DEVELOPMENT OF RESCUE ANTI-EMETIC GUIDELINES FOR THE MANAGEMENT OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING (CINV) IN PAEDIATRIC PATIENTS AT THE RHSC, EDINBURGH Julia Zingel MSc, MRPharmS, Janet Ferguson DipClinPharm MRPharmS IPSP, Moira Kinnear MSc MRPharmS, Julienne Johnson PHD MRPharmS, Steve Hudson MPharm FRPharmS.

 Objective: To improve the existing local anti-emetic guidelines at the RHSC Haematology / Oncology Department, Edinburgh by developing evidence based rescue anti-emetic guidelines for the management of chemotherapy-induced nausea and vomiting (CINV) in paediatric patients with haematological / oncological malignancies.

Methods: An extensive literature search on anti-emetics and the management of CINV in paediatrics was undertaken and current local anti-emetic guidelines from the RHSCE and three other UK paediatric Haematology / Oncology centres were reviewed. Semi-structured questionnaires were designed and issued to doctors, pharmacist and nurses with expertise in paediatric haematology / oncology practicing at the RHSCE to obtain their opinions on the local anti-emetic guidelines and the information regarding their practice in management of breakthrough / delayed and refractory CINV in paediatric patients. A multidisplinary team discussion took place to validate the draft guidelines.

Results: The revised guidelines now include: updated prophylactic sections for acute and delayed CINV and a rescue anti-emetic therapy section for breakthrough and refractory emesis for all CINV phases, treatment flow charts, drug information table for drugs used in the management of CINV and chemotherapy regime specific anti-emetic guidelines.

Conclusion: The revised anti-emetic guidelines provide a decision support system for clinicians and other healthcare professionals in applying evidence-based anti-emetic treatment strategies for the management of CINV into their practices and support the use of appropriate care to each patient. References: RHSCE Antiemetic Guidelines. Version 1. December 2002. Holdsworth MT, Raisch DW, Frost J. Acute and delayed nausea and emesis control in paediatric oncology patients. Cancer 2006; 106(4): 931-40. Jordan K, Sippel C, Schmoll H-J. Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present and future recommendations. The Oncologist 2007; 12: 1143-1150.