not receive it until commencement of vomitting. The Baxter Animated Retching Face (BARF) scale was developed by Baxter et al. as a tool to assess and monitor the presence and severity of nausea in children aged between 4 and 18 years.
Several studies have examined the incidence of acute and delayed nausea and vomiting, particularly in children12,21,24. Despite the use of antiemetics, CINV continues to be a contributing factor in reducing patients’ quality of life after undergoing highly and moderately emetogenic chemotherapy. Most studies that assessed the incidence of chemotherapy-induced nausea and vomiting (CINV) included patients who underwent HEC; however, studies on those undergoing chemotherapy with a moderate or low level of emetogenicity are rare. Similarly, data from Saudi Arabia’s pediatric population are scarce, especially prospectively.
To bridge the knowledge gap, this study aimed to assess the incidence and severity of acute and delayed CINV in pediatric cancer patients who are receiving any form of chemotherapy. Furthermore, we examined our institution’s adherence to the published Pediatric Oncology Group of Ontario (POGO) guidelines. Nausea and vomiting can have non-treatment-related causes. In our study, we focused only on treatment-related causes. Proactive assessment of CINV has a great potential for improving treatment tolerance and decreasing health care cost by reducing the number of re-admission secondary to excessive CINV. In addition, implementation of CINV guidelines can increase adherence to antiemetic guidelines and ultimately improving outcomes