[Prevention and treatment of antineoplastic drug-induced nausea and vomiting in pediatric onco-hematology: An update]. / Prévention et traitement des nausées et vomissements induits par les traitements anticancéreux (NVITAC) en hémato-oncologie pédiatrique : mise à jour.

Antineoplastic drug induced nausea and vomiting are common adverse events in cancer care of paediatric patients ; therefore, prevention and management of these adverse events is a major concern for healthcare professionals. There are common features between paediatric and adult patients in terms of the emetogenic level depending on antineoplastic agents or about available medicines. However, there are also specificities for paediatric population including individual risk factors of emesis or nausea assessment for example. Knowledge relative to available medicines is also limited in the paediatric population, especially for recent medicines. This review aims to provide a comprehensive overview about antiemetics in paediatric oncology to clinicians and other healthcare professionals involved in paediatric cancer care. First of all, we describe physiopathological paediatric specificity, risk factors and clinical assessment of antineoplastic drug induced nausea and vomiting. Secondly, we focus on available medicines and also address the issue of complementary and alternative medicines.

Comparing the physical, psychological, social, and spiritual needs of patients with non-cancer and cancer diagnoses in a tertiary palliative care setting.

OBJECTIVE: The purpose was to describe the physical, psychological, social, and spiritual needs of patients with non-cancer serious illness diagnoses compared to those of patients with cancer. METHOD: We conducted a retrospective chart review of all patients with a non-cancer diagnosis admitted to a tertiary palliative care unit between January 2008 and December 2017 and compared their needs to those of a matched cohort of patients with cancer diagnoses. The prevalence of needs within the following four main concerns was recorded and the data analyzed using descriptive statistics and content analysis: •Physical: pain, dyspnea, fatigue, anorexia, edema, and delirium•Psychological: depression, anxiety, prognosis, and dignity•Social: caregiver burden, isolation, and financial•Spiritual: spiritual distress. RESULTS: The prevalence of the four main concerns was similar among patients with non-cancer and cancer diagnoses. Pain, nausea/vomiting, fatigue, and anorexia were more prevalent among patients with cancer. Dyspnea was more commonly the primary concern in patients with non-cancer diagnoses (39%), who also had a higher prevalence of anxiety and concerns about dignity. Spirituality was addressed more often in patients with cancer. SIGNIFICANCE OF RESULTS: The majority of patients admitted to tertiary palliative care settings have historically been those with cancer. The tertiary palliative care needs of patients with non-cancer diagnoses have not been well described, despite the increasing prevalence of this population. Our description of the palliative care needs of patients with non-cancer diagnoses will help guide future palliative care for the increasing population of patients with non-cancer serious illness diagnoses.

Differences in set-shifting and central coherence across anorexia nervosa subtypes in children and adolescents.

OBJECTIVE: Regarding executive functioning in anorexia nervosa (AN), little is known about differences between the restricting (AN-R) and binge eating/purging (AN-BP) subtypes. Especially for adolescents, there is sparse data. Hence, the current aim is to investigate differences in set-shifting, central coherence, and self-reported executive functioning across adolescent AN subtypes. METHODS: Ninety AN-R, 21 AN-BP, and 63 controls completed an extensive assessment battery including neuropsychological tests for executive functioning and the self-report questionnaire Behavior Rating Inventory of Executive Functioning. RESULTS: Patients with AN-R and AN-BP did not differ on neuropsychological measures, and both performed similarly to controls. Behavior Rating Inventory of Executive Functioning scores fell within the normal range with AN subtypes showing mostly comparable ratings. AN-BP patients scored higher on 2 composite indices and the "shift" subscale compared with AN-R. CONCLUSIONS: The results suggest similar cognitive functioning in adolescent AN subtypes as well as healthy controls. However, more research is needed to draw more general conclusions.

Cyclic Vomiting Syndrome in Adults and Children: A Hypothesis.

OBJECTIVE: To see how patients' clinical descriptions compare to the third classification of International Classification of Headache Disorders (ICHD-III beta). BACKGROUND: CVS is an episodic syndrome associated with migraine. It is a rare disorder of childhood and adulthood. New criteria are proposed in the third classification of International Classification of Headache Disorders. METHODS: This study describes children and adults' CVS characteristics at a French tertiary-care center, according to the ICHD-II and ICHD-III beta criteria. Clinical features, and results of paraclinical tests were characterized. RESULTS: Fifteen patients were included: 8 adults, 2 children, and 5 adolescents. Familial history of migraine or CVS was respectively noticed in 12 and 4 patients. The duration of premonitory, emetic, and postdromal phases was evaluated from hours to days. Some symptoms described in theses phases are also described in migrainous population, with a comparable frequency. Cranial or systemic autonomic symptoms were respectively reported in 47% and 93%. Nine patients described a circadian periodicity, and six patients described a circannual periodicity. The predictable periodicity was from 1 week to 12 months. A brain perfusion SPECT showed an increased hypothalamic perfusion during emetic phase in one patient. CONCLUSIONS: CVS is a rare episodic syndrome associated with migraine. Some clinical features and paraclincal tests suggest a chronobiological disease.

Do restrictive and bingeing/purging subtypes of anorexia nervosa differ on central coherence and set shifting?

OBJECTIVE: Anorexia nervosa (AN) has been associated with weak central coherence (CC) and weak set shifting (SS). The main aim of this study was to examine possible differences between restrictive AN (AN-R) and bingeing/purging AN (AN-BP) on these features. METHODS: A total of 31 patients with AN-R, 20 patients with AN-BP and 26 healthy controls (HC) completed five neuropsychological tests (Block Design, Object Assembly, an adapted task-switching paradigm, Wisconsin Card Sorting Test and Trail Making Test). RESULTS: Using Block Design and Object Assembly, indicative for CC, AN-R patients performed significantly worse than AN-BP patients and HC, without any difference between AN-BP and HC. On SS measures, no group differences were observed. DISCUSSION: The results suggest that cognitive profiles of AN-R and AN-BP patients differ significantly on CC and not on SS. Our current findings support the idea that the two subtypes of AN have a distinctive underlying nature and might need a different approach in cognitive remediation.

Dosimetric predictors of radiation-induced acute nausea and vomiting in IMRT for nasopharyngeal cancer.

PURPOSE: We wanted to investigate dosimetric parameters that would predict radiation-induced acute nausea and vomiting in intensity-modulated radiation therapy (IMRT) for undifferentiated carcinoma of the nasopharynx (NPC). METHODS AND MATERIALS: Forty-nine consecutive patients with newly diagnosed NPC were treated with IMRT alone in this prospective study. Patients receiving any form of chemotherapy were excluded. The dorsal vagal complex (DVC) as well as the left and right vestibules (VB-L and VB-R, respectively) were contoured on planning computed tomography images. A structure combining both the VB-L and the VB-R, named VB-T, was also generated. All structures were labeled organs at risk (OAR). A 3-mm three-dimensional margin was added to these structures and labeled DVC+3 mm, VB-L+3 mm, VB-R+3 mm, and VB-T+3 mm to account for physiological body motion and setup error. No weightings were given to these structures during optimization in treatment planning. Dosimetric parameters were recorded from dose-volume histograms. Statistical analysis of parameters' association with nausea and vomiting was performed using univariate and multivariate logistic regression. RESULTS: Six patients (12.2%) reported Grade 1 nausea, and 8 patients (16.3%) reported Grade 2 nausea. Also, 4 patients (8.2%) complained of Grade 1 vomiting, and 4 patients (8.2%) experienced Grade 2 vomiting. No patients developed protracted nausea and vomiting after completion of IMRT. For radiation-induced acute nausea, V40 (percentage volume receiving at least 40Gy) to the VB-T and V40>=80% to the VB-T were predictors, using univariate analysis. On multivariate analysis, V40>=80% to the VB-T was the only predictor. There were no predictors of radiation-induced acute vomiting, as the number of events was too small for analysis. CONCLUSIONS: This is the first study demonstrating that a V40 to the VB-T is predictive of radiation-induced acute nausea. The vestibules should be labeled as sensitive OARs, and weightings should be considered for dose sparing during optimization in the treatment planning of IMRT.

Náuseas, vómitos, diarrea, estreñimiento e hiporexia en la alimentación del niño con cáncer / Nausea, vomiting, diarrhea, constipation and decreased appetite in feeding the child with cancer

Entre las manifestaciones digestivas que se presentan en el tratamiento del niño con cáncer, bien sea por la quimioterapia, la radioterapia, los medicamentos subyacentes a estas terapias o a la misma enfermedad per sé, se encuentran las náuseas, los vómitos, la diarrea, el estreñimiento y la disminución del apetito. Todos ellos, junto con la pérdida de la actividad física y los cambios en los hábitos alimentarios, pueden conllevar a malnutrición. Es necesario así entonces realizar algunas sugerencias preventivas nutricionales y de puericultura, para evitar la morbilidad secundaria a ello.

Among the digestive symptoms that occur in the treatment of children with cancer, either gy chemotherapy, radiotherapy, drug therapy or underlying these the same disease per se, include nausea, vomiting, diarrea, constipation and the decline and loss of appetite. They, along with the loss of physycal activit and changes in eating habits, can lead to malnutrition. Need and then make some suggestions preventive nutrition and childcare, to avoid the morbidity secondary to it.

Differentiating purging and nonpurging bulimia nervosa and binge eating disorder.

OBJECTIVE: To explore similarities and differences in clinical and personality variables across three groups: binge eating disorder (BED), bulimia nervosa-purging type (BN-P), and bulimia nervosa-non purging type (BN-NP). METHOD: The participants were 102 female eating disorders patients (34 BED, 34 BN-P, and 34 BN-NP) consecutively admitted to the eating disorders unit, at the University Hospital of Bellvitge, and diagnosed according to DSM-IV criteria. RESULTS: BED patients were older, and more likely to have personal and family history of obesity. A gradient in psychopathological scores emerged with BN-P patients having higher pathological scores on the SCL-90-R, followed by BN-NP and BED patients. No statistically significant differences were observed in personality traits. DISCUSSION: Our data supported that eating disorders (namely BED, BN-NP, and BN-P) followed a linear trend in general psychopathology. Whereas personality may represent a shared vulnerability factor, differences in clinical severity suggest there to be a continuum with BN-P being the most severe and BED being the least severe.

The validity and clinical utility of purging disorder.

OBJECTIVE: To review evidence of the validity and clinical utility of Purging Disorder and examine options for the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-V). METHOD: Articles were identified by computerized and manual searches and reviewed to address five questions about Purging Disorder: Is there "ample" literature? Is the syndrome clearly defined? Can it be measured and diagnosed reliably? Can it be differentiated from other eating disorders? Is there evidence of syndrome validity? RESULTS: Although empirical classification and concurrent validity studies provide emerging support for the distinctiveness of Purging Disorder, questions remain about definition, diagnostic reliability in clinical settings, and clinical utility (i.e., prognostic validity). DISCUSSION: We discuss strengths and weaknesses associated with various options for the status of Purging Disorder in the DSM-V ranging from making no changes from DSM-IV to designating Purging Disorder a diagnosis on equal footing with Anorexia Nervosa and Bulimia Nervosa.

Reflexo de gag em jovens e idosos sem indícios de disfagia orofaríngea / Gag reflex in young and old without evidence of oropharyngeal dysphagia

Introdução: A disfagia, muito comum em idosos, interfere negativamente na saúde humana. Identifi cá-la o quanto antes requer procedimentos adequados, dentre esses a pesquisa do refl exo de gag é uma questão controversa. Os objetivos deste trabalho foram: verifi car o gag, (refl exo de vômito), e o seu local de disparo em jovens e idosos sem indício de disfagia orofaríngea; comparar a ocorrência do gag e o local de disparo entre jovens e idosos; comparar a ocorrência do gag desta amostra aos da literatura (indivíduos sem e com disfagia). Material e Método:Testou-se o gag em 15 jovens e 15 idosos saudáveis, verifi cando-se ocorrência, tipo de gag e local de disparo, comparando os grupos entre si e com a literatura (Teste qui-quadrado de Pearson). Resultados: 80% dos jovens e dos idosos apresentaram gag. O local de disparo nos jovens foi igual à dos idosos (p=0,23). A presença e a ausência do gag nos jovens foi igual à literatura (p=0,17). A ausência nos idosos foi maior do que a literatura (p<0,001). Quando considerada toda a amostra, a ausência de gag e do hiper-gag foi maior do que a literatura (p<0,001), e a do gag normal, menor (p<0,001). Comparados aos sujeitos disfágicos (literatura), não houve diferenças quanto à ausência, mas sim quanto à presença de gag (normal e exacerbado) (p<0,001). Conclusões: Não houve relação entre o gag, nem locais de disparo, e a idade. A ocorrência do gag desta amostra se equiparou a um estudo com indivíduos saudáveis, e discordou de outro. Não houve relação entre o gag e a deglutição.

Introdution: Dysphagia is common in elderly patients and has negative effects in human health. To detect it as soon as possible it is necessary to use appropriated methods, being the gag testing controversial. The aims of this paper were: to verify the gag refl ex and the structure where it was defl agrated in young and elderly subjects without suspected oropharyngeal dysphagia; to compare these groups (young and elderly); to compare the gag presence to the literature data (dysphagic and non-dysphagic people). Material and Method: The gag refl ex was tested in 15 healthy youngsters and 15 healthy elderly individuals to verify the presence and type of gag and place it was defl agrated, comparing the data between young and elderly and these to the literature (Pearson's Chi-Square Test). Results: 80% of young and elderly had gag. The structure in which it was defl agrated was the same in both groups (p=0,23). The presence and absence of gag in young subjects was the same as data found in literature (p=0,17). The absent gag was greater than literature reports (p<0,001). When considered together, young and older people had absent and exacerbated gag as frequently as the literature reports (p<0,001), and inferior to normal gag references (p<0,001). Compared to dysphagic subjects (literature), the absent gag was equal, but gag and hipergag were different (p<0,001). Conclusions: There was no relationship between age, gag and place it was defl agrated. The occurrence of gag in this paper was the same to some healthy people, but different from others cited by literature. There was no relationship between gag and deglutition.

Introducción: La disfagia, muy común en los adultos mayores, afecta negativamente a la salud humana. Identifi carla lo antes posible requiere procedimientos adecuados, entre ellos, la búsqueda del refl ejo de gag es una questión polemica. Los objetivos de este estudio fueron: determinar el gag (refl ejo de vomito) y su lugar de disparo en jóvenes y adultos mayores sin ocurrencia de la disfagia orofaríngea; comparar la ocurrencia del gag y el lugar de disparo entre los jóvenes y adultos mayores, comparar la ocurrencia del gag de esta muestra a los de la literatura (personas con y sin disfagia). Material y método: el gag fue probada en 15 jóvenes y 15 adultos mayores sanos, para verifi car la ocurrencia, tipo de gag y lugar de disparo, comparando los grupos entre sí y con la literatura (Test Chi cuadrado de Pearson). Resultados: 80% de los jóvenes y de los adultos mayores presentaron gag. El lugar de disparo en los jovenes fue similar al de los adultos mayores (p = 0,23). La presencia y la ausencia del gag en los jovenes fue igual al de la literatura (p = 0,17). La ausencia en los adultos mayores fue superior al de la literatura (p <0001). Considerando la totalidad de la muestra, la ausencia de gag y hiper-gag fue superior al de la literatura (p <0,001), y la de gag normal, inferior (p <0001). Comparados a los sujetos disfágicos (literatura), no hubo diferencias en la ausencia, pero si en la presencia de gag (normal y exacerbado) (p <0,001). Conclusiones: No hubo relación entre el gag, o lugares de disparo, y la edad. La aparición de gag de esta muestra se equiparó a un estudio con sujetos sanos, y discordó de otro. No hubo relación entre gag y la deglución.

Prospective evaluation of ondansetron for undifferentiated nausea and vomiting in the prehospital setting.

OBJECTIVE: To evaluate the change in nausea scales and incidence of vomiting with the use of ondansetron in the treatment of nausea and vomiting in the prehospital setting. METHODS: Data were prospectively collected on all emergency medical service patients who received ondansetron for undifferentiated nausea and vomiting during a 6-month study period. Added outcome measures for this study were verbal quantitative (scale of 1-10) and qualitative "nausea scales," incidence of vomiting prior to and after administration of ondansetron, and adverse events. Patients who had this additional data collected and ones who did not were compared. Changes in the "nausea scales" and incidence of vomiting before and after administration and correlation among these measures were also compared. There was no control or placebo group. RESULTS: Ondansetron was administered to 952 patients of 20,054 patients transported during this time period (5%); of these 472 had at least some of the outcome measures documented. There were minimal differences in the two cohorts; 198 patients had paired before and after quantitative "nausea scales" documented: 7.6 +/- 2.4 and 4.6 +/- 3.1, respectively (Delta = 2.9, 95% CI: 2.5-3.4); 447 patients had a qualitative change in nausea level documented: 0.4% "a lot worse," 1.3% "a little worse," 34% "unchanged," 40% "a little better," and 25% "a lot better"; 187 patients had all three measures documented with a Pearson correlation coefficient of 0.63 between the change in the quantitative scale and the qualitative scale (95% CI: 0.14-0.20, R(2) 0.39). In 462 patients, vomiting decreased from 60% to 30% (Wilcoxon signed ranks test p < 0.001). The Pearson correlation coefficients for the change in vomiting incidence with the qualitative and quantitative "nausea scales" were poor: 0.012 (95% CI: -0.015 to 0.039, R(2) 0.00014) and 0.051 (95% CI: -0.032 to 0.118, R(2) 0.00026), respectively. There were no reported adverse events. CONCLUSIONS: Ondansetron appears to be moderately effective in decreasing nausea and vomiting in undifferentiated prehospital patients. Additional controlled trials may be needed to compare it with other antiemetics.

Evaluation of a modified prediction instrument to identify significant pediatric intracranial injury after blunt head trauma.

STUDY OBJECTIVE: We evaluate the effect of a modification of the University of California-Davis Pediatric Head Injury Rule on the ability of the decision instrument for pediatric head injury to predict clinically important intracranial injury in an external cohort. METHODS: We analyzed data prospectively recorded in 1,666 pediatric patients enrolled in the derivation set of the National Emergency X-Radiography Utilization Study II (NEXUS II). Treating physicians at 21 emergency departments recorded the presence or absence of clinical predictors on all patients who received a head computed tomography (CT) scan after experiencing blunt head trauma. Predictors included 3 exact elements of the University of California-Davis Rule (abnormal mental status, signs of skull fracture, and scalp hematoma in children < or = 2 years of age), some with different wording, and 2 modified elements with new definitions (the presence of high-risk vomiting or severe headache, rather than any vomiting or headache). RESULTS: A significant intracranial injury was identified by CT in 138 (8.3%) patients. Sensitivity of the modified instrument to detect significant intracranial injury was 90.4% (95% confidence interval [CI] 85.4% to 95.4%); 13 children with such an injury were misclassified as low risk. Specificity of the modified instrument was 42.7% (95% CI 40.1% to 45.3%). CONCLUSION: In the NEXUS II cohort, a modified version of the University of California-Davis Rule misclassified a substantial proportion of pediatric patients with clinically important blunt head injury. Although we cannot evaluate the exact University of California-Davis Rule, we demonstrate that using stricter definitions of "headache" and "vomiting" and different wording than in the original study may have unintended or negative consequences. We emphasize the importance of careful attention to precise definitions of clinical predictors when a decision instrument is used.

Náuseas y vómitos inducidos por quimioterapia antineoplásica: guía de tratamiento / Antineoplastic chemotherapy-induced nausea and vomiting. Treatment guide

El control de las náuseas y los vómitos inducidos por quimioterapia (N y VIQ) aumenta considerablemente la calidad de vida de los pacientes que reciben quimioterapia antineoplásica y constituyen pilares fundamentales en el tratamiento. El objetivo del presente artículo fue establecer recomendaciones para la atención a los pacientes con N y VIQ. Se revisaron las guías de práctica clínicas disponibles al nivel internacional, y la base de datos MEDLINE desde 1999 hasta el 2005. Todas las búsquedas fueron evaluadas críticamente por al menos 3 de los autores, quienes identificaron las referencias para ser incluidas en la lista final. Para que una recomendación fuera aceptada requirió del consenso del 75 por ciento del panel de autores. Esta guía revisa el tratamiento farmacológico y no farmacológico en la prevención de la emesis acorde a las categorías, el tratamiento en situaciones especiales y el manejo de la emesis refractaria(AU)

Factors related to severity of vomiting behaviors in bulimia nervosa.

Assessments of the severity of vomiting (weekly frequency), depressive and eating-related psychopathology, anger level and management, and personality dimensions were used to characterize patients with bulimia nervosa binge purging type (BN-BP). The sample comprised 130 outpatients with BN and 130 control women. The Eating Disorder Inventory-2 (EDI-2), the State-Trait Anger Expression Inventory, the Beck Depression Inventory, and the Temperament and Character Inventory (TCI) were administered to all patients. The Self-Directedness dimension of the TCI and the Bulimia subscale of the EDI-2 were the strongest predictors of the severity of bulimic behavior; anger levels and anger expression were not so strongly related to illness severity. A more severe form of bulimic symptomatology probably has substrata in specific character deficits (low Self-Directedness on the TCI) and particular psychopathological features (high bulimia on the EDI-2). Patients with a high frequency of vomiting need specific therapeutic interventions to enhance the character dimension of Self-Directedness.

Evaluation of new antiemetic agents and definition of antineoplastic agent emetogenicity--an update.

Development of effective antiemetic therapy depends upon an understanding of both the antiemetic agents and the emetogenic challenges these agents are designed to address. New potential antiemetic agents should be studied in an orderly manner, proceeding from phase I to phase II open-label trials and then to randomized double-blind phase III trials comparing new agents and regimens to best standard therapy. Use of placebos in place of antiemetic therapy against highly or moderately emetogenic chemotherapy is unacceptable. Nausea and vomiting should be evaluated separately and for both the acute and delayed periods. Defining the emetogenicity of new antineoplastic agents is a challenge, since such data are often not reliably recorded during early drug development. A four-level classification system is proposed for emetogenicity of intravenous antineoplastic agents. A separate four-level classification system for emetogenicity of oral antineoplastic agents, which are often given over an extended period of time, is also proposed.