Nausea and Vomiting and Cancer Treatment

Nausea is when you feel sick to your stomach, as if you have the urge to throw up. Vomiting is when you throw up. Both are common side effects of cancer treatments, including chemotherapy and radiation therapy.

The reassuring part: antinausea medicines often prevent or relieve nausea and vomiting before they start or become a problem. Uncontrolled vomiting can lead to serious problems. Those include dehydration, electrolyte imbalances (an upset in the body's salts and minerals), and weight loss. So it's worth managing early.

Nausea and vomiting can happen at different times:

• Acute — within 24 hours of treatment.
• Delayed — 1 to 7 days after.
• Anticipatory — before treatment, triggered by the treatment setting.
• Chronic — ongoing after treatment ends.

Cancer and cancer treatments can both cause nausea and vomiting. Other causes include anxiety, pain medicines, taking certain medicines on an empty stomach, and other medical conditions.

Nausea and vomiting can be a sign of some cancers. Those include cancers in the abdomen, brain and central nervous system cancers, advanced cancer, and cancer that has spread to the bones. Many treatments can also cause them. Those include chemotherapy, radiation therapy, targeted therapy, immunotherapy, bone marrow or stem cell transplant, and surgery.

Medicines called antiemetics work well to prevent and relieve nausea and vomiting. Your doctor may prescribe more than one type. They will also tell you when to take them — before or after chemotherapy, for example, or a certain time before eating.

You will usually receive antinausea medicine before chemotherapy starts. That is because nausea and vomiting from chemotherapy are more difficult to treat once they develop. There are many kinds of antiemetics. Your doctor will choose the ones that fit your situation.

• Drink plenty of fluids. Sip water, broth, fruit juices, ginger ale, tea, or sports drinks through the day to prevent dehydration.
• Eat foods that are easy on your stomach. Cold foods work well: popsicles, pudding, yogurt, and gelatin. So do bland starchy foods like toast, rice, plain pasta, crackers, and pretzels. Ginger foods and drinks may help.
• Avoid certain foods. Skip greasy, fried, sweet, or spicy foods if they make you feel sick.
• Avoid strong odors when eating. Coffee, fish, onions, and garlic can bother you. Ask others to cook, and eat in a well-ventilated room.
• Eat smaller meals more often. Try five to six small meals instead of three large ones.
• Rest after eating. Sit upright, or lie with your head raised, for 30 minutes after eating.
• Keep a record. Note when you feel nauseous and what you ate or did beforehand. That helps your team find triggers.

Relaxation techniques can also help. These include deep breathing, guided imagery, hypnosis, massage, music, and meditation. Acupressure on a point in your wrist may relieve nausea, and so may Sea-Band wristbands. Both are used alongside medication, so ask your doctor first. Always check with your doctor before trying supplements or alternative therapies, because some can make cancer treatments work less well.

Nausea and vomiting are serious side effects for children being treated for cancer. Many of the same medicines used in adults can treat them, often at lower doses. Some integrative therapies may be especially helpful for children. These include hypnosis, guided imagery, music therapy, support groups, and virtual reality games.

Watch for delayed nausea in children. It can be harder to notice. A change in eating pattern may be the only sign. Tell your child's team about any nausea, vomiting, or sudden change in eating habits.

MedlinePlus sets out where the line falls for vomiting in adults.

• Call 911 or go to an emergency department if there is blood in what you bring up, or the material looks dark, like coffee grounds. Go in as well if a fever of 100.4°F (38°C) or higher arrives during treatment: NCI treats infection during cancer treatment as life threatening and needing urgent care, and vomiting may stop you keeping antibiotics down.
• Call your care team the same day if the vomiting has run past 24 hours, nothing has stayed down for 12 hours or more, you have not passed urine for 8 hours, the pain in your belly is severe, you have a headache or a stiff neck, or you have thrown up three or more times in one day.
• Call your care team within a day or two if your antinausea medicine is no longer holding the sickness back. There are other antiemetics to try, and the dose or the timing can be changed.

Sources: MedlinePlus, Nausea and vomiting - adults and NCI, Infection and Neutropenia during Cancer Treatment.

Nausea and vomiting can be hard both physically and emotionally. Ask your health care team for support. They can help you prepare for and get through difficult times. Caregivers and family members can find helpful suggestions in NCI's caregiver resources.