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