Side Effect Management - Nausea & Vomiting

Nausea and vomiting are potential side effects of many cancer treatments, affecting approximately 80% of cancer patients.

Feeling like you’re going to throw up and/or actually vomiting make life with cancer much more difficult. Thankfully, there is good news: nausea and vomiting caused by cancer treatment can be controlled and even prevented.

Causes of Nausea and Vomiting in Cancer Patients

Nausea is controlled by a part of the autonomic nervous system which controls involuntary body functions (such as breathing or digestion).

Many different things can cause nausea and/or vomiting in cancer patients, such as:

Chemotherapy
Radiation therapy
Other non-chemo medicines
The cancer itself
Bowel issues, such as slowdown or blockage (obstruction)
Inner ear problems
Pain
Smells or tastes that don’t settle well
Anxiety
Infections
An imbalance of minerals and salts (electrolytes) in the blood
The worry or expectation of vomiting (called anticipatory vomiting)
Other diseases or illnesses

Types of nausea and vomiting caused by cancer treatment and other conditions

Nausea and vomiting can occur before, during, or after cancer treatment. There are a few types, including:

Acute: Nausea and vomiting that happens within 24 hours after a course of treatment starts.
Delayed: Nausea and vomiting that happens more than 24 hours after a chemotherapy session is over. This is also called late nausea and vomiting.
Anticipatory: Nausea and vomiting that happens before a chemotherapy treatment begins. If a patient has had nausea and vomiting after an earlier chemotherapy session, he or she may have anticipatory nausea and vomiting before the next treatment. This usually begins after the third or fourth treatment. The smells, sights, and sounds of the treatment room may remind the patient of previous times and may trigger nausea and vomiting before the chemotherapy session has even begun.
Breakthrough: Nausea and vomiting that happen within 5 days after getting anti-nausea treatment. Different drugs or doses are needed to prevent more nausea and vomiting.
Refractory: Nausea and vomiting that does not respond to drugs.
Chronic: Nausea and vomiting that lasts for a period of time after treatment ends.

Managing cancer-related nausea and vomiting

It is important to manage nausea and vomiting for cancer patients so that they can continue with their treatment plan and perform regular activities. When left uncontrolled, nausea and vomiting can cause the following:

Loss of appetite
Malnutrition
Dehydration
Reopening of surgical wounds
Conditions such as heart arrhythmias, muscle cramping, and muscle weakness, which can be attributed to a depletion of certain body chemicals due to vomiting
Mental change, such as changes in concentration, memory, attention, or alertness

You may be advised to take these steps to feel better:

Take an anti-nausea medicine.

Your cancer care team knows which side effects are common with the treatments you’ll be receiving. Because of this, they will plan to give you an anti-nausea medicine before and/or during your treatment, often in the IV bag.

After you leave the cancer center, it may be necessary to take an anti-nausea medicine – even if you’re feeling good. Tell your doctor or nurse if the medicine doesn’t help. There are different kinds of anti-nausea medicines, and one may work better than another for you.

Drink plenty of water and fluids.

Drinking will help to prevent dehydration, a serious problem that happens when your body loses too much fluid and you are not drinking enough. Try to sip on water, fruit juices, ginger ale, tea, and/or sports drinks throughout the day.

Avoid foods that trigger nausea.

Don’t eat greasy, fried, sweet, or spicy foods if you feel sick after eating them. It may take some trial and error to know what’s okay and what makes you feel bad. If the smells that come with preparing food are bothersome, ask others to make your food. Try cold foods that do not have strong smells (although you should avoid uncooked foods while going through cancer treatment), or let food cool down before you eat it.

Learn about complementary therapies that may help reduce nausea and vomiting.

Acupuncture relieves nausea and/or vomiting caused by chemotherapy in some people. Deep breathing, guided imagery, hypnosis, and other relaxation or distraction techniques (such as listening to music, reading a book, or meditating) also help some people. Aromatherapy and non-medication options such as ginger and peppermint in tea/candy/chews can help alleviate nausea.

In addition to the recommendations above, some people find that it helps to eat a small snack before treatment. Others avoid eating or drinking right before or after treatment because it makes them feel sick. After treatment, try to wait at least 1 hour before you eat or drink.

When should you talk to your cancer care team about nausea and vomiting?

Although nausea and vomiting are expected side effects of cancer treatment, it doesn’t make them any less unpleasant to deal with. Consider asking your cancer care team the following questions about nausea and vomiting before starting cancer treatment.

What symptoms or problems should I call you about?
Are there anti-nausea medicines in my treatment plan? When should I take this medicine?
How much liquid should I drink each day?
What should I do if I throw up more than once or twice?
Is it normal to throw up more than 24 hours after treatment?
What foods would be easy on my stomach? What foods should I avoid?
Could I meet with a registered dietitian to learn more?
What specialists could I see to learn about acupuncture and other practices that could help to reduce the impact of this side effect?

If the recommendations above or the recommendations given to you by your cancer care team aren’t providing relief, you may want to speak with them again.

It is important to remember that nausea and vomiting can make it hard for your body to get the nutrition you need. That’s why you want to be sure to let your cancer care team know right away if any of these happen:

You can’t keep fluids down
You can’t take the medicines you need
You’re vomiting for 24 hours or longer

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