Nausea and vomiting, side effects of cancer treatment

nausea and vomitingNausea and vomiting are always distressing. They are a dreaded side effect for many undergoing cancer treatment. As an oncology nurse that has administered chemotherapy, I’ve witnessed firsthand how troublesome they can be for patients.

Nausea and vomiting caused by chemotherapy, commonly called chemotherapy-induced nausea and vomiting or CINV, can affect as many as 50% of patients. Treatment for these two symptoms has improved over the years with better medications. However, these twin side effects to cancer treatment still remain a barrier to quality of life.

What are the different types of chemotherapy induced nausea and vomiting that occur?

  • Acute – within the first 24 hours
  • Delayed – occurs more than 24 hours after chemotherapy is given
  • Anticipatory – just the thought of having chemotherapy causes a person to be sick (think of Pavlov’s dogs)
  • Breakthrough – become sick after prevention medications are given, and require additional therapy to combat it
  • Refractory – occurs despite prevention and rescue medications

What are the risk factors for chemotherapy induced nausea and vomiting?

  • Female
  • Younger age (less than 50 years old)
  • History of nausea with stressful events
  • Current use of antidepressants or antianxiety agents
  • History of motion sickness
  • No or minimal history of alcohol use
  • Certain agents have a greater potential to cause nausea and vomiting like adriamycin, cisplatin and ifosfamide
  • Typically the higher the dose of chemotherapy given, the greater the risk of nausea and vomiting

What’s the treatment?

  • Medication is the mainstay of treatment. Medications called antiemetics are used.
  • Prevention is the key to success, as treatment and management are harder once CINV starts.
  • Using more than one medication is more effective than using a single agent.
  • There are numerous new agents on the market, so if one combination is not working well, let your doctor know so you can try a different combination.

What are some measures that can help?

  • Avoid an empty stomach before chemotherapy.
  • Eat smaller meals.
  • Avoid spicy and fatty foods.
  • Avoid food and other stimuli with strong odors.
  • Eat easily digested foods such as toast, crackers, potatoes, noodles, white rice, gelatin and yogurt.
  • Don’t drink large amounts of fluid, but sip smaller amounts throughout the day. Using a straw can be helpful.
  • Drinking fluids that are cool or warm rather than hot or cold is best.
  • Hypnosis
  • Progressive muscle relaxation and guided imagery
  • Other measures that have been studied, but the effectiveness not clearly established are: acupuncture, acupressure, use of ginger and yoga.

Research has shown that many patients (up to 50%) don’t let their doctor know they don’t feel well. Don’t be afraid to talk with your care team if you have any type of stomach upset or queasiness. This can be controlled.

Take the next step:

  • Find out what the U-M Comprehensive Cancer Center says about managing nausea.
  • Read recommendations (PDF) from the National Cancer Institute on nausea and vomiting.
  • Review an extensive pamphlet (PDF) from CancerCare Connect on coping with these unpleasant symptoms.
  • Still have questions? Call the nurses at the University of Michigan Cancer AnswerLine™. They can help patients or their loved ones find a clinical trial or provide insights into the newest and latest cancer treatments. Feel free to call at 1-800-865-1125 or send an e-mail.

KimZThe Cancer AnswerLine™ nurses are experienced in oncology care, including helping patients and their families who have questions about cancer. These registered oncology nurses are available by calling 800-865-1125 Monday through Friday, 8 a.m. – 5 p.m. Your call is always free and confidential.



Cancer-center-informal-vertical-sig-150x150The University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan according to U.S. News & World Report. Our multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.