A survey of antiemetic use in children with cancer

Article Abstract:

Chemotherapy treatments can cause severe side effects, particularly nausea and vomiting. Antiemetic agents, drugs that prevent vomiting, can be given to patients receiving chemotherapy treatments. There is a wide variety of antiemetics available. When used for children, these drugs are often given in doses based upon adult regimens rather than on results of studies in children. The outcome is that often the dose given is not optimal and either the drug does not prevent vomiting or it produces side effects of its own. Pediatricians and pediatric nurses working with child cancer patients appear to vary in their knowledge of the antiemetics available and the potencies of these agents. This situation leads to inadequate treatment of the side effects of chemotherapy in children. This study examined the use and knowledge of antiemetics by pediatric oncology (cancer) nurses and physicians. A questionnaire was sent to all physicians and nurses belonging to the Pediatric Oncology Group (POG). Seventy-six questionnaires were returned. Thirty-one institutions returned one questionnaire each, 12 returned 2, and 5 returned 3 or more with results varying widely within as well as between institutions. Responses revealed that antiemetics were used 17 percent of the time with mild chemotherapeutic agents, 79 percent of the time that moderate agents were used, and 98 percent of the time severe agents were administered. The average number of antiemetics used relative to chemotherapeutic agent severity was 1.4, 2.0, and 3.1, respectively. Antihistamines were most often used to prevent nausea and vomiting, followed by phenothiazines and metoclopramide-based compounds. The latter were usually used when severe chemotherapy agents were given. The reason given for choosing a particular antiemetic was primarily personal experience, according to 82 percent of the respondents. Use of antiemetics in children was reported to be higher than in an earlier study. These results indicate that antiemetic use in children is rising with the various chemotherapy combinations being used, despite the fact that few studies on optimal doses of antiemetics have been conducted. A review of studies that have been done suggests that the clinical use of antiemetics is not always in accordance with research findings. However, further research is needed to set more exact standards for the use of antiemetics in children who are receiving chemotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Complications and side effects, Children, Drug therapy, Cancer in children, Childhood cancer, Vomiting, Chemotherapy, Antiemetics, Vomiting in children

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The Caring Program for Children: the Michigan experience

Article Abstract:

Using the current health care financing and delivery system as a means of expanding services is a worthy challenge. One such program is called the Caring Program for Children (CPC). This idea was begun by Blue Cross of Western Pennsylvania and has spread to 11 other Blue Cross and Blue Shield plans nationwide. These programs provide health insurance to the uninsured or to those who are otherwise ineligible for public or private health insurance. In Michigan, the CPC has become a private-public sector partnership; in addition to private funding, all levels of government participate. Concern for the uninsured child and family is universal. Various approaches have been tried, and some have had success. Understanding the urgent necessity of providing for the needs of these persons is half the solution. In Michigan, a multitude of agencies, with differing agendas and approaches to the problem, agreed that the problem was urgent; they initiated 'Healthy Start'. An expansion of Medicaid, Healthy Start was designed to enable eligible children of the working poor to obtain health care. Blue Cross-Blue Shield of Michigan (BCBSM) proposed private funding for the program, and the Department of Social Services (DSS) joined the effort. The CPC is administered by BCBSM without charge, and the DSS handles funds and coordinates the collaborative programs. The population served consists of children 18 years and younger who are from families that are ineligible for Medicaid or other sponsored health programs. All the children in one family, well and sick, are enrolled simultaneously and recertified annually. The aim of CPC is to provide primary health care and preventive services and avoid the development of chronic illnesses. All services, except inpatient hospital care, are covered in full. Participating physicians and pharmacies are eligible for reimbursement. Funding is by voluntary contributions, and state and federal dollars. This program works in Michigan and in other states, and stands as a model to be duplicated nationwide. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Economic aspects, Health planning, Michigan, Health services administration, Child health services

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