Chemotherapy-induced nausea and vomiting (CINV) is a common — and often costly — problem among patients with cancer.
Chemotherapy is the use of specific drugs, administered by a paediatric oncologist, to destroy cancer cells by preventing the cancer cells from growing and dividing to make more new cells. Cancer cells generally grow and divide much faster than healthy cells; chemotherapy destroys them more quickly than it destroys most healthy cells.
Chemotherapy drugs are very powerful and they cause damage to many growing cells, including some healthy cells. This damage causes the side effects of chemotherapy, which can include Nausea and Vomiting; Diarrhoea; Constipation; Heartburn or Stomach Ache; Sore Mouth or Throat/Mouth Sores; Change in Taste – Foods Have Less Taste or a Bitter Metallic Taste; Hair Loss; Skin Redness; Dry, Itching Skin; Moist Skin; Rashes; Sun Sensitivity; Swelling, Redness, or Pain at The Needle Site Where Chemotherapy Drugs are Given; Bladder Irritation and Infection; Change in Urine Colour & Strong Urine Odour; Nerve Damage; Stress Fractures; Fever; Flu-Like Symptoms; Infection; Anaemia/Fatigue; Blood Clotting Problems (Bleeding); Swelling/Fluid Retention; and Allergic Reaction.
If you are the parent of a Child with Cancer then you are used to CINV and know how it ravages a child already weakened by the cancer itself as well as cancer treatments such as Chemotherapy.
According to a recent study in which 37,730 reports of hospitalisation due to 
nausea and vomiting that occurred during 2014, and which was presented at the 2017 Palliative and Supportive Care in Oncology Symposium, the average amount paid by insurers for each CINV-related hospitalisation is more than $15,000.
According to the authors of the study, “This economic impact, in addition to the consequences for patients’ quality of life, suggests the need for continued advances in preventing CINV and optimizing compliance with national antiemetic guidelines, particularly for chemotherapy with high emetogenic potential.”
Further, Eric Roeland, M.D., author, medical oncologist and palliative care specialist at University of California San Diego Health, mentioned that health care organisations may not always follow proper protocol that could help decrease the risk of CINV.
“Surprisingly, the adherence to evidence-based guidelines is poor with approximately half of institutions not implementing the proper CINV prophylactic strategies,” he said.
“Consequently, CINV is still a major concern for patients with cancer. If patients do not receive proper CINV prophylaxis [prevention], I would estimate that more than half of patients suffer from CINV. With the proper CINV prophylaxis, it is about 25% of patients who still have persistent symptoms of nausea and vomiting, especially in the breast cancer patient population.”
Roeland hopes that research will continue to advance in the field of CINV, particularly in assessing who is at a higher risk for the effect, as well as implementing and standardising treatment protocols that can take people from having less nausea and vomiting to having none at all.
Gary Binder, another author on the study, Senior Director, HEOR and Value, also shared similar concerns.
“Further research is needed to identify the specific levels on compliance with guidelines and steps are needed to help streamline medical professionals’ ability to comply with the guidelines,” he said. “In addition, more monitoring of patient symptoms between office visits would help build awareness of the actual rate of CINV events, which would help avoid recurrence and hopefully reinforce the need for guideline compliance.”
What You Can Do for your Child with CINV
Fortunately, if your Child with Cancer is suffering from CINV, there are various steps that you can take to help them:
- Speak to your child’s doctor regarding any medication that can be prescribed to help control the nausea and vomiting and/or a sedative to help your child sleep through the nausea;
- Ask your doctor if it is okay to give your child milk or antacids before taking oral anticancer drugs. Some oral anticancer drugs should not be taken with milk;
- Feed your child something light about 3-4 hours before the treatment;
- Encourage your child to rather eat small amounts of food often and slowly than try to eat a big meal;
- Do not give your child greasy, sweet, or spicy foods or foods that have strong smells;
- Make your child cold meals like sandwiches instead of hot food;
- Encourage your child to drink liquids first – then wait 30-60 minutes before eating solids. Most children can handle liquids better than solids;
- See that your child rests after meals;
- If your child is vomiting, do not give him or her anything to eat or drink until the vomiting is under control:
a) Once the vomiting is under control, give him or her small amounts of clear liquids such as water, a thin stock soup, milk-free ice lollies, and gelatine desserts
b) Start with 1 teaspoon every 10 minutes and gradually increase the amount to 1 tablespoon every 20 minutes. Work up to 2 tablespoonfuls every 30 minutes
c) When your child can keep down clear liquids, try denser liquids such as strained cereal, pudding, yoghurt, milkshakes, and cream soups
d) Give small amounts as often as your child can keep them down, and gradually work up to solid foods
